Reviewer’ s report
Title: Psychiatric, Cognitive Functioning and Socio-cultural Views of Menstrual Psychosis in
Oman: An Idiographic Approach
Version: 3Date: 13 Feb 2020
Reviewer: Caroline Gurvich
Reviewer's report:
This is an interesting manuscript that describes 4 cases of premenstrual psychosis in Oman. I
wonder if this manuscript is better suited to a case report or case report series rather than aresearch article?
The introduction is well written. It is important to emphasise that much (if not all) of the work in
(pre)menstrual psychosis is in the form of case studies. The introduction should also introduceBrockington's classification by timing that are applied to the case reports - I think it would fitbetter here than in the discussion.
Case report 1
Minor points -replace "AA's ordeal…" with "AA's symptoms were reported to recede…."Can you clarify whether her pattern of symptoms aligned with her menstrual cycle in her follow upvisits? Can you also report on the frequency of her psychotic episodes at the time of her 6 monthsof follow up.
Case report 2
Can you clarify if the two episodes of relapse were during menstruation and whether they subsided
with the end of her menstrual flow?
Case report 3
Can you clarify the timing and frequency of her "psychotic" episodes?
I note that case reports 1 and 2 both experience moderate depressive symptoms and case report 3
experienced mild depressive symptoms - I assume these depression assessments were completedduring the follicular phase of their menstrual cycles in the absence of psychosis? I wonder if youcan claim in the discussion that these patients experience "a total resolution of distress" (paragraph1 - discussion). I also wonder if the neuropsychological pattern of reduced speed of processingand reduced executive functions (figure 1) is consistent with the underlying depression?
Table 1 - include age at time of testing and medication at time of assessment for completenessDiscussion - the comment that "Excess estrogen that is unopposed by progesterone was another
postulated etiological…" needs a reference. Generally estrogen is considered a neuroprotectivesteroid hormone and the reduction of estrogen during menstruation is considered to contribute to
exacerbation of psychosis. I am not sure the idea of "Excess estrogen" is correct?
I am aware that normative data for cognitive testing in Oman is scarce - are the percentiles based
on normative data from Oman or Arabic populations - I note that some of the references providedfor the neuropsychological testing suggest this, but I could not see this clarified in the text.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
NoAre the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
YesAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
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