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Brand BA, de Boer JN, Willemse EJM, Weickert CS, Sommer IE, Weickert TW. Antipsychotic-induced prolactin elevation in premenopausal women with schizophrenia: associations with estrogen, disease severity and cognition. Arch Womens Ment Health 2024:10.1007/s00737-024-01491-9. [PMID: 38995314 DOI: 10.1007/s00737-024-01491-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Antipsychotic-induced prolactin elevation may impede protective effects of estrogens in women with schizophrenia-spectrum disorders (SSD). Our study sought to confirm whether the use of prolactin-raising antipsychotics is associated with lower estrogen levels, and to investigate how estrogen and prolactin levels relate to symptom severity and cognition in premenopausal women with SSD. METHODS This cross-sectional study included 79 premenopausal women, divided in three groups of women with SSD treated with prolactin-sparing antipsychotics (n = 21) or prolactin-raising antipsychotics (n = 27), and age-matched women without SSD (n = 31). Circulating 17β-estradiol was compared among groups. In patients, we assessed the relationship between prolactin and 17β-estradiol, and the relationships of these hormones to symptom severity and cognition, using correlation analyses and backward regression models. RESULTS In women receiving prolactin-raising antipsychotics, 17β-estradiol levels were lower as compared to both other groups (H(2) = 8.34; p = 0.015), and prolactin was inversely correlated with 17β-estradiol (r=-0.42, p = 0.030). In the prolactin-raising group, 17β-estradiol correlated positively with verbal fluency (r = 0.52, p = 0.009), and 17β-estradiol and prolactin together explained 29% of the variation in processing speed (β17β-estradiol = 0.24, βprolactin = -0.45, F(2,25) = 5.98, p = 0.008). In the prolactin-sparing group, 17β-estradiol correlated negatively with depression/anxiety (r = -0.57, p = 0.014), and together with prolactin explained 26% of the variation in total symptoms (β17β-estradiol = -0.41, βprolactin = 0.32, F(2,18) = 4.44, p = 0.027). CONCLUSIONS In women with SSD, antipsychotic-induced prolactin elevation was related to lower estrogen levels. Further, estrogens negatively correlated with symptom severity and positively with cognition, whereas prolactin levels correlated negatively with cognition. Our findings stress the clinical importance of maintaining healthy levels of prolactin and estrogens in women with SSD.
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Affiliation(s)
- Bodyl A Brand
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands.
- Department of Biomedical Sciences and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
| | - Janna N de Boer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands
- Department of Biomedical Sciences and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Center for Young Children, Karakter Child and Adolescent Psychiatry, Nijmegen, The Netherlands
| | - Elske J M Willemse
- Department of Biomedical Sciences and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Cynthia S Weickert
- Neuroscience Research Australia, Sydney, NSW, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Iris E Sommer
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands
- Department of Biomedical Sciences and Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Thomas W Weickert
- Neuroscience Research Australia, Sydney, NSW, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Li W, Cao X, Liang Q, Li Y, Zhou C, Du J, Xie S. Gender differences in cognitive improvements after two months of atypical antipsychotic treatment in first episode schizophrenia. Front Psychiatry 2024; 15:1369532. [PMID: 38742135 PMCID: PMC11089100 DOI: 10.3389/fpsyt.2024.1369532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Aims This study aims to explore the gender differences in cognitive improvements after two months of atypical antipsychotic treatment in first episode schizophrenia (FES). Methods 82 patients with FES, including 50 male patients and 32 female patients, were enrolled in the present study. Positive and Negative Syndrome Scale (PANSS) and MATRICS Consensus Cognitive Battery (MCCB) were respectively conducted to evaluate the clinical symptoms and cognitive function of patients with FES at baseline and after treatment. Repeated measure ANOVA was performed to compare gender differences in cognitive domains scores between baseline and 2-month follow-up. Stepwise liner regression model was performed to explore the effect factors of cognitive improvements in patients. Results There was no significant difference in age of onset, education years, PANSS scores, duration of untreated psychosis and Olanzapine equivalent doses between male and female patients (all p > 0.05). In the comparisons of cognition function, male patients exhibited better performance in social cognition compared with female patients at baseline (t = 3.20, p < 0.05). After treatment, improvements of attention/vigilance and working memory were both found in male patients and female patients (attention/vigilance, F = 11.867, p < 0.05; working memory, F = 18.265, p < 0.05). In addition, improvement of speed of information processing was only found in female patients (F = 11.65, p < 0.01). Significant interaction between time and gender was found in speed information of processing (F = 4.140, p = 0.045). Stepwise liner regression model revealed that improvements of negative symptoms promote improvements of cognitive function in female patients (all p < 0.05). Conclusions Our findings revealed gender differences of cognitive improvements in patients with FES after 2-month treatment. It provides new evidence for gender differences in cognitive symptoms of schizophrenia, and also provides preliminary clues for further individualized cognitive intervention strategies.
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Affiliation(s)
| | | | | | | | | | - Jinglun Du
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shiping Xie
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Wang D, Xia L, Zhang Z, Camkurt MA, Issac A, Wu E, Xiu M, Chen D, Zhang XY. Sex difference in association between cognitive and P50 deficits in patients with chronic schizophrenia. Arch Womens Ment Health 2023; 26:793-801. [PMID: 37673838 DOI: 10.1007/s00737-023-01367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
A large number of studies have reported that sensory gating disorders represented by P50 inhibition may be involved in the pathophysiological process of schizophrenia. However, few studies have explored the relationship between sensory gating disorders and cognitive dysfunction in patients with schizophrenia. This study aimed to explore sex differences in the relationship between cognitive and P50 deficits in patients with chronic schizophrenia, which has not been reported. A total of 183 chronic schizophrenia patients (128 males and 55 females) and 166 healthy controls (76 males and 90 females) participated in this study. The MATRICS Consensus Cognitive Battery (MCCB) was measured for cognitive function and P50 components for the sensory gating in all participants. The Positive and Negative Syndrome Scales (PANSS) was used to assess the psychopathological symptoms in patients. Female patients performed significantly better than male patients in several cognitive domains of MCCB (all p < 0.01). There were no significant differences in P50 components between male and female patients (all p > 0.05). Further analysis showed that in female patients, latency of S2 was negatively correlated with reasoning and problem-solving domain of MCCB (p < 0.05), and P50 ratio was negatively correlated with social cognition domain of MCCB (p < 0.05). In male patients, there was no any correlation between P50 and cognitive domains of MCCB. Our results suggest that there is a sex difference in the association between P50 deficiency and cognitive impairment in Chinese Han patients with schizophrenia.
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Affiliation(s)
- Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, 100101, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Luyao Xia
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, 100101, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhiqi Zhang
- Department of Psychology, Barnard College, Columbia University, New York, NY, USA
| | - Mehmet A Camkurt
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aaron Issac
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Dachun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, 100101, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Mao J, Fan K, Zhang Y, Wen N, Fang X, Ye X, Chen Y. 10 Hz repetitive transcranial magnetic stimulation (rTMS) may improve cognitive function: An exploratory study of schizophrenia patients with auditory hallucinations. Heliyon 2023; 9:e19912. [PMID: 37809845 PMCID: PMC10559318 DOI: 10.1016/j.heliyon.2023.e19912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/18/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Cognitive impairment in schizophrenia patients with auditory hallucinations is more prominent compared to those without. Our study aimed to investigate the cognitive improvement effects of 10 Hz repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) in schizophrenia with auditory hallucinations. Methods A total of 60 schizophrenic patients with auditory hallucinations in this study were randomly assigned to sham or active group. Both groups received 10 Hz or sham rTMS targeted in left DLPFC for 20 sessions. The Positive and Negative Syndrome Scale (PANSS), the Auditory Hallucination Rating Scale (AHRS), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Udvalg for Kliniske Under-sogelser (UKU) side effect scale were used to measure psychiatric symptoms, auditory hallucinations, cognition, and side reaction, respectively. Results Our results indicated that the active group experienced greater improvements in RBANS-total score (P = 0.043) and immediate memory subscale score (P = 0.001). Additionally, the PANSS-total score, negative and positive subscale score were obviously lower in the active group compared to the sham group (all P < 0.050). Furthermore, our study found that the improvement of RBANS-total score was positively associated with the decline of positive factor score, and the improvement of language score in RBANS was positively associated with the reduction in PANSS-total scale, negative and positive subscale score in the real stimulation group (all P < 0.050). Conclusion Our results demonstrated that a four-week intervention of 10 Hz rTMS over the left DLPFC can improve cognition (particularly immediate memory) among schizophrenia patients with auditory hallucinations. Future studies with larger sample size are needful to verify our preliminary findings.
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Affiliation(s)
- Jiankai Mao
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, PR China
| | - Kaili Fan
- Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, PR China
| | - Yaoyao Zhang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, Zhejiang, PR China
| | - Na Wen
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, Zhejiang, PR China
| | - Xinyu Fang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiangming Ye
- Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, PR China
| | - Yi Chen
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, Zhejiang, PR China
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Sommer IE, Brand BA, Gangadin S, Tanskanen A, Tiihonen J, Taipale H. Women with Schizophrenia-Spectrum Disorders After Menopause: A Vulnerable Group for Relapse. Schizophr Bull 2022; 49:136-143. [PMID: 36198044 PMCID: PMC9810004 DOI: 10.1093/schbul/sbac139] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS Throughout the life stages of women with schizophrenia-spectrum disorders (SSD), lower estrogen levels are associated with more severe disease course. At perimenopause in the mid-forties, estrogen levels decline to remain persistently low after menopause. This period is hypothesized to increase relapse risk and reduce antipsychotic effectiveness in preventing relapse. STUDY DESIGN The cohort of persons with schizophrenia/schizoaffective disorder was identified from Finnish nationwide registers (N = 61 889) and stratified by sex and age <45 vs. ≥45 years. Hospitalizations for psychosis were defined per 5-year age group during the follow-up 1996-2017. Risk of psychosis hospitalization (Adjusted Hazard Ratio, aHR) was assessed using within-individual design, by comparing antipsychotic monotherapy use to nonuse periods in the same individuals for seven dose categories in defined daily doses (DDDs/day). RESULTS Starting at age 45-50, women were consistently more often hospitalized for psychosis than their male peers. Women ≥45 had significantly higher aHRs than women <45 at antipsychotic monotherapy >0.6 DDDs/day, and than men at >1.1 DDDs/day. This female-specific age-dependent decrease in effectiveness was present for clozapine doses >0.6 DDDs/day, olanzapine doses >1.4 DDDs/day, and for specific doses of quetiapine (0.9-1.1 DDDs/day) and risperidone (0.6-0.9 DDDs/day). CONCLUSIONS While younger women have a lower risk of relapse and generally need a lower antipsychotic dose to prevent rehospitalization than men, antipsychotic effectiveness declines in women after the age of 45. Starting in mid-forties, older women with SSD should be regarded as a vulnerable group that deserve special attention.
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Affiliation(s)
- Iris E Sommer
- To whom correspondence should be addressed; Antonius Deusinglaan 2, Groningen, Netherlands; tel: +31-625647485, e-mail:
| | - Bodyl A Brand
- Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Center Groningen (UMCG), Groningen, Netherlands
| | - Shiral Gangadin
- Department of Psychiatry, Rijksuniversiteit Groningen (RUG), University Medical Center Groningen (UMCG), Groningen, Netherlands
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Heidi Taipale
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
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Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis. WOMEN 2022. [DOI: 10.3390/women2020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A protective effect has traditionally been attributed to estrogen in psychotic disorders. The aim of this study was to investigate cumulative lifetime estrogen by assessing the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and the age of menarche, measuring their effects on symptoms, cognition, social cognition, and metacognition. As it was not possible to directly measure cumulative estrogen levels over the lifetime of a patient, the study sample was composed of 42 women with first-episode psychosis; estrogen levels were inferred by the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and menarche. All patients were assessed with a battery of questionnaires using the BDI, PSYRATS, PANSS, STROOP, TAVEC, WSCT, IPSAQ, and BCIS questionnaires. The results related to menstrual cycle length showed a relationship with memory; specifically, shorter cycles with semantic strategies (p = 0.046) and longer cycles with serial strategies in the short term (p = 0.005) as well as in the long term (p = 0.031). The results also showed a relationship with perseverative errors (p = 0.035) and self-certainty (p = 0.049). Only personalized bias (p = 0.030) was found to be significant in relation to the age at menarche. When analyzing the differences in years of difference between the age at menarche and the onset of psychotic symptoms, the results indicated lower scores in women with a smaller difference between both events in memory (short-term (p = 0.050), long-term (p = 0.024), intrusions (p = 0.013), and recognition (p = 0.043)) and non-perseverative errors (p = 0.024). No relationship was found between symptoms and menstrual characteristics. The investigatory outcomes seem to indicate a relationship between estrogen cumulative effects and the memory domain. More in-depth investigations in the field are necessary in order to improve personalized treatment in women with psychosis.
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Chen M, Zhang L, Jiang Q. Gender Difference in Cognitive Function Among Stable Schizophrenia: A Network Perspective. Neuropsychiatr Dis Treat 2022; 18:2991-3000. [PMID: 36578902 PMCID: PMC9792107 DOI: 10.2147/ndt.s393586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the gender differences and influencing factors of cognitive function in stable schizophrenic patients, and to explore the cognitive characteristics of male and female patients. METHODS A total of 298 patients with chronic schizophrenia were divided into two groups according to gender. The differences of demographic and clinical characteristics between the two groups were firstly analyzed. Then the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to measure their cognitive function, and the correlation between cognitive function and demographic characteristics and clinical characteristics was analyzed. Finally, the gender-based cognitive characteristics were explored through network analysis. RESULTS There was no significant difference in the RBANS total score and sub-item score between the male schizophrenia and female schizophrenia patients. Correlation analysis showed that RBANS total score was inversely proportional with age, duration and Positive and Negative Syndrome Scale (PANSS) score in male schizophrenia, while being directly proportional with age at onset and inversely proportional with PANSS score in female schizophrenia. Network analysis showed that language was the core of cognitive function for male schizophrenia, and the delayed memory was the core of cognitive function for female schizophrenia. CONCLUSION There was no significant gender difference in cognitive function score among patients with stable schizophrenia. The core cognitive functions of male and female schizophrenia are language and delayed memory, respectively.
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Affiliation(s)
- Mengyi Chen
- Department of Geriatric, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Lei Zhang
- Department of Geriatric, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Qi Jiang
- Department of Geriatric, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People's Republic of China
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Murillo-García N, Setién-Suero E, Pardo-de-Santayana G, Murillo-García M, Pelayo-Terán JM, Crespo-Facorro B, Ayesa-Arriola R. Entire duration of active psychosis and neurocognitive performance in first-episode non-affective psychosis. Early Interv Psychiatry 2021; 15:1266-1275. [PMID: 33244853 DOI: 10.1111/eip.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/27/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
AIM To explore if the entire duration of active psychosis (DAP) is related to neurocognitive performance at baseline and at 3-year follow-up in patients with first episode psychosis (FEP). METHODS DAP was estimated for 481 FEP patients. A neuropsychological battery was administered to measure neurocognitive specific domains, and a global indicator of neurocognitive impairment (global deficits score, GDS) was calculated. According to the DAP quartiles, four subgroups were formed, and these were compared. In addition, a logistic regression analysis was carried out to predict neurocognitive impairment at 3-year follow-up. RESULTS FEP patients with the longest DAP (more than 18.36 months) presented a more severe global neurocognitive impairment evidenced in their GDS, both at baseline (F = 5.53; p˂ .01) and at 3-year follow-up (F = 4.16; p˂ .01). Moreover, a subgroup of participants with DAP between 7.40 and 18.36 months showed a specific attentional decline over the 3-year follow-up (F = 3.089; p˂ .05).The logistic regression model showed that sex (Wald = 7.29, p < .010), premorbid adjustment (Wald = 7.24, p < .010), attention (Wald = 12.10, p < .001), verbal memory (Wald = 16.29, p < .001) and visual memory (Wald = 9.41, p < .010) were significant predictors of neurocognitive impairment 3 years after the FEP. The variables composing the DAP were not significant predictors in this model. CONCLUSIONS DAP seems to be related to global neurocognitive impairment in FEP patients. These findings contribute in several ways to our understanding of the effects of active psychosis on the brain, and provide the basis for future research.
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Affiliation(s)
- Nancy Murillo-García
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,Department of Molecular Biology, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | | | | | - Marisol Murillo-García
- International Education Program, Framingham State University, Framingham, Massachusetts, USA
| | - José María Pelayo-Terán
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.,Servicio de Salud de Castilla y León, Unidad de Calidad Asistencial y Seguridad del Paciente, Ponferrada, ES, Spain
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain
| | - Rosa Ayesa-Arriola
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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González-Rodríguez A, Guàrdia A, Monreal JA. Peri- and Post-Menopausal Women with Schizophrenia and Related Disorders Are a Population with Specific Needs: A Narrative Review of Current Theories. J Pers Med 2021; 11:jpm11090849. [PMID: 34575626 PMCID: PMC8465365 DOI: 10.3390/jpm11090849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 12/17/2022] Open
Abstract
Background: While gender differences in antipsychotic response have been recognized, the potential role of menopause in changing drug efficacy and clinical outcome in schizophrenia related disorders has been understudied. We aimed to review the relevant literature to test whether optimizing menopausal and post-menopausal treatment and addressing specific health needs of this stage in life will improve outcome. Methods: Non-systematic narrative review using the PubMed database (1900–July 2021) focusing on randomized controlled trial results addressing our question. Forty-nine studies met our criteria. Results: Premenopausal women show significantly better antipsychotic response than postmenopausal women. Hormone replacement therapies (HRT) should be used in postmenopausal women with schizophrenia with caution. Raloxifene, combined with antipsychotics, is effective for psychotic and cognitive symptoms in postmenopausal women with schizophrenia and related disorders. Medical comorbidities increase after menopause, but the influence of comorbidities on clinical outcomes has been poorly investigated. Preventive strategies include weighing risks and benefits of treatment, preventing medical comorbidities, and enhancing psychosocial support. Ideal treatment settings for this population warrant investigation. Conclusions: Antipsychotic dose adjustment at menopause is recommended for schizophrenia. Raloxifene may play an important role in permitting dose reduction and lessening adverse effects. Prevention of comorbidities will help to reduce the mortality rate.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, University of Barcelona, 08221 Terrassa, Spain; (A.G.); (J.A.M.)
- Correspondence:
| | - Armand Guàrdia
- Department of Mental Health, Mutua Terrassa University Hospital, University of Barcelona, 08221 Terrassa, Spain; (A.G.); (J.A.M.)
| | - José Antonio Monreal
- Department of Mental Health, Mutua Terrassa University Hospital, University of Barcelona, 08221 Terrassa, Spain; (A.G.); (J.A.M.)
- Institut de Neurociències, Universitat Autònoma de Barcelona (UAB), 08211 Terrassa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 08221 Terrassa, Spain
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Abstract
PURPOSE OF REVIEW Schizophrenia is a heterogeneous psychiatric disorder with a different, but not necessarily milder clinical presentation in women as compared to men. These sex differences have largely been attributed to the protective role of estrogens. This article reviews the current state of estrogen research in schizophrenia. RECENT FINDINGS Estrogens regulate important pathophysiological pathways in schizophrenia, including dopamine activity, mitochondrial function, and the stress system. Estrogen deficiency is common in both sexes and is associated with increases in psychotic symptoms. Hyperprolactinemia causes secondary estrogen deficiency and can be a reaction to stress, or secondary to prolactin-raising antipsychotics. Therefore, prolactin-sparing antipsychotics should be preferred especially in premenopausal women, who are more prone to hyperprolactinemia. Premenopausal women furthermore require lower doses of antipsychotics than men, since estrogens raise the availability and efficacy of antipsychotics. SUMMARY The past years have established the importance of estrogens in the pathophysiology of schizophrenia and have shown its relevance to clinical practice through its influence on antipsychotic drug efficacy. Future research should focus on the neurobiological and clinical effect of contraceptives in premenopausal women with schizophrenia. Furthermore, the potential of estrogen-like augmentation with raloxifene and phytoestrogens in schizophrenia should be established in the coming years.
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Affiliation(s)
- Bodyl A. Brand
- University of Groningen, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen
| | - Janna N. de Boer
- University of Groningen, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands
| | - Iris E.C. Sommer
- University of Groningen, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen
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Abstract
BACKGROUND A percentage of women patients with schizophrenia may suffer from menstrual dysfunction associated with antipsychotic medication. This study evaluated menstrual dysfunction in women with schizophrenia given maintenance risperidone, and investigated the association between menstrual dysfunction and the duration and dose of risperidone and clinical symptoms. METHODS The data of 161 women were obtained from the Risperidone Maintenance Treatment in Schizophrenia study, including patients' characteristics, menstrual conditions, and duration and dosage of risperidone. Qualitative data regarding menstrual health were evaluated at baseline (clinical stabilization after 4-8 weeks maintenance treatment with a standard risperidone dose 4-8 mg/d) and follow-up interviews up to 52 weeks. RESULTS At baseline, 73.2% (119/161) of the patients were eumenorrheic; specific rates of menstrual dysfunction were 14.3% (23/161) irregular menstruation, 6.8% (11/161) oligomenorrhea, and 5.0% (8/161) amenorrhea. At the end of follow-up, 16.0% (19/119) of those with eumenorrhea at baseline reported menstrual dysfunction. During the entire risperidone maintenance treatment, 37.9% (61/161) experienced menstrual dysfunction. The range of onset time from the beginning of risperidone treatment to menstrual dysfunction was 64 to 243 days. Risperidone dose was positively associated with menstrual dysfunction (r = 0.187, P = 0.046). The total Positive and Negative Syndrome Scale score was significantly associated with menstrual dysfunction (r = 0.274, P = 0.001). CONCLUSIONS Attention should be given to menstrual dysfunction of women with schizophrenia that is an adverse effect of risperidone maintenance treatment. Menstrual dysfunction may occur early or late during maintenance treatment, partly depending on the dose.ClinicalTrials.govidentifier: NCT00848432.
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Gurvich C, Le J, Thomas N, Thomas EHX, Kulkarni J. Sex hormones and cognition in aging. VITAMINS AND HORMONES 2021; 115:511-533. [PMID: 33706960 DOI: 10.1016/bs.vh.2020.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hormones of the hypothalamic-pituitary-gonadal axis that regulate reproductive function are also potent neurosteriods that have multiple effects on the development, maintenance and function of the brain. There is a growing body of evidence linking sex hormones to cognitive functioning across the lifespan. Both subjective and objective cognitive changes can occur with aging. For women, cognitive complains are commonly associated with the menopause transition-a time of significant hormone flux. Sex differences in neurodegenerative conditions associated with cognitive dysfunction, such as Alzheimer's disease and Parkinson's disease, suggest a potential link between sex hormones and cognitive decline. Evidence for the effects of hormone therapy on cognition is growing, but remains inconclusive. This chapter provides an overview of sex hormones and cognition in association with healthy aging, including a focus on the menopause transition, as well as reviewing findings linking sex hormones to cognitive decline associated with Alzheimer's disease and Parkinson's disease. An overview of hormone therapy and cognition is also provided.
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Affiliation(s)
- Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia.
| | - Jessica Le
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia
| | - Natalie Thomas
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia
| | - Elizabeth H X Thomas
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, VIC, Australia
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Abstract
Delusional disorder is a difficult-to-treat clinical condition with health needs that are often undertreated. Although individuals with delusional disorder may be high functioning in daily life, they suffer from serious health complaints that may be sex-specific. The main aim of this narrative review is to address these sex-specific health needs and to find ways of integrating their management into service programs. Age is an important issue. Delusional disorder most often first occurs in middle to late adult life, a time that corresponds to menopause in women, and menopausal age correlates with increased development of both somatic and psychological health problems in women. It is associated with a rise in the prevalence of depression and a worsening of prior psychotic symptoms. Importantly, women with delusional disorder show low compliance rates with both psychiatric treatment and with medical/surgical referrals. Intervention at the patient, provider, and systems levels are needed to address these ongoing problems.
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14
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Zhou JH, Zhang DL, Ning BL, Xue XJ, Zhao L, Wu Q, Yan LD, Liu M, Fu WB. The Role of Acupuncture in Hormonal Shock-Induced Cognitive-Related Symptoms in Perimenopausal Depression: A Randomized Clinical Controlled Trial. Front Psychiatry 2021; 12:772523. [PMID: 35095593 PMCID: PMC8793332 DOI: 10.3389/fpsyt.2021.772523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/20/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Perimenopausal depression is predominantly caused by hormone shock, but the underlying physical and psychological factors are still unclear. Objectives: To explore the constituent components of perimenopausal depression by dynamically depicting its influencing factors and interactive pathways from the perspective of embodied cognition. Methods: This is a randomized clinical controlled trial. In this study, electroacupuncture was compared with escitalopram. A total of 242 participants with mild to moderate perimenopausal depression were enrolled from 6 hospitals in China. Each participant had a 12-week intervention and a 12-week follow-up period. The primary outcome of this study is the Hamilton Depression Rating Scale (HAMD-17), and the secondary outcome is the menopause-specific quality of life scale (MENQOL), serum Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estrogen (E2) levels. Results: The structural equation model suggested that hormone levels were not directly associated with HAMD-17 (P = 0.852), while MENQOL was statistically correlated with HAMD-17 as an intermediary variable (P < 0.001). Electroacupuncture gradually showed positive impacts on MENQOL and HAMD-17 during the follow-up period (P < 0.05). Cognitive impairment is the dominant dimension of perimenopausal depression. Conclusions: Hormonal shock may affect clinical symptoms and poor quality of life to induce cognitive impairment leading perimenopausal depression, and this impact on cognition is embodied. Electroacupuncture has positive effect on perimenopausal depression and quality of life.
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Affiliation(s)
- Jun-He Zhou
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; School of Psychology Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.,The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De-Long Zhang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; School of Psychology Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Bai-Le Ning
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; School of Psychology Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Xiao-Juan Xue
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; School of Psychology Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Lin Zhao
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qian Wu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lu-Da Yan
- Shenzhen Bao'an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ming Liu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; School of Psychology Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Wen-Bin Fu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Innovative Research Team of Acupuncture for Depression and Related Disorders, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
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15
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Hwang WJ, Lee TY, Kim NS, Kwon JS. The Role of Estrogen Receptors and Their Signaling across Psychiatric Disorders. Int J Mol Sci 2020; 22:ijms22010373. [PMID: 33396472 PMCID: PMC7794990 DOI: 10.3390/ijms22010373] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 12/23/2022] Open
Abstract
Increasing evidence suggests estrogen and estrogen signaling pathway disturbances across psychiatric disorders. Estrogens are not only crucial in sexual maturation and reproduction but are also highly involved in a wide range of brain functions, such as cognition, memory, neurodevelopment, and neuroplasticity. To add more, the recent findings of its neuroprotective and anti-inflammatory effects have grown interested in investigating its potential therapeutic use to psychiatric disorders. In this review, we analyze the emerging literature on estrogen receptors and psychiatric disorders in cellular, preclinical, and clinical studies. Specifically, we discuss the contribution of estrogen receptor and estrogen signaling to cognition and neuroprotection via mediating multiple neural systems, such as dopaminergic, serotonergic, and glutamatergic systems. Then, we assess their disruptions and their potential implications for pathophysiologies in psychiatric disorders. Further, in this review, current treatment strategies involving estrogen and estrogen signaling are evaluated to suggest a future direction in identifying novel treatment strategies in psychiatric disorders.
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Affiliation(s)
- Wu Jeong Hwang
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul 08826, Korea; (W.J.H.); (J.S.K.)
| | - Tae Young Lee
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea
- Correspondence: ; Tel.: +82-55-360-2468
| | - Nahrie Suk Kim
- Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul 08826, Korea; (W.J.H.); (J.S.K.)
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Korea
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16
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Shen J, Lin L, Liao L, Liang W, Yang X, Lin K, Ke L, Zhang L, Kang J, Ding S, Li C, Zheng Z. The involvement of Notch1 signaling pathway in mid-aged female rats under chronic restraint stress. Neurosci Lett 2020; 738:135313. [PMID: 32827575 DOI: 10.1016/j.neulet.2020.135313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Women are vulnerable to adverse stress events, especially during perimenopause. Substantial evidence has associated the impaired neuronal plasticity with abnormal behaviors under stressful conditions in animals. The Notch signaling pathway is critical for neuronal plasticity in the structure and function of brain areas. In this study, the mid-aged female rats were subjected to chronic restraint stress(CRS) in combination with isolated rearing for 6 weeks. The behavior tests and HPA activity were conducted to evaluate the model. The mRNA and protein levels of Notch1 signaling related genes in the hippocampus(HIP) and prefrontal cortex(PFC) were analyzed by RT-qPCR and western blotting. The promoter methylation levels were measured by bisulfite sequencing PCR analysis. CRS induced depression-like and anxiety-like behaviors in mid-aged stressed females, as shown by decreased locomotor activity, sucrose consumption and increased HPA activity. Moreover, after CRS, the rats exhibited decreased mRNA and protein levels in Jagged1, Notch1 and Hes5 in the HIP and Notch1, Hes1 and Hes5 in the PFC. However, there were no significant promotor methylation changes between the stressed and control female rats. These findings suggest that Notch1 signaling pathway may contribute to the behavioral changes following CRS in mid-aged female rats and the upstream cause of the gene expression changes needs to be further investigated.
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Affiliation(s)
- Jianying Shen
- Research Center of Neurobiology, Department of Biochemistry and Molecular Biology, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, 350122, China
| | - Ling Lin
- Research Center of Neurobiology, Department of Biochemistry and Molecular Biology, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, 350122, China
| | - Linghong Liao
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Wenna Liang
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Xiaoting Yang
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Kaimin Lin
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Long Ke
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Lingyuan Zhang
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Jie Kang
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Shanshan Ding
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Candong Li
- Fujian Key Laboratory of TCM Health State, Research Base of TCM Syndrome, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, 350122, China
| | - Zhihong Zheng
- Research Center of Neurobiology, Department of Biochemistry and Molecular Biology, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian Province, 350122, China.
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17
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Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155594. [PMID: 32756418 PMCID: PMC7432627 DOI: 10.3390/ijerph17155594] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life—paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods—while constituting vulnerable time periods for the mother—require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.
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18
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Shen J, Lin L, Liao L, Liang W, Yang X, Lin K, Ke L, Zhang L, Kang J, Ding S, Li C, Zheng Z. WITHDRAWN: The Involvement of Notch1 Signaling Pathway in Mid-aged Female Rats under Chronic Restraint Stress. Neurosci Lett 2020:135244. [PMID: 32652209 DOI: 10.1016/j.neulet.2020.135244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/18/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
This article has been withdrawn at the request of the Editor-in-Chief. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Jianying Shen
- Research Center of Neurobiology, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Ling Lin
- Research Center of Neurobiology, Fujian Medical University, Fuzhou 350122, Fujian Province, China
| | - Linghong Liao
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Wenna Liang
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Xiaoting Yang
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Kaimin Lin
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Long Ke
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Lingyuan Zhang
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Jie Kang
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Shanshan Ding
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Candong Li
- Fujian Key Laboratory of TCM Health State, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
| | - Zhihong Zheng
- Research Center of Neurobiology, Fujian Medical University, Fuzhou 350122, Fujian Province, China.
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19
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Sex-specific spatial memory deficits in mice with a conditional TrkB deletion on parvalbumin interneurons. Behav Brain Res 2019; 372:111984. [DOI: 10.1016/j.bbr.2019.111984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
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20
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Du X, Hill RA. Hypothalamic-pituitary-gonadal axis dysfunction: An innate pathophysiology of schizophrenia? Gen Comp Endocrinol 2019; 275:38-43. [PMID: 30753842 DOI: 10.1016/j.ygcen.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/08/2019] [Accepted: 02/08/2019] [Indexed: 12/21/2022]
Abstract
The female hormone 17β-estradiol is postulated to be protective against schizophrenia onset and severity. Hypoestrogenism is a common phenomenon in women with schizophrenia that has serious effects that adds to the burden of an already very onerous disease. The cause of hypoestrogenism is largely attributed to antipsychotic-induced hyperprolactinemia. Evidence suggest however that a significant portion of female schizophrenia patients develop hypoestrogenism either before antipsychotic treatment or without regard to the level of prolactin, suggesting that for a sizeable segment of female patients, gonadal abnormality may be an innate and early aspect of the disease. This review aims to summarise the available literature that examines gonadal dysfunction in schizophrenia through this prism as well as to outline some recent developments in treatment strategies that may provide feasible ways to successfully tackle hypoestrogenism in schizophrenia.
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Affiliation(s)
- X Du
- Behavioural Neuroscience Laboratory, Department of Psychiatry, Monash University, Clayton, Victoria 3168, Australia.
| | - R A Hill
- Behavioural Neuroscience Laboratory, Department of Psychiatry, Monash University, Clayton, Victoria 3168, Australia
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21
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Gurvich C, Hudaib A, Gavrilidis E, Worsley R, Thomas N, Kulkarni J. Raloxifene as a treatment for cognition in women with schizophrenia: the influence of menopause status. Psychoneuroendocrinology 2019; 100:113-119. [PMID: 30299258 DOI: 10.1016/j.psyneuen.2018.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023]
Abstract
Cognitive impairments cause significant functional issues for people with schizophrenia, often emerging before the onset of hallucinations, delusions and other psychosis symptoms. Current pharmacological treatments do not target cognitive dysfunction. Several lines of evidence support the beneficial effects of estrogens on cognition. Raloxifene hydrochloride, a selective estrogen receptor modulator, has been associated with cognitive improvements in healthy postmenopausal women and in schizophrenia, although findings are inconsistent. Using pooled data from two clinical trials, the aim of the current study was to compare the efficacy of 120 mg/day adjunctive raloxifene to placebo for 12 weeks on cognitive performance in women with schizophrenia who were stratified by menopause status (pre-menopausal; peri-menopausal or post-menopausal). A total of sixty-nine participants with a diagnosis of schizophrenia or schizoaffective disorder were included. Cognition was assessed at baseline and study end using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results indicated that after stratifying for menopause status (strata) and adjusting for endogenous hormone levels (estrogen, progesterone, follicle stimulating hormone and luteinising hormone), semantic fluency, picture naming and list recognition change from baseline scores for the raloxifene group differed significantly from the placebo group. The findings from the current study highlight the importance of considering menopause status when interpreting the effects of hormonal treatments.
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Affiliation(s)
- C Gurvich
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia.
| | - A Hudaib
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
| | - E Gavrilidis
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
| | - R Worsley
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
| | - N Thomas
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
| | - J Kulkarni
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
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