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Salvadé A, Golay P, Abrahamyan L, Bonnarel V, Solida A, Alameda L, Ramain J, Conus P. Gender differences in first episode psychosis: Some arguments to develop gender specific treatment strategies. Schizophr Res 2024; 271:300-308. [PMID: 39084105 DOI: 10.1016/j.schres.2024.07.046] [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: 02/22/2023] [Revised: 07/20/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Some aspects of gender differences in patients with schizophrenia spectrum disorders (SSD) have been studied, especially in cross-sectional designs and with a short-term follow-up. However, only a few studies have considered the evolution during the follow-up of SSD patients according to their gender. In this study, we explore gender differences from the time of entry in an early intervention program for psychosis, up to three years follow-up. METHODS We conducted a prospective study including a cohort of 474 patients treated at the Treatment and Early Intervention in Psychosis (TIPP) program, 319 men and 155 women, having presented a first episode of psychosis (FEP). Data regarding premorbid and baseline sociodemographic, psychopathological and patient functioning, were collected. These data were reassessed longitudinally after 2, 6, 12, 18, 24, 30 and 36 months after entry in TIPP. RESULTS Regarding premorbid and baseline characteristics, woman developed threshold symptoms of a FEP 1 year later than men on average. Women were more likely to be married, men were more likely to live in pension or care home facility or to be homeless. Women displayed a higher rate of history of suicide attempts and exposure to childhood trauma, while men were more likely to have a forensic history, a history of abuse of alcohol and cannabis as well as a dependency to cannabis at the time of entry in TIPP. Regarding evolution, men were more prone to violent acts and were less likely to decrease their usage of substances. The longitudinal analysis highlighted that men displayed greater negative symptoms over the entire treatment period, lower functioning after 6 months and on all assessment points after. Both genders displayed similar rate of improvement in these 3 dimensions over time. CONCLUSION Our study confirms that there are some gender differences in the early phase of psychosis that may require differentiation of assessment and treatment to improve recovery.
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Affiliation(s)
- Aude Salvadé
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Philippe Golay
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. Vinet 30, Lausanne, Switzerland
| | - Lilith Abrahamyan
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Bonnarel
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Alessandra Solida
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Département de psychiatrie de l'adulte II, Centre Neuchâtelois de Psychiatrie, Neuchâtel, Switzerland
| | - Luis Alameda
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK; Centro Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Departamento de Psiquiatria, Universidad de Sevilla, Sevilla, Spain
| | - Julie Ramain
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Training and Research Institute in Mental Health (IFRSM), Neuchâtel Centre of Psychiatry, Neuchâtel, Switzerland
| | - Philippe Conus
- General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Galbally M, Wynter K, Siskind D, Correll CU, Northwood K, Every-Palmer S. Sex Differences Between Female and Male Individuals in Antipsychotic Efficacy and Adverse Effects in the Treatment of Schizophrenia. CNS Drugs 2024; 38:559-570. [PMID: 38713452 PMCID: PMC11182865 DOI: 10.1007/s40263-024-01089-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND OBJECTIVE Antipsychotics are core treatments for people living with psychotic disorders. Understanding individualised factors that influence both efficacy and adverse responses will improve outcomes. The objective of this study was to examine sex differences in antipsychotic-related efficacy and tolerability. METHODS This was a secondary analysis of data from phase 1 and 1a of Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE); participants with schizophrenia were randomly assigned to double-blinded treatment with oral olanzapine, quetiapine, risperidone, ziprasidone or perphenazine. Measures included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions (CGI) scale and Calgary Depression Rating Scale, as well as self-reported side effects, medication compliance, dosage, weight measurements and various blood parameters. RESULTS There were 1460 participants including 380 female and 1080 male individuals. Very few differences existed between male and female participants in response, adverse reactions, compliance or antipsychotic dosage. However, significantly more female participants than male participants reported constipation (28% vs 16%), dry mouth (50% vs 38%), gynecomastia/galactorrhea (11% vs 3%), incontinence/nocturia (16% vs 8%) and self reported weight gain (37% vs 24%) [all p < 0.001]. Within the risperidone treatment group, there was a significantly greater increase in prolactin levels (p < 0.001) among female participants (n = 61) than male participants (n = 159). No overall differences in clinician-rated measures, weight gain or other laboratory indicators were found. CONCLUSIONS While overall sex differences were limited across efficacy and tolerability for antipsychotic treatment, there were some specific findings with risperidone. Further examination of sex differences within antipsychotic trials will be important to improve efficacy and reduce adverse responses across as well as individualising care for people with schizophrenia.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.
- Health Futures Institute, Murdoch University, Perth, WA, Australia.
| | - Karen Wynter
- School of Clinical Sciences, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Dan Siskind
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Hospital and Health Service, Brisbane, QLD, Australia
| | - Christoph U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, Berlin, Germany
| | - Korinne Northwood
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Hospital and Health Service, Brisbane, QLD, Australia
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Yang C, Tian Y, Yang X, Liu L, Ling C, Xia L, Liu H. Hematological and inflammatory markers in Han Chinese patients with drug-free schizophrenia: relationship with symptom severity. Front Immunol 2024; 15:1337103. [PMID: 38352871 PMCID: PMC10861680 DOI: 10.3389/fimmu.2024.1337103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background There is a growing amount of evidence suggesting that immunity and inflammation play an important role in the pathophysiology of schizophrenia. In this study, we aimed to examine the relationship between hematological and inflammatory markers with symptom severity in Han Chinese patients with drug-free schizophrenia. Methods This retrospective study was conducted at Chaohu Hospital of Anhui Medical University and data were extracted from the electronic medical record system over a 5-year period (May 2017 to April 2022), including participants' general and clinical information as well as Brief Psychiatric Rating Scale (BPRS) scores and hematological parameters. Results A total of 2,899 patients with schizophrenia were identified through the initial search. After screening, 91 patients and 141 healthy controls (HCs) were included. The patients had a higher value of neutrophils/lymphocytes ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio (PLR) than HCs (all P < 0.001). MLR was positively correlated with BPRS total score (r = 0.337, P = 0.001) and resistance subscale score (r = 0.350, P = 0.001). Binary logistic regression analyses revealed that severely ill was significantly associated with being male and a higher value of MLR (Natural Logaruthm, Ln) (all P < 0.05), and the receiver operating characteristic (ROC) analysis showed good performance of a regression model with an area under the curve (AUC) value of 0.787. Conclusion Patients with drug-free schizophrenia have an unbalanced distribution of peripheral blood granulocytes, and elevated NLR, MLR and PLR. Patients with higher value of MLR tend to have more psychotic symptoms, especially those symptoms of hostility, uncooperativeness, and suspiciousness. Our study gives a preliminary indication that MLR is a potential predictor of disease severity in patients with drug-free schizophrenia.
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Affiliation(s)
- Cheng Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Yinghan Tian
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Xiaoxue Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Lewei Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Chen Ling
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- Department of Psychiatry, Anhui Psychiatric Center, Anhui Medical University, Hefei, China
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Ziemka-Nalecz M, Pawelec P, Ziabska K, Zalewska T. Sex Differences in Brain Disorders. Int J Mol Sci 2023; 24:14571. [PMID: 37834018 PMCID: PMC10572175 DOI: 10.3390/ijms241914571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
A remarkable feature of the brain is its sexual dimorphism. Sexual dimorphism in brain structure and function is associated with clinical implications documented previously in healthy individuals but also in those who suffer from various brain disorders. Sex-based differences concerning some features such as the risk, prevalence, age of onset, and symptomatology have been confirmed in a range of neurological and neuropsychiatric diseases. The mechanisms responsible for the establishment of sex-based differences between men and women are not fully understood. The present paper provides up-to-date data on sex-related dissimilarities observed in brain disorders and highlights the most relevant features that differ between males and females. The topic is very important as the recognition of disparities between the sexes might allow for the identification of therapeutic targets and pharmacological approaches for intractable neurological and neuropsychiatric disorders.
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Affiliation(s)
| | | | | | - Teresa Zalewska
- NeuroRepair Department, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5, A. Pawinskiego Str., 02-106 Warsaw, Poland; (M.Z.-N.); (P.P.); (K.Z.)
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Li Z, Wang Y, Wang Z, Kong L, Liu L, Li L, Tang Y. Estradiol and raloxifene as adjunctive treatment for women with schizophrenia: A meta-analysis of randomized, double-blind, placebo-controlled trials. Acta Psychiatr Scand 2023; 147:360-372. [PMID: 36585771 DOI: 10.1111/acps.13530] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We conducted a comprehensive meta-analysis of all available trials to evaluate the efficacy and safety of estrogen and selective estrogen receptor modulators as adjunctive treatment for women with schizophrenia. METHODS Multiple databases were searched from the inception until March 2022. Only randomized, double-blind, placebo-controlled studies (randomized controlled trials) were included. Mean differences (MDs) and their 95% confidence intervals (CIs) were calculated using random effects models. RESULTS The meta-analysis included six estradiol versus placebo studies (n = 724) and seven raloxifene versus placebo studies (n = 419), covering a total of 1143 patients. Adjunctive estradiol outperformed the placebo in terms of the Positive and Negative Syndrome Scale (PANSS) total score (MD = -7.29; 95% CI = -10.67 to -3.91; I2 = 59.1%; p < 0.001; k = 9; N = 858), positive symptom score (MD = -1.54; 95% CI = -3.04 to -0.72; I2 = 45.8%; p < 0.001; k = 7; N = 624), negative symptom score (MD = -1.9; 95% CI = -1.77 to -0.34; I2 = 37.6%; p < 0.05; k = 14; N = 1042), and general psychopathology score (MD = -4.27; 95% CI = -7.14 to -1.41; I2 = 76.3%; p < 0.005; k = 7; N = 624). Adjunctive raloxifene outperformed the placebo in terms of the PANSS total score (MD = -6.83; 95% CI = -11.69 to -1.97; I2 = 67.8%; p = 0.006; k = 8; N = 432) and general psychopathology score (MD = -3.82; 95% CI = -6.36 to -1.28; I2 = 65.3%; p < 0.005; k = 8; N = 432). CONCLUSIONS Our meta-analysis showed that estradiol and raloxifene are effective and safe adjunctive treatments that improve schizophrenia symptoms in women. Moreover, the effects of estradiol and raloxifene differed in terms of timing and dosage. Both are promising adjunctive treatments that merit further study.
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Affiliation(s)
- Zijia Li
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yucheng Wang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, People's Republic of China
- School of Public Health, China Medical University, Shenyang, People's Republic of China
| | - Zhe Wang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lingtao Kong
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Linzi Liu
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Liu Li
- Shenyang Women's and Children's Hospital, Shenyang, People's Republic of China
| | - Yanqing Tang
- Department of Psychiatry and Geriatrics, The First Hospital of China Medical University, Shenyang, People's Republic of China
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Matuszewska A, Kowalski K, Jawień P, Tomkalski T, Gaweł-Dąbrowska D, Merwid-Ląd A, Szeląg E, Błaszczak K, Wiatrak B, Danielewski M, Piasny J, Szeląg A. The Hypothalamic-Pituitary-Gonadal Axis in Men with Schizophrenia. Int J Mol Sci 2023; 24:ijms24076492. [PMID: 37047464 PMCID: PMC10094807 DOI: 10.3390/ijms24076492] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/18/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Schizophrenia is a severe mental disorder with a chronic, progressive course. The etiology of this condition is linked to the interactions of multiple genes and environmental factors. The earlier age of onset of schizophrenia, the higher frequency of negative symptoms in the clinical presentation, and the poorer response to antipsychotic treatment in men compared to women suggests the involvement of sex hormones in these processes. This article aims to draw attention to the possible relationship between testosterone and some clinical features in male schizophrenic patients and discuss the complex nature of these phenomena based on data from the literature. PubMed, Web of Science, and Google Scholar databases were searched to select the papers without limiting the time of the publications. Hormone levels in the body are regulated by many organs and systems, and take place through the neuroendocrine, hormonal, neural, and metabolic pathways. Sex hormones play an important role in the development and function of the organism. Besides their impact on secondary sex characteristics, they influence brain development and function, mood, and cognition. In men with schizophrenia, altered testosterone levels were noted. In many cases, evidence from available single studies gave contradictory results. However, it seems that the testosterone level in men affected by schizophrenia may differ depending on the phase of the disease, types of clinical symptoms, and administered therapy. The etiology of testosterone level disturbances may be very complex. Besides the impact of the illness (schizophrenia), stress, and antipsychotic drug-induced hyperprolactinemia, testosterone levels may be influenced by, i.a., obesity, substances of abuse (e.g., ethanol), or liver damage.
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Orsini CA, Truckenbrod LM, Wheeler AR. Regulation of sex differences in risk-based decision making by gonadal hormones: Insights from rodent models. Behav Processes 2022; 200:104663. [PMID: 35661794 PMCID: PMC9893517 DOI: 10.1016/j.beproc.2022.104663] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023]
Abstract
Men and women differ in their ability to evaluate options that vary in their rewards and the risks that are associated with these outcomes. Most studies have shown that women are more risk averse than men and that gonadal hormones significantly contribute to this sex difference. Gonadal hormones can influence risk-based decision making (i.e., risk taking) by modulating the neurobiological substrates underlying this cognitive process. Indeed, estradiol, progesterone and testosterone modulate activity in the prefrontal cortex, amygdala and nucleus accumbens associated with reward and risk-related information. The use of animal models of decision making has advanced our understanding of the intersection between the behavioral, neural and hormonal mechanisms underlying sex differences in risk taking. This review will outline the current state of this literature, identify the current gaps in knowledge and suggest the neurobiological mechanisms by which hormones regulate risky decision making. Collectively, this knowledge can be used to understand the potential consequences of significant hormonal changes, whether endogenously or exogenously induced, on risk-based decision making as well as the neuroendocrinological basis of neuropsychiatric diseases that are characterized by impaired risk taking, such as substance use disorder and schizophrenia.
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Affiliation(s)
- Caitlin A. Orsini
- Department of Psychology, University of Texas at Austin, Austin, TX, USA,Department of Neurology, University of Texas at Austin, Austin, TX, USA,Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, Austin, TX, USA,Institute for Neuroscience, University of Texas at Austin, Austin, TX, USA,Correspondence to: Department of Psychology & Neurology, Waggoner Center for Alcohol and Addiction Research, 108 E. Dean Keaton St., Stop A8000, Austin, TX 78712, USA. (C.A. Orsini)
| | - Leah M. Truckenbrod
- Department of Neurology, University of Texas at Austin, Austin, TX, USA,Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, Austin, TX, USA,Institute for Neuroscience, University of Texas at Austin, Austin, TX, USA
| | - Alexa-Rae Wheeler
- Department of Neurology, University of Texas at Austin, Austin, TX, USA,Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, Austin, TX, USA,Institute for Neuroscience, University of Texas at Austin, Austin, TX, USA
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Culbert KM, Thakkar KN, Klump KL. Risk for midlife psychosis in women: critical gaps and opportunities in exploring perimenopause and ovarian hormones as mechanisms of risk. Psychol Med 2022; 52:1612-1620. [PMID: 35582864 PMCID: PMC9743981 DOI: 10.1017/s0033291722001143] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Women show a heightened risk for psychosis in midlife that is not observed in men. The menopausal transition (i.e. perimenopause) and accompanying changes in ovarian hormones are theorized to account for this midlife increase in risk. This narrative review aims to empirically examine these theories by reviewing studies of midlife and perimenopausal psychosis risk in women and potential ovarian hormone mechanisms of effects. Clinical and pre-clinical studies examining the effects of midlife age, menopausal stage, and ovarian hormones across adulthood on psychosis risk were identified. Synthesis of this body of work revealed that the peak ages of midlife psychosis risk in women overlap with the age range of key menopausal stages (especially the perimenopausal transition), although studies directly assessing menopausal stage are lacking. Studies examining ovarian hormone effects have almost exclusively focused on earlier developmental stages and events (e.g. pregnancy, the menstrual cycle) and show increases in psychotic symptoms in women and female rats during periods of lower estradiol levels. Estrogen treatment also tends to enhance the effects of neuroleptics in females across species at various reproductive phases. Initial data are promising in suggesting a role for menopausal stage and ovarian hormones in psychosis risk. However, critical gaps in our knowledge base remain, as there is a tendency to rely on indirect and proxy measures of menopausal status and hormones. Opportunities for future research are discussed with the goal of increasing research in this critical area of women's health.
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Affiliation(s)
| | - Katharine N. Thakkar
- Department of Psychology, Michigan State University, East Lansing, MI
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, MI
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Sánchez‐Olguin CP, Zamudio SR, Guzmán‐Velázquez S, Márquez‐Portillo M, Caba‐Flores MD, Camacho‐Abrego I, Flores G, Melo AI. Neonatal ventral hippocampus lesion disrupts maternal behavior in rats: An animal model of schizophrenia. Dev Psychobiol 2022; 64:e22283. [DOI: 10.1002/dev.22283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/17/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Claudia P. Sánchez‐Olguin
- Departamento de Fisiología Escuela Nacional de Ciencias Biológicas Instituto Politécnico Nacional Mexico City Mexico
- Maestría en Ciencias Biológicas Universidad Autónoma de Tlaxcala Tlaxcala Mexico
| | - Sergio R. Zamudio
- Departamento de Fisiología Escuela Nacional de Ciencias Biológicas Instituto Politécnico Nacional Mexico City Mexico
| | - Sonia Guzmán‐Velázquez
- Departamento de Fisiología Escuela Nacional de Ciencias Biológicas Instituto Politécnico Nacional Mexico City Mexico
| | - Mariana Márquez‐Portillo
- Centro de Investigación en Reproducción Animal CINVESTAV Laboratorio Tlaxcala Universidad Autónoma de Tlaxcala Tlaxcala Mexico
| | | | - Israel Camacho‐Abrego
- Laboratorio de Neuropsiquiatría Instituto de Fisiología Benemérita Universidad Autónoma de Puebla Puebla Mexico
- Doctorado en Ciencias Biológicas Universidad Autónoma de Tlaxcala Tlaxcala Mexico
| | - Gonzalo Flores
- Laboratorio de Neuropsiquiatría Instituto de Fisiología Benemérita Universidad Autónoma de Puebla Puebla Mexico
| | - Angel I. Melo
- Centro de Investigación en Reproducción Animal CINVESTAV Laboratorio Tlaxcala Universidad Autónoma de Tlaxcala Tlaxcala Mexico
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S-SCAM inhibits Axin-dependent synaptic function of GSK3β in a sex-dependent manner. Sci Rep 2022; 12:4090. [PMID: 35260764 PMCID: PMC8904762 DOI: 10.1038/s41598-022-08220-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
S-SCAM/MAGI-2 gene duplication is associated with schizophrenia (SCZ). S-SCAM overexpression in the forebrain induces SCZ-like phenotypes in a transgenic (Tg) mouse model. Interestingly, S-SCAM Tg mice show male-specific impairments in synaptic plasticity and working memory. However, mechanisms underlying the sex-specific deficits remain unknown. Here we report that S-SCAM Tg mice have male-specific deficits in synaptic GSK3β functions, as shown by reduced synaptic protein levels and increased inhibitory phosphorylation of GSK3β. This GSK3β hyper-phosphorylation was associated with increased CaMKII activities. Notably, synaptic levels of Axin1, to which GSK3β binds in competition with S-SCAM, were also reduced in male S-SCAM Tg mice. We demonstrated that Axin-binding is required for the S-SCAM overexpression-induced synaptic GSK3β reduction. Axin stabilization using XAV939 rescued the GSK3β deficits and restored the temporal activation of GSK3β during long-term depression in S-SCAM overexpressing neurons. Interestingly, synaptic Axin2 levels were increased in female S-SCAM Tg mice. Female sex hormone 17β-estradiol increased Axin2 expression and increased synaptic GSK3β levels in S-SCAM overexpressing neurons. These results reveal the role of S-SCAM in controlling Axin-dependent synaptic localization of GSK3β. Moreover, our studies point out the pathological relevance of GSK3β hypofunction found in humans and contribute to understanding the molecular underpinnings of sex differences in SCZ.
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Yin J, Luo X, Peng Q, Xiong S, Lv D, Dai Z, Fu J, Wang Y, Wei Y, Liang C, Xu X, Zhang D, Wang L, Zhu D, Wen X, Ye X, Lin Z, Lin J, Li Y, Wang J, Ma G, Li K, Wang Y. Sex-Specific Associations of MIR137 Polymorphisms With Schizophrenia in a Han Chinese Cohort. Front Genet 2021; 12:627874. [PMID: 33708240 PMCID: PMC7942225 DOI: 10.3389/fgene.2021.627874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/21/2021] [Indexed: 01/14/2023] Open
Abstract
Objective: To investigate the effects of microRNA-137 (MIR137) polymorphisms (rs1198588 and rs2660304) on the risk of schizophrenia in a Han Chinese population. Methods: Schizophrenia was diagnosed according to the DSM-5. Clinical symptoms and cognitive functions were assessed with the Positive and Negative Symptom Scale (PANSS) and Brief Assessment of Cognition in Schizophrenia (BACS), respectively. The polymorphisms were genotyped by improved multiplex ligation detection reaction (iMLDR) technology in 1,116 patients with schizophrenia and 1,039 healthy controls. Results: Significant associations were found between schizophrenia and MIR137 in the distributions of genotypes (p = 0.037 for rs1198588; p = 0.037 for rs2660304, FDR corrected) and alleles (p = 0.043 for rs1198588; p = 0.043 for rs2660304, FDR corrected) of two SNPs. When the population was stratified by sex, we found female-specific associations between MIR137 and schizophrenia in terms of genotype and allele distributions of rs1198588 (χ 2 = 4.41, p = 0.036 and χ 2 = 4.86, p = 0.029, respectively, FDR corrected) and rs2660304 (χ 2 = 4.74, p=0.036 and χ 2 = 4.80, p = 0.029, respectively, FDR corrected). Analysis of the MIR137 haplotype rs1198588-rs2660304 showed a significant association with schizophrenia in haplotype T-T [χ 2 = 4.60, p = 0.032, OR = 1.32, 95% CI (1.02-1.70)]. Then, significant female-specific associations were found with the haplotypes T-T and G-A [χ 2 = 4.92, p = 0.027, OR = 1.62, 95% CI (1.05-2.50); χ 2 = 4.42, p = 0.035, OR = 0.62, 95% CI (0.39-0.97), respectively]. When the TT genotype of rs1198588 was compared to the GT+GG genotype, a clinical characteristics analysis also showed a female-specific association in category instances (t = 2.76, p = 0.042, FDR corrected). Conclusion: The polymorphisms within the MIR137 gene are associated with susceptibility to schizophrenia, and a female-specific association of MIR137 with schizophrenia was reported in a Han Chinese population.
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Affiliation(s)
- Jingwen Yin
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, China
- Department of Psychology, Faculty of Social Sciences, University of Macau, Taipa, China
- Institute of Neurology, Guangdong Medical University, Zhanjiang, China
| | - Xudong Luo
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qian Peng
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Susu Xiong
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dong Lv
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhun Dai
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiawu Fu
- Stem Cell Research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ying Wang
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yaxue Wei
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chunmei Liang
- Stem Cell Research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xusan Xu
- Stem Cell Research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dandan Zhang
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lulu Wang
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongjian Zhu
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xia Wen
- Stem Cell Research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoqing Ye
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhixiong Lin
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Juda Lin
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - You Li
- Stem Cell Research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiafeng Wang
- Maternal and Children’s Health Research Institute, Shunde Maternal and Children’s Hospital, Guangdong Medical University, Foshan, China
| | - Guoda Ma
- Stem Cell Research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Keshen Li
- Stem Cell Research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yajun Wang
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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González-Rodríguez A, Guàrdia A, Palao DJ, Labad J, Seeman MV. Moderators and mediators of antipsychotic response in delusional disorder: Further steps are needed. World J Psychiatry 2020; 10:34-45. [PMID: 32399397 PMCID: PMC7203082 DOI: 10.5498/wjp.v10.i4.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/04/2020] [Accepted: 03/22/2020] [Indexed: 02/05/2023] Open
Abstract
Delusional disorder (DD) has been traditionally considered a relatively rare and treatment-resistant psychotic disorder. In the last decade, increasing attention has focused on therapeutic outcomes of individuals affected by this disorder. The aim of this paper is to provide a synthesis of the literature addressing two very important questions arising from DD research: (1) For which patients with DD do antipsychotic medications work best (the moderators of response); and (2) What variables best explain the relationship between such treatments and their effectiveness (the mediators of response). We searched PubMed and Google Scholar databases for English, German, French and Spanish language papers published since 2000. We also included a few classic earlier papers addressing this topic. Variables potentially moderating antipsychotic response in DD are gender, reproductive status, age, duration of illness, the presence of comorbidity (especially psychiatric comorbidity) and its treatment, brain structure, and genetics of neurochemical receptors and drug metabolizing enzymes. Antipsychotic and hormonal blood levels during treatment, as well as functional brain changes, are potential mediating variables. Some, but not all, patients with DD benefit from antipsychotic treatment. Understanding the circumstances under which treatment works best can serve to guide optimal management.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell 08280, Spain
| | - Armand Guàrdia
- Department of Mental Health, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell 08280, Spain
| | - Diego José Palao
- Department of Mental Health, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell 08280, Spain
| | - Javier Labad
- Department of Mental Health, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell 08280, Spain
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada
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Abstract
Summary
Pregnancy, childbirth and motherhood are new situations for women and require adjustment. Women suffering from schizophrenia require special attention due to the course of the disease. Physiological changes that occur in the body during pregnancy may be unacceptable for women suffering from schizophrenia. They may delusively deny the existence of the pregnancy, lead an unhealthy lifestyle (stimulants, poor diet, lack of gynaecological check-ups), which in turn causes an increased risk of complications. In the research conducted so far, it has been proven that three kinds of complications are associated with schizophrenia: complications concerning pregnancy itself (bleeding, diabetes, Rh-incompatibility, pre-eclampsia), intrauterine growth restriction (low birth weight, congenital malformations, small head circumference) and complications regarding labour (uterine atony, asphyxia, emergency Caesarean section). The course of the labour itself in this specific group of patients has not yet been sufficiently examined. It has also been proven that perinatal complications are one of the factors determining an increased risk of schizophrenia.
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Gurvich C, Gavrilidis E, Worsley R, Hudaib A, Thomas N, Kulkarni J. Menstrual cycle irregularity and menopause status influence cognition in women with schizophrenia. Psychoneuroendocrinology 2018; 96:173-178. [PMID: 29980009 DOI: 10.1016/j.psyneuen.2018.06.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 01/19/2023]
Abstract
Cognitive impairments are a core feature of schizophrenia and contribute significantly to functional complications. Current pharmacological treatments do not ameliorate cognitive dysfunction and the aetiology of cognitive impairments are poorly understood. Hormones of the hypothalamic-pituitary-gonadal (HPG) axis that regulate reproductive function have multiple effects on the development, maintenance and function of the brain and have been suggested to also influence cognition. The aim of the current study was to investigate how HPG axis hormones effect cognition, specifically exploring the influence of menopause status and menstrual cycle irregularity on cognitive performance in women with schizophrenia. The data for the present study represents pooled baseline data from three clinical trials. Two hundred and forty female participants with a diagnosis of schizophrenia or schizoaffective disorder were included in the analysis. Cognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status. Hormone assays for serum sex steroids and pituitary hormones (including estradiol, progesterone, luteinising hormone and follicle-stimulating hormone) were conducted and women were classified as postmenopausal; perimenopausal; premenopausal/reproductive, further classified into regular and irregular menstrual cycles. To model a comparison of cognitive performance for i) perimenopausal; ii) post-menopausal women and iii) reproductive aged women with irregular cycles to reproductive aged women with regular cycles a semiparametric regression model (generalised additive mode) was fitted. The results revealed that in females with schizophrenia, menstrual cycle irregularity predicted significantly poorer cognitive performance in the areas of psychomotor speed, verbal fluency and verbal memory. Perimenopause was not associated with cognitive changes and the post-menopausal period was associated with poorer visuospatial performance. This study provides evidence to associate reproductive hormones with cognitive dysfunction in schizophrenia.
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Affiliation(s)
- C Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia.
| | - E Gavrilidis
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
| | - R Worsley
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
| | - A Hudaib
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
| | - N Thomas
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
| | - J Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne, Australia
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Büki A, Horvath G, Benedek G, Ducza E, Kekesi G. Impaired GAD1 expression in schizophrenia‐related WISKET rat model with sex‐dependent aggressive behavior and motivational deficit. GENES BRAIN AND BEHAVIOR 2018; 18:e12507. [DOI: 10.1111/gbb.12507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 01/10/2023]
Affiliation(s)
- A. Büki
- Department of Physiology, Faculty of MedicineUniversity of Szeged Szeged Hungary
| | - G. Horvath
- Department of Physiology, Faculty of MedicineUniversity of Szeged Szeged Hungary
| | - G. Benedek
- Department of Physiology, Faculty of MedicineUniversity of Szeged Szeged Hungary
| | - E. Ducza
- Department of Pharmacodynamics and BiopharmacyFaculty of Pharmacy, University of Szeged Szeged Hungary
| | - G. Kekesi
- Department of Physiology, Faculty of MedicineUniversity of Szeged Szeged Hungary
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Zhu XM, Zheng W, Li XH, Cai DB, Yang XH, Ungvari GS, Ng CH, Wang XP, Kulkarni J, Grigg J, Ning YP, Xiang YT. Adjunctive raloxifene for postmenopausal women with schizophrenia: A meta-analysis of randomized, double-blind, placebo-controlled trials. Schizophr Res 2018; 197:288-293. [PMID: 29395611 DOI: 10.1016/j.schres.2018.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/26/2017] [Accepted: 01/17/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Raloxifene, a selective estrogen receptor modulator, has been used in treating postmenopausal women with schizophrenia with inconsistent results. This meta-analysis of randomized, double-blind, placebo-controlled trials (RCTs) examined its efficacy and safety for postmenopausal women with schizophrenia. METHOD Standardized mean differences (SMDs) and risk ratio (RR) together with their 95% confidence intervals (CIs) were calculated using the random effects model. RESULTS The meta-analysis included 5 RCTs (n = 240) comparing raloxifene (n = 125, 60 or 120 mg/day) with placebo (n = 115). Adjunctive raloxifene outperformed placebo with regard to the Positive and Negative Syndrome Scale (PANSS) total psychopathology [n = 240, SMD:-0.64 (95%CI:-0.90, -0.37), P < 0.00001; I2 = 0%], positive symptoms [n = 240, SMD:-0.49 (95%CI:-0.81, -0.16), P = 0.003; I2 = 29%], negative symptoms [n = 240, SMD:-0.43 (95%CI:-0.68, -0.17), P = 0.001; I2 = 0%], and general psychopathology scores [n = 240, SMD:-0.66 (95%CI:-0.92, -0.39), P < 0.00001; I2 = 0%]. Both groups had similar rates of adverse events and discontinuation (n = 159, RR: 1.32 (95%CI: 0.65, 2.70), P = 0.44, I2 = 0%). CONCLUSION Adjunctive raloxifene appears to be effective and safe in improving psychotic symptoms for postmenopausal women with schizophrenia. Review registration: CRD 42017059946.
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Affiliation(s)
- Xiao-Min Zhu
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiao-Hong Li
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Dong-Bin Cai
- Clinics of Chinese Medicine, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Graylands Hospital, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Xiao-Ping Wang
- Mental Health Institute of the Second Xiangya Hospital, Hunan Province Technology Institute of Psychiatry & Key Laboratory of Psychiatry, Mental Health of Hunan Province, Central South University, China
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Alfred Hospital, Melbourne, Australia; Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Jasmin Grigg
- Monash Alfred Psychiatry Research Centre, Alfred Hospital, Melbourne, Australia; Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Abstract
OBJECTIVE The aim of this review is to examine three questions: What are the risks and benefits of treating women with schizophrenia with hormone therapy (HT) at menopause? Should the antipsychotic regimen be changed at menopause? Do early- and late-onset women with schizophrenia respond differently to HT at menopause? METHODS MEDLINE databases for the years 1990 to 2016 were searched using the following interactive terms: schizophrenia, gender, menopause, estrogen, and hormones. The selected articles (62 out of 800 abstracts) were chosen on the basis of their applicability to the objectives of this targeted narrative review. RESULTS HT during the perimenopause in women with schizophrenia ameliorates psychotic and cognitive symptoms, and may also help affective symptoms. Vasomotor, genitourinary, and sleep symptoms are also reduced. Depending on the woman's age and personal risk factors and antipsychotic side effects, the risk of breast cancer and cardiovascular disease may be increased. Antipsychotic types and doses may need to be adjusted at menopause, as may be the mode of administration. CONCLUSIONS Both HT and changes in antipsychotic management should be considered for women with schizophrenia at menopause. The question about differences in response between early- and late-onset women cannot yet be answered.
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McGregor C, Riordan A, Thornton J. Estrogens and the cognitive symptoms of schizophrenia: Possible neuroprotective mechanisms. Front Neuroendocrinol 2017; 47:19-33. [PMID: 28673758 DOI: 10.1016/j.yfrne.2017.06.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 06/25/2017] [Accepted: 06/27/2017] [Indexed: 02/07/2023]
Abstract
Schizophrenia is a complex neuropsychiatric illness with marked sex differences. Women have later onset and lesser symptoms, which has led to the hypothesis that estrogens are protective in schizophrenia. Cognitive dysfunction is a hallmark of the disease and the symptom most correlated with functional outcome. Here we describe a number of mechanisms by which estrogens may be therapeutic in schizophrenia, with a focus on cognitive symptoms. We review the relationship between estrogens and brain derived neurotrophic factor, neuroinflammation, NMDA receptors, GABA receptors, and luteinizing hormone. Exploring these pathways may enable novel treatments for schizophrenia and a greater understanding of this devastating disease.
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Affiliation(s)
- Claire McGregor
- Department of Neuroscience, Oberlin College, 119 Woodland St, Oberlin, OH 44074, USA.
| | - Alexander Riordan
- Department of Neuroscience, Oberlin College, 119 Woodland St, Oberlin, OH 44074, USA
| | - Janice Thornton
- Department of Neuroscience, Oberlin College, 119 Woodland St, Oberlin, OH 44074, USA
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Abstract
The aim of this narrative review is to provide readers with a summary of the recent literature on women and schizophrenia and to address commonly asked questions about the role of gender in this illness. Important gender distinctions were found in the knowledge base around schizophrenia, particularly in the areas of symptom onset, hormonal and immune effects, and antipsychotic drug kinetics and their consequences. We also discuss and address commonly asked questions about gender and schizophrenia. This review concludes that gender differences influence the effectiveness of various treatments and need to be taken into account when planning comprehensive care services for individuals with schizophrenia.
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Affiliation(s)
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, 260 Heath St. W. Suite 605, Toronto, ON M5P 3L6, Canada
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Tu HP, Yu CL, Lan CCE, Yu S. Prevalence of schizophrenia in patients with psoriasis: a nationwide study. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2016.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Mehta CM, Gruen JR, Zhang H. A method for integrating neuroimaging into genetic models of learning performance. Genet Epidemiol 2017; 41:4-17. [PMID: 27859682 PMCID: PMC5154929 DOI: 10.1002/gepi.22025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 11/11/2022]
Abstract
Specific learning disorders (SLD) are an archetypal example of how clinical neuropsychological (NP) traits can differ from underlying genetic and neurobiological risk factors. Disparate environmental influences and pathologies impact learning performance assessed through cognitive examinations and clinical evaluations, the primary diagnostic tools for SLD. We propose a neurobiological risk for SLD with neuroimaging biomarkers, which is integrated into a genome-wide association study (GWAS) of learning performance in a cohort of 479 European individuals between 8 and 21 years of age. We first identified six regions of interest (ROIs) in temporal and anterior cingulate regions where the group diagnosed with learning disability has the least overall variation, relative to the other group, in thickness, area, and volume measurements. Although we used the three imaging measures, the thickness was the leading contributor. Hence, we calculated the Euclidean distances between any two individuals based on their thickness measures in the six ROIs. Then, we defined the relative similarity of one individual according to the averaged ranking of pairwise distances from the individuals to those in the SLD group. The inverse of this relative similarity is called the neurobiological risk for the individual. Single nucleotide polymorphisms in the AGBL1 gene on chromosome 15 had a significant association with learning performance at a genome-wide level. This finding was supported in an independent cohort of 2,327 individuals of the same demographic profile. Our statistical approach for integrating genetic and neuroimaging biomarkers can be extended into studying the biological basis of other NP traits.
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Affiliation(s)
- Chintan M. Mehta
- Department of Biostatistics, Yale University, 300 George Street, Suite 523, New Haven, Connecticut, 06511 (USA)
| | - Jeffrey R. Gruen
- Department of Pediatrics and Genetics, Yale University, 464 Congress Avenue, Suite 208, New Haven, Connecticut, 06511 (USA)
| | - Heping Zhang
- Department of Biostatistics, Yale University, 300 George Street, Suite 523, New Haven, Connecticut, New Haven, Connecticut, USA
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Sun J, Walker AJ, Dean B, van den Buuse M, Gogos A. Progesterone: The neglected hormone in schizophrenia? A focus on progesterone-dopamine interactions. Psychoneuroendocrinology 2016; 74:126-140. [PMID: 27608362 DOI: 10.1016/j.psyneuen.2016.08.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 12/25/2022]
Abstract
Sex differences appear to be an important factor in schizophrenia. Women with schizophrenia tend to exhibit less disease impairment than men, typically presenting with a later age-at-onset, lower overall incidence and less severe symptoms. These observations underpin the estrogen hypothesis of schizophrenia, which postulates a protective role of estrogen against the development and severity of the disorder. While there has been significant attention placed on the impact of estrogens in schizophrenia, less consideration has been afforded to the role of progesterone, the other main female gonadal hormone. This narrative review discusses the role of progesterone as a neuroactive steroid and how it may be dysregulated in schizophrenia. Preclinical and molecular studies relevant to schizophrenia are discussed with a particular focus on the interactions between progesterone and the dopaminergic system. Notably, existing data on progesterone in relation to schizophrenia is inconsistent, with some studies suggesting a neuroprotective role for the hormone (e.g. animal models of cognitive dysfunction and positive symptoms), while other studies posit a disruptive impact of the hormone (e.g. negative correlations with symptom modulation in patients). This review aims to thoroughly address these discrepancies, concluding that altogether the data suggest that progesterone is a key modulator of central systems implicated in schizophrenia. On this basis, we argue that a more inclusive, considered effort of future studies to understand the intricacies of the interactions between progesterone and estrogen. Such an effort may enhance our understanding of the roles of sex hormones in schizophrenia, thus leading to avenues for novel therapeutic approaches.
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Affiliation(s)
- Jeehae Sun
- Division of Biological Psychiatry and Mental Health, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, VIC, Australia
| | - Adam J Walker
- Division of Biological Psychiatry and Mental Health, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, VIC, Australia
| | - Brian Dean
- Division of Biological Psychiatry and Mental Health, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, VIC, Australia
| | - Maarten van den Buuse
- School of Psychology and Public Health, La Trobe University, VIC, Australia; Department of Pharmacology, University of Melbourne, VIC, Australia; The College of Public Health, Medical and Veterinary Sciences, James Cook University, QLD, Australia
| | - Andrea Gogos
- Division of Biological Psychiatry and Mental Health, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, VIC, Australia.
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Abstract
BACKGROUND The loss of estrogens in the menopause may lead to increased vulnerability for psychotic relapse, poor clinical outcome, and a need for increased antipsychotic dose. However, confounders such as cumulative estrogen exposure and time since menopause have been inadequately studied. Our aim was to investigate potential variables capable of influencing antipsychotic response in a sample of postmenopausal women with schizophrenia. METHODS Sixty-four postmenopausal schizophrenic women were followed in a 12-week prospective treatment-by-clinical requirement study. Duration of reproductive years was considered an indirect measure of lifetime cumulative estrogens exposure. Psychopathological assessment included the following: Positive and Negative Syndrome Scale, Personal and Social Performance, and Clinical Global Impression-Schizophrenia Scale. Response was defined as a reduction of 30% or more of Positive and Negative Syndrome Scale total scores. Antipsychotic adherence was assessed by plasma level monitoring at 4 weeks. Regression analyses were performed to investigate the association between potential confounding factors and antipsychotic response. RESULTS Forty-two participants (66%) were found to be antipsychotic responders. Time since menopause was significantly and negatively associated with overall antipsychotic response, explaining almost 42% of the variance of the model used. Smoking and cumulative estrogen exposures were associated with improvement in negative symptoms. Smoking and time since menopause were associated with improvement in excitement symptoms, and smoking was positively associated with improvement in depressive and cognitive symptoms. DISCUSSION Time since menopause was significantly negatively associated with antipsychotic response in postmenopausal schizophrenic women, suggesting a decline in antipsychotic response after menopause. The neurobiological basis for antipsychotic response may include a role for estrogen and nicotine receptors.
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A systematic review comparing sex differences in cognitive function in schizophrenia and in rodent models for schizophrenia, implications for improved therapeutic strategies. Neurosci Biobehav Rev 2016; 68:979-1000. [DOI: 10.1016/j.neubiorev.2016.06.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 06/11/2016] [Accepted: 06/20/2016] [Indexed: 01/07/2023]
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Yadav P, Stigall K, Johnson HE, Rayapati AO, Chopra N. Functional foods: How functional are they? A case report of supplement-induced psychosis. Int J Psychiatry Med 2016. [PMID: 28629290 DOI: 10.1177/0091217417696733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is rising evidence of patients' use of alternative and complementary medicine. The percentage of the U.S. population who used at least one dietary supplement increased from 42% in 1988-1994 to 53% in 2003-2006. We present a case of an Asian female in her 40s, with no previous psychiatric illness, who presented to the emergency room following a brief psychotic episode, during which she self-amputated the tips of her fingers, after using multivitamins and herbal supplements including ginseng, gui yuan rou (Chinese herb), astaxanthin, goji (Chinese fruit), selenium, saw palmetto, grape seed extract, citrus bioflavanoid, lutein (zeaxantin), resvexatrol, sun chlorella, spirulina powder, phytoceramides, phytoestrogen, glucosatrin, bromelain plus, and American bee pollen. Comprehensive laboratory workup, drug screening, and diagnostic imaging were negative. Vital signs were stable. Other than the amputated finger tips, the remainder of her physical examination was unremarkable. Her mental status improved significantly after treatment with risperidone 1 mg twice daily, during a five-day psychiatric hospitalization. This case draws attention to the fact that supplements have the potential of producing frank psychosis and require close monitoring and study by physicians.
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Affiliation(s)
- Priyanka Yadav
- 1 Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Kyle Stigall
- 2 College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Hannah E Johnson
- 3 Department of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Abner O Rayapati
- 4 Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Nitin Chopra
- 5 Acute Care Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
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27
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Seeman MV. Gendering psychosis: the illness of Zelda Fitzgerald. MEDICAL HUMANITIES 2016; 42:65-69. [PMID: 26392268 DOI: 10.1136/medhum-2015-010734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 06/05/2023]
Abstract
Psychiatric textbooks tend to describe psychosis as it is experienced by men. The well-documented illness of Zelda Fitzgerald illustrates the feminine side of psychosis. The distinctive features of Zelda's illness--its specific precipitants, the timing of its onset, the discontinuities in its course, the pronounced mood swings, the preservation of intellect and of agency, the maintenance of human ties, the association of flare-ups with immune and hormonal changes, the responsiveness to treatment, the lifelong creativity and productivity--show the female side of psychotic illness, one that is rarely described in diagnostic manuals. This paper relies on Nancy Milford's biography of Zelda, as well as on several other biographical sources and, using Zelda's own words and the words of her husband and friends, allows entry into a feminine world of psychosis, not encountered in textbooks. The expression of psychotic illness varies from person to person, its exact shape depending on many factors, most of them still undetermined, but gender is a critically important core component of variance.
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Vitucci D, Di Giorgio A, Napolitano F, Pelosi B, Blasi G, Errico F, Attrotto MT, Gelao B, Fazio L, Taurisano P, Di Maio A, Marsili V, Pasqualetti M, Bertolino A, Usiello A. Rasd2 Modulates Prefronto-Striatal Phenotypes in Humans and 'Schizophrenia-Like Behaviors' in Mice. Neuropsychopharmacology 2016; 41:916-27. [PMID: 26228524 PMCID: PMC4707838 DOI: 10.1038/npp.2015.228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/03/2015] [Accepted: 07/25/2015] [Indexed: 12/18/2022]
Abstract
Rasd2 is a thyroid hormone target gene, which encodes for a GTP-binding protein enriched in the striatum where, among other functions, it modulates dopaminergic neurotransmission. Here we report that human RASD2 mRNA is abundant in putamen, but it also occurs in the cerebral cortex, with a distinctive expression pattern that differs from that present in rodents. Consistent with its localization, we found that a genetic variation in RASD2 (rs6518956) affects postmortem prefrontal mRNA expression in healthy humans and is associated with phenotypes of relevance to schizophrenia, including prefrontal and striatal grey matter volume and physiology during working memory, as measured with magnetic resonance imaging. Interestingly, quantitative real-time PCR analysis indicated that RASD2 mRNA is slightly reduced in postmortem prefrontal cortex of patients with schizophrenia. In the attempt to uncover the neurobiological substrates associated with Rasd2 activity, we used knockout mice to analyze the in vivo influence of this G-protein on the prepulse inhibition of the startle response and psychotomimetic drug-related behavioral response. Data showed that Rasd2 mutants display deficits in basal prepulse inhibition that, in turn, exacerbate gating disruption under psychotomimetic drug challenge. Furthermore, we documented that lack of Rasd2 strikingly enhances the behavioral sensitivity to motor stimulation elicited by amphetamine and phencyclidine. Based on animal model data, along with the finding that RASD2 influences prefronto-striatal phenotypes in healthy humans, we suggest that genetic mutation or reduced levels of this G-protein might have a role in cerebral circuitry dysfunction underpinning exaggerated psychotomimetic drugs responses and development of specific biological phenotypes linked to schizophrenia.
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Affiliation(s)
- Daniela Vitucci
- Ceinge Biotecnologie Avanzate, Naples, Italy,Dipartimento di Scienze Motorie e del Benessere DiSMeB, Università degli Studi di Napoli Parthenope, Naples, Italy
| | - Annabella Di Giorgio
- Istituto di Ricovero e Cura a Carattere Scientifico ‘Casa Sollievo della Sofferenza', Foggia, Italy
| | - Francesco Napolitano
- Ceinge Biotecnologie Avanzate, Naples, Italy,Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II', Naples, Italy
| | - Barbara Pelosi
- Department of Biology, Unit of Cell and Developmental Biology, University of Pisa, Pisa, Italy
| | - Giuseppe Blasi
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro', Bari, Italy
| | - Francesco Errico
- Ceinge Biotecnologie Avanzate, Naples, Italy,Department of Molecular Medicine and Medical Biotechnology, University of Naples ‘Federico II', Naples, Italy
| | - Maria Teresa Attrotto
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro', Bari, Italy
| | - Barbara Gelao
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro', Bari, Italy
| | - Leonardo Fazio
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro', Bari, Italy
| | - Paolo Taurisano
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro', Bari, Italy
| | | | | | - Massimo Pasqualetti
- Department of Biology, Unit of Cell and Developmental Biology, University of Pisa, Pisa, Italy,Istituto Italiano di Tecnologia, Center for Neuroscience and Cognitive Systems, Rovereto (Trento), Italy
| | - Alessandro Bertolino
- Group of Psychiatric Neuroscience, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro', Bari, Italy,pRED, Neuroscience DTA, Hoffmann-La Roche, Basel, Switzerland,Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro', Piazza G. Cesare 11, Bari 70124, Italy, Tel: +39 0805478572, Fax: +39 0805593172,
| | - Alessandro Usiello
- Ceinge Biotecnologie Avanzate, Naples, Italy,Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, Second University of Naples (SUN), Caserta, Italy,Ceinge Biotecnologie Avanzate, Via G. Salvatore 486, Naples 80145, Italy, Tel: +39 0813737899, Fax: +39 0813737808. E-mail:
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Landek-Salgado MA, Faust TE, Sawa A. Molecular substrates of schizophrenia: homeostatic signaling to connectivity. Mol Psychiatry 2016; 21:10-28. [PMID: 26390828 PMCID: PMC4684728 DOI: 10.1038/mp.2015.141] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 02/06/2023]
Abstract
Schizophrenia (SZ) is a devastating psychiatric condition affecting numerous brain systems. Recent studies have identified genetic factors that confer an increased risk of SZ and participate in the disease etiopathogenesis. In parallel to such bottom-up approaches, other studies have extensively reported biological changes in patients by brain imaging, neurochemical and pharmacological approaches. This review highlights the molecular substrates identified through studies with SZ patients, namely those using top-down approaches, while also referring to the fruitful outcomes of recent genetic studies. We have subclassified the molecular substrates by system, focusing on elements of neurotransmission, targets in white matter-associated connectivity, immune/inflammatory and oxidative stress-related substrates, and molecules in endocrine and metabolic cascades. We further touch on cross-talk among these systems and comment on the utility of animal models in charting the developmental progression and interaction of these substrates. Based on this comprehensive information, we propose a framework for SZ research based on the hypothesis of an imbalance in homeostatic signaling from immune/inflammatory, oxidative stress, endocrine and metabolic cascades that, at least in part, underlies deficits in neural connectivity relevant to SZ. Thus, this review aims to provide information that is translationally useful and complementary to pathogenic hypotheses that have emerged from genetic studies. Based on such advances in SZ research, it is highly expected that we will discover biomarkers that may help in the early intervention, diagnosis or treatment of SZ.
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Affiliation(s)
- M A Landek-Salgado
- Department of Psychiatry, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - T E Faust
- Department of Psychiatry, John Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neuroscience, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Sawa
- Department of Psychiatry, John Hopkins University School of Medicine, Baltimore, MD, USA
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30
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Mendrek A, Mancini-Marïe A. Sex/gender differences in the brain and cognition in schizophrenia. Neurosci Biobehav Rev 2015; 67:57-78. [PMID: 26743859 DOI: 10.1016/j.neubiorev.2015.10.013] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/17/2015] [Accepted: 10/26/2015] [Indexed: 01/03/2023]
Abstract
The early conceptualizations of schizophrenia have noted some sex/gender differences in epidemiology and clinical expression of the disorder. Over the past few decades, the interest in differences between male and female patients has expanded to encompass brain morphology and neurocognitive function. Despite some variability and methodological shortcomings, a few patterns emerge from the available literature. Most studies of gross neuroanatomy show more enlarged ventricles and smaller frontal lobes in men than in women with schizophrenia; finding reflecting normal sexual dimorphism. In comparison, studies of brain asymmetry and specific corticolimbic structures, suggest a disturbance in normal sexual dimorphism. The neurocognitive findings are somewhat consistent with this picture. Studies of cognitive functions mediated by the lateral frontal network tend to show sex differences in patients which are in the same direction as those observed in the general population, whereas studies of processes mediated by the corticolimbic system more frequently reveal reversal of normal sexual dimorphisms. These trends are faint and future research would need to delineate neurocognitive differences between men and women with various subtypes of schizophrenia (e.g., early versus late onset), while taking into consideration hormonal status and gender of tested participants.
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Affiliation(s)
- Adrianna Mendrek
- Department of Psychology, Bishop's University, Sherbrooke, QC, Canada; Department of Psychiatry, Université de Montréal, Montreal, QC, Canada; Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.
| | - Adham Mancini-Marïe
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada; Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry, Centre neuchâtelois de psychiatrie, Neuchâtel, Suisse
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31
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Rapado-Castro M, Bartholomeusz CF, Castro-Fornieles J, González-Pinto A, Otero S, Baeza I, Moreno C, Graell M, Janssen J, Bargalló N, Pantelis C, Desco M, Arango C. Gender effects on brain changes in early-onset psychosis. Eur Child Adolesc Psychiatry 2015; 24:1193-205. [PMID: 25589436 DOI: 10.1007/s00787-014-0669-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/18/2014] [Indexed: 11/24/2022]
Abstract
Progressive loss of cortical gray matter (GM) and increase of cerebrospinal fluid (CSF) have been reported in early-onset psychosis (EOP). EOP typically begins during adolescence, a time when developmental brain trajectories differ by gender. This study aimed to determine gender differences in progression of brain changes in this population. A sample of 61 (21 females) adolescents with a first psychotic episode and a matched sample of 70 (23 females) controls underwent both baseline and 2-year follow-up anatomical brain imaging assessments. Regional GM and CSF volumes were obtained using automated methods based on the Talairach's proportional grid system. At baseline, only male patients showed a clear pattern of alterations in the frontal lobe relative to controls (smaller GM and larger CSF volumes). However, parallel longitudinal changes for male and female patients relative to controls were observed, resulting in a common pattern of brain changes across both genders: rate of left frontal lobe GM volume loss was larger in male (-3.8%) and female patients (-4.2%) than in controls (-0.7% males; -0.4% females). The reverse was found for the CSF volume in the left frontal lobe. While the GM and CSF volumes of females with EOP appear to be within the normal range at initial illness onset, our results point to a similar trajectory of increased/accelerated brain changes in both male and female patients with EOP. The pattern of progression of brain changes in psychosis appears to be independent of gender or structural alterations on appearance of psychotic symptoms.
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Affiliation(s)
- Marta Rapado-Castro
- Child and Adolescent Psychiatry Department, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain.
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, VIC, 3053, Australia.
| | - Cali F Bartholomeusz
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, VIC, 3053, Australia
| | - Josefina Castro-Fornieles
- Child Psychiatry and Psychology Department, Neurosciences Institute, Hospital Clinic de Barcelona, IDIBAPS, SGR-1119, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Ana González-Pinto
- Hospital Santiago Apóstol de Vitoria, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Kronikgune, EHU-UPV, Vitoria, Spain
| | - Soraya Otero
- Child Psychiatry Unit, Hospital Universitario Marqués de Valdecilla, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Santander, Spain
| | - Inmaculada Baeza
- Child Psychiatry and Psychology Department, Neurosciences Institute, Hospital Clinic de Barcelona, IDIBAPS, SGR-1119, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Carmen Moreno
- Child and Adolescent Psychiatry Department, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Montserrat Graell
- Psychiatry and Psychology Department, Hospital Infantil Universitario Niño Jesús, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Joost Janssen
- Child and Adolescent Psychiatry Department, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
- Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
| | - Nuria Bargalló
- Image Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, 161 Barry Street, Carlton South, VIC, 3053, Australia
| | - Manuel Desco
- Department of Bioengineering and Aerospatial Engineering, University Carlos III de Madrid, Madrid, Spain
- Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and Adolescent Psychiatry Department, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón, IiSGM, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid, Spain
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Almey A, Milner TA, Brake WG. Estrogen receptors in the central nervous system and their implication for dopamine-dependent cognition in females. Horm Behav 2015; 74:125-38. [PMID: 26122294 PMCID: PMC4820286 DOI: 10.1016/j.yhbeh.2015.06.010] [Citation(s) in RCA: 179] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 12/12/2022]
Abstract
This article is part of a Special Issue "Estradiol and cognition". Over the past 30 years, research has demonstrated that estrogens not only are important for female reproduction, but also play a role in a diverse array of cognitive functions. Originally, estrogens were thought to have only one receptor, localized exclusively to the cytoplasm and nucleus of cells. However, it is now known that there are at least three estrogen receptors (ERs): ERα, ERβ and G-protein coupled ER1 (GPER1). In addition to being localized to nuclei, ERα and ERβ are localized to the cell membrane, and GPER1 is also observed at the cell membrane. The mechanism through which ERs are associated with the membrane remains unclear, but palmitoylation of receptors and associations between ERs and caveolin are implicated in membrane association. ERα and ERβ are mostly observed in the nucleus using light microscopy unless they are particularly abundant. However, electron microscopy has revealed that ERs are also found at the membrane in complimentary distributions in multiple brain regions, many of which are innervated by dopamine inputs and were previously thought to contain few ERs. In particular, membrane-associated ERs are observed in the prefrontal cortex, dorsal striatum, nucleus accumbens, and hippocampus, all of which are involved in learning and memory. These findings provide a mechanism for the rapid effects of estrogens in these regions. The effects of estrogens on dopamine-dependent cognition likely result from binding at both nuclear and membrane-associated ERs, so elucidating the localization of membrane-associated ERs helps provide a more complete understanding of the cognitive effects of these hormones.
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Affiliation(s)
- Anne Almey
- Centre for Studies in Behavioral Neurobiology (CSBN), Department of Psychology, Concordia University, Montreal, QC, Canada.
| | - Teresa A Milner
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY USA; Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, USA.
| | - Wayne G Brake
- Centre for Studies in Behavioral Neurobiology (CSBN), Department of Psychology, Concordia University, Montreal, QC, Canada.
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S-SCAM, a rare copy number variation gene, induces schizophrenia-related endophenotypes in transgenic mouse model. J Neurosci 2015; 35:1892-904. [PMID: 25653350 DOI: 10.1523/jneurosci.3658-14.2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Accumulating genetic evidence suggests that schizophrenia (SZ) is associated with individually rare copy number variations (CNVs) of diverse genes, often specific to single cases. However, the causality of these rare mutations remains unknown. One of the rare CNVs found in SZ cohorts is the duplication of Synaptic Scaffolding Molecule (S-SCAM, also called MAGI-2), which encodes a postsynaptic scaffolding protein controlling synaptic AMPA receptor levels, and thus the strength of excitatory synaptic transmission. Here we report that, in a transgenic mouse model simulating the duplication conditions, elevation of S-SCAM levels in excitatory neurons of the forebrain was sufficient to induce multiple SZ-related endophenotypes. S-SCAM transgenic mice showed an increased number of lateral ventricles and a reduced number of parvalbumin-stained neurons. In addition, the mice exhibited SZ-like behavioral abnormalities, including hyperlocomotor activity, deficits in prepulse inhibition, increased anxiety, impaired social interaction, and working memory deficit. Notably, the S-SCAM transgenic mice showed a unique sex difference in showing these behavioral symptoms, which is reminiscent of human conditions. These behavioral abnormalities were accompanied by hyperglutamatergic function associated with increased synaptic AMPA receptor levels and impaired long-term potentiation. Importantly, reducing glutamate release by the group 2 metabotropic glutamate receptor agonist LY379268 ameliorated the working memory deficits in the transgenic mice, suggesting that hyperglutamatergic function underlies the cognitive functional deficits. Together, these results contribute to validate a causal relationship of the rare S-SCAM CNV and provide supporting evidence for the rare CNV hypothesis in SZ pathogenesis. Furthermore, the S-SCAM transgenic mice provide a valuable new animal model for studying SZ pathogenesis.
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Crespi BJ. Oxytocin, testosterone, and human social cognition. Biol Rev Camb Philos Soc 2015; 91:390-408. [PMID: 25631363 DOI: 10.1111/brv.12175] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 02/06/2023]
Abstract
I describe an integrative social-evolutionary model for the adaptive significance of the human oxytocinergic system. The model is based on a role for this hormone in the generation and maintenance of social familiarity and affiliation across five homologous, functionally similar, and sequentially co-opted contexts: mothers with offspring, female and male mates, kin groups, individuals with reciprocity partners, and individuals within cooperating and competing social groups defined by culture. In each situation, oxytocin motivates, mediates and rewards the cognitive and behavioural processes that underlie the formation and dynamics of a more or less stable social group, and promotes a relationship between two or more individuals. Such relationships may be positive (eliciting neurological reward, reducing anxiety and thus indicating fitness-enhancing effects), or negative (increasing anxiety and distress, and thus motivating attempts to alleviate a problematic, fitness-reducing social situation). I also present evidence that testosterone exhibits opposite effects from oxytocin on diverse aspects of cognition and behaviour, most generally by favouring self-oriented, asocial and antisocial behaviours. I apply this model for effects of oxytocin and testosterone to understanding human psychological disorders centrally involving social behaviour. Reduced oxytocin and higher testosterone levels have been associated with under-developed social cognition, especially in autism. By contrast, some combination of oxytocin increased above normal levels, and lower testosterone, has been reported in a notable number of studies of schizophrenia, bipolar disorder and depression, and, in some cases, higher oxytocin involves maladaptively 'hyper-developed' social cognition in these conditions. This pattern of findings suggests that human social cognition and behaviour are structured, in part, by joint and opposing effects of oxytocin and testosterone, and that extremes of such joint effects partially mediate risks and phenotypes of autism and psychotic-affective conditions. These considerations have direct implications for the development of therapies for alleviating disorders of social cognition, and for understanding how such disorders are associated with the evolution of human cognitive-affective architecture.
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Affiliation(s)
- Bernard J Crespi
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
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35
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Mendrek A. Is It Important to Consider Sex and Gender in Neurocognitive Studies? Front Psychiatry 2015; 6:83. [PMID: 26082728 PMCID: PMC4451577 DOI: 10.3389/fpsyt.2015.00083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/18/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- Adrianna Mendrek
- Department of Psychology, Bishop's University , Sherbrooke, QC , Canada
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36
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Cunningham C, Peters K. Aetiology of schizophrenia and implications for nursing practice: a literature review. Issues Ment Health Nurs 2014; 35:732-8. [PMID: 25259635 DOI: 10.3109/01612840.2014.908441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Schizophrenia is recognised as a major mental illness and is prevalent in approximately 1% of the global population. This paper reviewed literature published between 2001 and 2013 to explore the aetiology of schizophrenia and discuss implications for mental health nursing practice. Although the causes of schizophrenia are largely unknown, there is a strong correlation between identified physiological and environmental markers and the development of the disease. With this knowledge, mental health nurses can potentially contribute to the development of strategies and approaches to complement current treatments, and therefore ensure improved outcomes for mental health clients.
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Selvendra A, Baetens D, Trauer T, Petrakis M, Castle D. First episode psychosis in an adult area mental health service-a closer look at early and late-onset first episode psychosis. Australas Psychiatry 2014; 22:235-241. [PMID: 24811714 DOI: 10.1177/1039856214532558] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review the characteristics of all patients presenting with a first episode of psychosis between the ages of 16 and 65 years to an adult area mental health service. METHODS The early psychosis programme at St Vincent's Hospital Melbourne treats all patients presenting in the early stages of psychosis between the ages of 16 and 65 years. A database was developed to capture the demographic and diagnostic characteristics of the group. The characteristics of those with an onset under 26 years were compared with those with a later onset. RESULTS A large proportion (55%) of those presenting with first episode psychosis presented after the age of 25 years. There were a higher number of cases of depression with psychotic features in the older onset patients (notably so for those over 40) and a trend towards greater metabolic morbidity. DISCUSSION Older patients presenting with a first episode of psychosis are relatively understudied but appear to have certain distinguishing qualities. Understanding the needs of these patients is important in tailoring optimal treatment packages and service responses.
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Affiliation(s)
- Ajit Selvendra
- Consultant Psychiatrist, Mental Health Service, St Vincent's Hospital, Fitzroy, VIC and; Honorary Fellow, University of Melbourne, Melbourne, VIC, Australia
| | - Dominiek Baetens
- Consultant Psychiatrist and Deputy Director of Clinical Services, Mental Health Service, St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia
| | - Tom Trauer
- Honorary Professorial Fellow, University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Petrakis
- Senior Research Fellow, Mental Health Service, St Vincent's Hospital, Fitzroy, VIC and; Lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - David Castle
- Chair of Psychiatry, Mental Health Service, St Vincent's Hospital, Fitzroy, VIC and; University of Melbourne, Melbourne, VIC, Australia
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38
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Davis MC, Horan WP, Marder SR. Psychopharmacology of the negative symptoms: current status and prospects for progress. Eur Neuropsychopharmacol 2014; 24:788-99. [PMID: 24252823 DOI: 10.1016/j.euroneuro.2013.10.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 10/12/2013] [Accepted: 10/19/2013] [Indexed: 12/12/2022]
Abstract
The past decade has witnessed a resurgence of interest in the development of novel pharmacological agents to treat the negative symptoms of schizophrenia. This review provides an overview of pharmacological approaches that have been evaluated as potential treatments and describes the emergence of several promising new approaches. First, we briefly describe recent methodological developments, including consensus-based clinical trial guidelines for patient selection criteria, symptom assessment, and trial duration. Next, we overview mono- and adjunctive-therapies that have been evaluated, including first- and second-generation antipsychotics, antidepressants, psychostimulants, molecules targeting cholinergic and glutamatergic systems, and hormones. We highlight the most promising pharmacological agents on the horizon, including glycine transporter-1 inhibitors, α7-nicotinic receptor positive allosteric modulators, and oxytocin, as well as non-pharmacological electromagnetic stimulation approaches. Further investigations, using optimal clinical trial design, hold considerable promise for discovering effective treatments for these functionally disabling symptoms in the near future.
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Affiliation(s)
- Michael C Davis
- Department of Veterans Affairs, VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA; UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - William P Horan
- Department of Veterans Affairs, VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Stephen R Marder
- Department of Veterans Affairs, VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA; UCLA Semel Institute of Neuroscience and Human Behavior, Los Angeles, CA, USA.
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Pei JC, Liu CM, Lai WS. Distinct phenotypes of new transmembrane-domain neuregulin 1 mutant mice and the rescue effects of valproate on the observed schizophrenia-related cognitive deficits. Front Behav Neurosci 2014; 8:126. [PMID: 24782733 PMCID: PMC3995064 DOI: 10.3389/fnbeh.2014.00126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/26/2014] [Indexed: 11/13/2022] Open
Abstract
Accumulating evidence suggests that neuregulin 1 (NRG1) might be involved in the neurodevelopment, neural plasticity, GABAergic neurotransmission, and pathogenesis of schizophrenia. NRG1 is abundantly expressed in the hippocampus, and emerging studies have begun to reveal the link between NRG1 signaling and cognitive deficits in schizophrenic patients. Because the transmembrane domain of NRG1 is vital for both forward and reverse signaling cascades, new Nrg1-deficient mice that carry a truncation of the transmembrane domain of the Nrg1 gene were characterized and used in this study to test a NRG1 loss-of-function hypothesis for schizophrenia. Both male and female Nrg1 heterozygous mutant mice and their wild-type littermates were used in a series of 4 experiments to characterize the impact of Nrg1 on behavioral phenotypes and to determine the importance of Nrg1 in the regulation of hippocampal neuromorphology and local GABAergic interneurons. First, a comprehensive battery of behavioral tasks indicated that male Nrg1-deficient mice exhibited significant impairments in cognitive functions. Second, pharmacological challenges were conducted and revealed that Nrg1 haploinsufficiency altered GABAergic activity in males. Third, although no genotype-specific neuromorphological alterations were found in the hippocampal CA1 pyramidal neurons, significant reductions in the hippocampal expressions of GAD67 and parvalbumin were revealed in the Nrg1-deficient males. Fourth, chronic treatment with valproate rescued the observed behavioral deficits and hippocampal GAD67 reduction in Nrg1-deficient males. Collectively, these results indicate the potential therapeutic effect of valproate and the importance of Nrg1 in the regulation of cognitive functions and hippocampal GABAergic interneurons, especially in males.
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Affiliation(s)
- Ju-Chun Pei
- Laboratory of Integrated Neuroscience and Ethology, Department of Psychology, National Taiwan University Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital Taipei, Taiwan
| | - Wen-Sung Lai
- Laboratory of Integrated Neuroscience and Ethology, Department of Psychology, National Taiwan University Taipei, Taiwan ; Graduate Institute of Brain and Mind Sciences, National Taiwan University Taipei, Taiwan ; Neurobiology and Cognitive Science Center, National Taiwan University Taipei, Taiwan
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Donoghue K, Doody GA, Murray RM, Jones PB, Morgan C, Dazzan P, Hart J, Mazzoncini R, Maccabe JH. Cannabis use, gender and age of onset of schizophrenia: data from the ÆSOP study. Psychiatry Res 2014; 215:528-32. [PMID: 24461684 DOI: 10.1016/j.psychres.2013.12.038] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/23/2013] [Accepted: 12/26/2013] [Indexed: 11/19/2022]
Abstract
An earlier age of onset of schizophrenia has been identified as a poor prognostic indicator. The current study examines the interaction effect of gender and cannabis use on age of onset of schizophrenia and schizoaffective disorder. This research forms part of a two-centre epidemiological study of first-episode psychosis and included individuals with a diagnosis of schizophrenia or schizoaffective disorder and an age of onset between age 16 and 45. Kaplan-Meier curves and Cox proportional hazards regression were used to compare the effects of cannabis use and gender on age of first symptom of schizophrenia. Akaike's information criteria were used to find the model with the best fit to the data. Cannabis users had an earlier age of first symptom than non-users. There was an interaction with gender; the gender difference in age of onset was diminished in cannabis smokers compared with non-cannabis smokers. The model including cannabis use interacting with gender was the most parsimonious model, followed by cannabis use alone. The addition of other illegal drug use did not improve the model. Cannabis use is associated with an earlier age of onset of schizophrenia, and the gender difference in age of onset is reduced among cannabis smokers.
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Affiliation(s)
- Kim Donoghue
- Addictions Department, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8BB, England, UK.
| | - Gillian A Doody
- Division of Psychiatry, University of Nottingham, England, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, England, UK
| | - Craig Morgan
- Section of Social Psychiatry, Institute of Psychiatry, King's College London, England, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
| | - Jozella Hart
- Section of Social Psychiatry, Institute of Psychiatry, King's College London, England, UK
| | - Rodolfo Mazzoncini
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Italy
| | - James H Maccabe
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, England, UK
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Bourne VJ, McKay RT. Paranoid males have reduced lateralisation for processing of negative emotions: An investigation using the chimeric faces test. Laterality 2014; 19:235-52. [DOI: 10.1080/1357650x.2013.809728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cocchi A, Lora A, Meneghelli A, La Greca E, Pisano A, Cascio MT, Preti A. Sex differences in first-episode psychosis and in people at ultra-high risk. Psychiatry Res 2014; 215:314-22. [PMID: 24355686 DOI: 10.1016/j.psychres.2013.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 09/24/2013] [Accepted: 11/24/2013] [Indexed: 01/29/2023]
Abstract
Sex-related differences in the clinical expression and outcome of schizophrenia have long been recognized; this study set out to evaluate whether they extend to those subjects who are at high risk of developing psychosis. In a sample enrolled in two early intervention programs in northern Italy, patients with first-episode psychosis (FEP; n=152) were compared to patients at ultra-high risk of psychosis (UHR; n=106) on a series of sex-related clinical characteristics of schizophrenia. In both the FEP and the UHR samples, males outnumbered females. In FEP patients, women had been referred at an older age than men and had a shorter duration of untreated illness (DUI) and of untreated psychosis. In UHR patients no sex differences were found in age of onset or DUI. There was no diagnosis by sex interaction on symptoms severity or level of functioning at presentation. The limited number of women in both samples, and the exclusion of people who were older than 30 and of those with substance dependence may have reduced the extent of sex-related differences in this study. Sex differences of precipitating factors for psychosis might be worthy of further investigation.
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Affiliation(s)
- Angelo Cocchi
- Dipartimento di Salute Mentale. Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000 - Via Livigno, 3, Azienda Ospedaliera, Ospedale Niguarda Ca' Granda, 20128 Milan, Italy.
| | - Antonio Lora
- Dipartimento di Salute Mentale, Azienda Ospedaliera di Desio e Vimercate, Italy
| | - Anna Meneghelli
- Dipartimento di Salute Mentale. Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000 - Via Livigno, 3, Azienda Ospedaliera, Ospedale Niguarda Ca' Granda, 20128 Milan, Italy
| | - Emanuela La Greca
- Dipartimento di Salute Mentale, Azienda Ospedaliera di Desio e Vimercate, Italy
| | - Alessia Pisano
- Dipartimento di Salute Mentale. Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000 - Via Livigno, 3, Azienda Ospedaliera, Ospedale Niguarda Ca' Granda, 20128 Milan, Italy
| | - Maria Teresa Cascio
- Dipartimento di Salute Mentale. Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000 - Via Livigno, 3, Azienda Ospedaliera, Ospedale Niguarda Ca' Granda, 20128 Milan, Italy
| | - Antonio Preti
- Dipartimento di Salute Mentale. Centro per l'individuazione e l'intervento precoce nelle psicosi-Programma 2000 - Via Livigno, 3, Azienda Ospedaliera, Ospedale Niguarda Ca' Granda, 20128 Milan, Italy; Centro Medico Genneruxi, via Costantinopoli 42, 09129 Cagliari, Italy
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González-Rodríguez A, Molina-Andreu O, Penadés Rubio R, Catalán Campos R, Bernardo Arroyo M. [Reproductive variables and gynaecological service use in delusional disorder outpatients]. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 8:92-6. [PMID: 24378254 DOI: 10.1016/j.rpsm.2013.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/21/2013] [Accepted: 10/16/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Oestrogens have been hypothesized to have a protective effect in psychotic disorders. Women with schizophrenia have a later age of menarche, fewer pregnancies and earlier age of menopause. However, little information is available focusing on delusional disorder (DD). We aimed to evaluate gynaecological variables and psychopathology, and rates of gynaecological service use in female DD outpatients. METHODS Fourty-six outpatients with DD (DSM-IV-TR) were attended at the Hospital Clinic of Barcelona, from 2008 to 2013. Demographic and clinical variables, as well as gynaecological features were recorded in twenty-five women with DD. Hamilton Rating Scale for Depression-17 for depression, Positive and Negative Syndrome Scale for psychopathology, Personal and Social Performance for functionality, and Columbia Suicide Severity Rating Scale were assessed. RESULTS Mean age of menarche (SD) was 12.83(1.54) years, mean age of menopause 48.73(2.69), mean age at onset of DD was 48.70(13.03). 48% of the sample did not receive gynaecological attention in the last 2-3 years. No statistically significant correlations were found between age at menopause and age at onset of DD. Age at menopause showed a tendency to be negatively correlated with Personal and Social Performance total scores (r = -0.431; P = .074), and was positively associated with suicidal ideation intensity (r = 0.541; P = .038). However, after controlling for social support variables, this relationship was no longer significant. CONCLUSIONS Although a small sample size, this is the first study to specifically examine gynaecological variables in DD. Low compliance rates in gynaecological service use were found. No correlations between age at menopause and clinical variables were statistically significant.
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Affiliation(s)
| | - Oriol Molina-Andreu
- Servicio de Psiquiatría, Hospital Universitari Mútua de Terrassa, Tarrasa, España
| | - Rafael Penadés Rubio
- Unidad de Esquizofrenia, Servicio de Psiquiatría y Psicología, Institut Clínic de Neurociencias, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Rosa Catalán Campos
- Unidad de Esquizofrenia, Servicio de Psiquiatría y Psicología, Institut Clínic de Neurociencias, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Miguel Bernardo Arroyo
- Unidad de Esquizofrenia, Servicio de Psiquiatría y Psicología, Institut Clínic de Neurociencias, Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Departamento de Psiquiatría y Psicobiologia Clínica, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, España
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Filia SL, Baker AL, Gurvich CT, Richmond R, Kulkarni J. The perceived risks and benefits of quitting in smokers diagnosed with severe mental illness participating in a smoking cessation intervention: Gender differences and comparison to smokers without mental illness. Drug Alcohol Rev 2013; 33:78-85. [DOI: 10.1111/dar.12091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 10/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Sacha L. Filia
- Monash Alfred Psychiatry Research Centre; Central Clinical School; The Alfred Hospital; Monash University; Melbourne Australia
| | - Amanda L. Baker
- Priority Research Centre for Translational Neuroscience and Mental Health; School of Medicine and Public Health; University of Newcastle; Newcastle Australia
| | - Caroline T. Gurvich
- Monash Alfred Psychiatry Research Centre; Central Clinical School; The Alfred Hospital; Monash University; Melbourne Australia
| | - Robyn Richmond
- School of Public Health and Community Medicine; University of New South Wales; Sydney Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre; Central Clinical School; The Alfred Hospital; Monash University; Melbourne Australia
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Testosterone is inversely related to brain activity during emotional inhibition in schizophrenia. PLoS One 2013; 8:e77496. [PMID: 24204845 PMCID: PMC3814976 DOI: 10.1371/journal.pone.0077496] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 09/04/2013] [Indexed: 01/30/2023] Open
Abstract
Sex steroids affect cognitive function as well as emotion processing and regulation. They may also play a role in the pathophysiology of schizophrenia. However, the effects of sex steroids on cognition and emotion-related brain activation in schizophrenia are poorly understood. Our aim was to determine the extent to which circulating testosterone relates to brain activation in men with schizophrenia compared to healthy men during cognitive-emotional processing. We assessed brain activation in 18 men with schizophrenia and 22 age-matched healthy men during an emotional go/no-go task using fMRI and measured total serum testosterone levels on the same morning. We performed an ROI analysis to assess the relationship between serum testosterone and brain activation, focusing on cortical regions involved the emotional go/no-go task. Slower RT and reduced accuracy was observed when participants responded to neutral stimuli, while inhibiting responses to negative stimuli. Healthy men showed a robust increase in activation of the middle frontal gyrus when inhibiting responses to negative stimuli, but there was no significant association between activation and serum testosterone level in healthy men. Men with schizophrenia showed a less pronounced increase in activation when inhibiting responses to negative stimuli; however, they did show a strong inverse association between serum testosterone level and activation of the bilateral middle frontal gyrus and left insula. Additionally, increased accuracy during inhibition of response to negative words was associated with both higher serum testosterone levels and decreased activation of the middle frontal gyrus in men with schizophrenia only. We conclude that endogenous hormone levels, even within the normal range, may play an enhanced modulatory role in determining the neural and behavioural response during cognitive-emotional processing in schizophrenia.
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van der Leeuw C, Habets P, Gronenschild E, Domen P, Michielse S, van Kroonenburgh M, van Os J, Marcelis M. Testing the estrogen hypothesis of schizophrenia: associations between cumulative estrogen exposure and cerebral structural measures. Schizophr Res 2013; 150:114-20. [PMID: 23938177 DOI: 10.1016/j.schres.2013.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 06/27/2013] [Accepted: 07/14/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bone mineral density (BMD), as an indicator of cumulative estrogen exposure, may be reduced in female patients with psychotic disorder (van der Leeuw et al., 2013), possibly reflecting reduced cerebral exposure to estrogen and alterations in neuroprotective effects. To the degree that BMD is a marker of cumulative (endogenous) estrogen exposure, we hypothesized that BMD would be positively associated with cerebral gray and white matter indices. METHODS Dual X-ray absorptiometry (DEXA) and magnetic resonance (MRI) scans were acquired in fourteen female patients diagnosed with a psychotic disorder. BMD was expressed in total BMD (g/cm(2)), Z- and T-scores. Cerebral cortical thickness (CT) (as indicator of gray matter status) and fractional anisotropy (FA) (as indicator of white matter integrity) were measured and served as the dependent variables in multilevel random regression models. BMD measures were the independent variables. RESULTS Femoral BMD measures were positively associated with CT at trend significance (total BMD: B=0.266, 95% CI: -0.019-0.552, p=0.067; Z-score: B=0.034, 95% CI: 0.001-0.067, p=0.046; T-score: B=0.034, 95% CI: 0.000-0.068, p=0.052). There were no significant associations between femoral BMD measures and FA. CONCLUSIONS The data suggest that in women with psychotic disorder, alterations in the neuroprotective effect of estrogen (as measured by BMD) impact cortical gray matter, but not white matter integrity. These findings merit further investigation and, if replicated, would lend support to the estrogen hypothesis of schizophrenia.
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Affiliation(s)
- C van der Leeuw
- Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, PO Box 616, 6200 MD Maastricht, The Netherlands
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Genetic variants in transforming growth factor-β gene (TGFB1) affect susceptibility to schizophrenia. Mol Biol Rep 2013; 40:5607-14. [PMID: 24065520 PMCID: PMC3824289 DOI: 10.1007/s11033-013-2662-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 09/14/2013] [Indexed: 01/28/2023]
Abstract
Immense body of evidence indicates that dysfunction of immune system is implicated in the etiology of schizophrenia. The immune theory of schizophrenia is supported by alterations in cytokine profile in the brain and peripheral blood. Given the strong genetic background of schizophrenia, it might be assumed that aberrant production of cytokines might be the consequence of genetic factors. This study aimed at investigating the association between schizophrenia susceptibility and selected functional polymorphisms in genes encoding cytokines including: interleukin-2 (IL2 −330T>G, rs2069756), interleukin-6 (IL-6 −174G>C, rs1800795), interferon-γ (IFNG +874T>A, rs2430561) as well as for the first time transforming growth factor-β1 (TGFB1 +869T>C, rs1800470 and +916G>C, rs1800471). We recruited 151 subjects with schizophrenia and 279 controls. There was a significant difference in the genotype distribution and allelic frequency of the TGFB1 +869T>C between patients with schizophrenia and healthy controls (p < 0.05). The risk of schizophrenia was more than two-fold higher in carriers of T allele (CT+TT genotypes) than individuals with CC genotype. Given documented gender differences in incidence of schizophrenia, we conducted separate analyses of male and female participants. We have shown that the association was significant in females, while in males it reached a trend toward statistical significance. To the best of our knowledge, it is the first report showing the association between TGFB1 +869T>C polymorphism and schizophrenia.
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Reduced adult hippocampal neurogenesis and working memory deficits in the Dgcr8-deficient mouse model of 22q11.2 deletion-associated schizophrenia can be rescued by IGF2. J Neurosci 2013; 33:9408-19. [PMID: 23719809 DOI: 10.1523/jneurosci.2700-12.2013] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
DiGeorge syndrome chromosomal region 8 (Dgcr8), a candidate gene for 22q11.2 deletion-associated schizophrenia, encodes an essential component for microRNA (miRNA) biosynthesis that plays a pivotal role in hippocampal learning and memory. Adult neurogenesis is known to be important in hippocampus-dependent memory, but the role and molecular mechanisms of adult neurogenesis in schizophrenia remain unclear. Here, we show that Dgcr8 heterozygosity in mice leads to reduced cell proliferation and neurogenesis in adult hippocampus, as well as impaired hippocampus-dependent learning. Several schizophrenia-associated genes were downregulated in the hippocampus of Dgcr8(+/-) mice, and one of them, insulin-like growth factor 2 (Igf2), rescued the proliferation of adult neural stem cells both in vitro and in vivo. Furthermore, IGF2 improved the spatial working memory deficits in Dgcr8(+/-) mice. These data suggest that defective adult neurogenesis contributes to the cognitive impairment observed in 22q11.2 deletion-associated schizophrenia and could be rectified by IGF2.
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Begemann MJH, Dekker CF, van Lunenburg M, Sommer IE. Estrogen augmentation in schizophrenia: a quantitative review of current evidence. Schizophr Res 2012; 141:179-84. [PMID: 22998932 DOI: 10.1016/j.schres.2012.08.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 07/03/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sex differences in the incidence, onset and course of schizophrenia have led to the hypothesis that estrogens play a protective role in the pathophysiology of this disorder. Several trials have assessed the potential of estrogens in reducing schizophrenia symptoms, showing inconsistent results. This quantitative review summarizes available evidence on the efficacy of estrogens in the treatment of schizophrenia. METHODS Only double-blind, placebo-controlled, randomized studies were included. Primary outcome measure was total symptom severity, secondary outcome measures were subscores for positive and negative symptoms. Effect sizes were calculated for individual studies and, if possible, pooled in meta-analyses to obtain combined, weighted effect sizes (Hedges's g). RESULTS Superior efficacy was found for estrogen treatment in female patients (four RCTs, 214 patients) on total symptom severity (Hedges's g=0.66), although heterogeneity was moderate to high. Estrogens were also superior in reducing positive (Hedges's g=0.54) and negative symptoms (Hedges's g=0.34), with low heterogeneity. As the included studies applied different forms of estrogens, a separate analysis was conducted on the trials applying estradiol (three RCTs, 170 patients). Even larger effect sizes were found for total symptom severity (Hedges's g=0.79), positive (Hedges's g=0.57) and negative symptoms (Hedges's g=0.45), with reduced heterogeneity. Estrogen treatment in male patients (one study, 53 patients) was not superior to placebo. CONCLUSIONS Our results suggest that estrogens, especially estradiol, could be an effective augmentation strategy in the treatment of women with schizophrenia. However, future larger trials are needed before recommendations on clinical applications can be made.
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Affiliation(s)
- Marieke J H Begemann
- Neuroscience Division, University Medical Center Utrecht (UMCU) & Rudolf Magnus Institute for Neuroscience, Heidelberglaan 100, 3485CX Utrecht, Netherlands
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