Estradiol and raloxifene as adjunctive treatment for women with schizophrenia: A meta-analysis of randomized, double-blind, placebo-controlled trials

Antipsychotic-induced prolactin elevation in premenopausal women with schizophrenia: associations with estrogen, disease severity and cognition

PURPOSE

Antipsychotic-induced prolactin elevation may impede protective effects of estrogens in women with schizophrenia-spectrum disorders (SSD). Our study sought to confirm whether the use of prolactin-raising antipsychotics is associated with lower estrogen levels, and to investigate how estrogen and prolactin levels relate to symptom severity and cognition in premenopausal women with SSD.

METHODS

This cross-sectional study included 79 premenopausal women, divided in three groups of women with SSD treated with prolactin-sparing antipsychotics (n = 21) or prolactin-raising antipsychotics (n = 27), and age-matched women without SSD (n = 31). Circulating 17β-estradiol was compared among groups. In patients, we assessed the relationship between prolactin and 17β-estradiol, and the relationships of these hormones to symptom severity and cognition, using correlation analyses and backward regression models.

RESULTS

In women receiving prolactin-raising antipsychotics, 17β-estradiol levels were lower as compared to both other groups (H(2) = 8.34; p = 0.015), and prolactin was inversely correlated with 17β-estradiol (r=-0.42, p = 0.030). In the prolactin-raising group, 17β-estradiol correlated positively with verbal fluency (r = 0.52, p = 0.009), and 17β-estradiol and prolactin together explained 29% of the variation in processing speed (β17β-estradiol = 0.24, βprolactin = -0.45, F(2,25) = 5.98, p = 0.008). In the prolactin-sparing group, 17β-estradiol correlated negatively with depression/anxiety (r = -0.57, p = 0.014), and together with prolactin explained 26% of the variation in total symptoms (β17β-estradiol = -0.41, βprolactin = 0.32, F(2,18) = 4.44, p = 0.027).

CONCLUSIONS

In women with SSD, antipsychotic-induced prolactin elevation was related to lower estrogen levels. Further, estrogens negatively correlated with symptom severity and positively with cognition, whereas prolactin levels correlated negatively with cognition. Our findings stress the clinical importance of maintaining healthy levels of prolactin and estrogens in women with SSD.

Hematological and inflammatory markers in Han Chinese patients with drug-free schizophrenia: relationship with symptom severity

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.

Estrogen and psychosis - a review and future directions

The link between sex hormones and schizophrenia has been suspected for over a century; however, scientific evidence supporting the pharmacotherapeutic effects of exogenous estrogen has only started to emerge during the past three decades. Accumulating evidence from epidemiological and basic research suggests that estrogen has a protective effect in women vulnerable to schizophrenia. Such evidence has led multiple researchers to investigate the role of estrogen in schizophrenia and its use in treatment. This narrative review provides an overview of the effects of estrogen as well as summarizes the recent work regarding estrogen as a treatment for schizophrenia, particularly the use of new-generation selective estrogen receptor modulators.

Clinical features and comorbidity in very early-onset schizophrenia: a systematic review

Background

Very early-onset schizophrenia (VEOS) is a form of schizophrenia that manifests before the age of 13 years and is characterized by the presence of positive, negative, and disorganized symptoms. The condition is exceptionally rare and, to date, limited studies have been conducted, resulting in incomplete information about its clinical features.

Methods

The present study involves a systematic review of the existing literature regarding the clinical features and comorbidities of VEOS.

Results

The first search retrieved 384 studies. Of these, 366 were removed following the application of exclusion criteria, resulting in 18 studies for the final set.

Conclusion

The results highlight that VEOS shares similarities with early-onset and adult-onset schizophrenia but also exhibits distinct and recognizable characteristics, including a more severe clinical profile (particularly in females), increased visual hallucinations, and high comorbidities with neurodevelopmental disorders. These findings may support clinicians in formulating early diagnoses and developing effective treatment strategies for pediatric and adolescent patients with psychosis.

Association Between Prolactin, Estradiol, and Testosterone Levels and the Development of Metabolic Syndrome in Female Inpatients with Schizophrenia: A Case-Control Study

This study was to investigate the association between sex hormone levels and metabolic syndrome (MetS) risk in female schizophrenia inpatients. In total, 93 female schizophrenia patients were enrolled based on their electronic medical records of hospitalization at the Zigong Psychiatric Research Center, China, between August 2022 to September 2022. Baseline information was collected retrospectively from medical records 6 months before. Logistic regression analysis was applied to assess the potential relationship between sex hormone levels and the risk of developing MetS. 31.2% (29/93) of the total patients, 25.5% (12/47) of the 18-49 age group, and 37.0% (17/46) of the ≥ 50 age group had a history of MetS; the newly-developed MetS prevalence among all female schizophrenia patients was 15.05% (14/93), which was slightly higher but not statistically significant in older patients (age ≥ 50) than in younger patients (age 18-49) (≥ 50 vs. 18-49, 21.74% vs. 8.5%, p = 0.074). Univariate analysis of sex hormone levels and developed MetS discovered that only high prolactin levels correlated with developed MetS in total participants (p = 0.006), especially in older patients (p = 0.004), while estradiol and testosterone levels were not associated. Furthermore, univariate logistic regression analysis of the total participants and with an adjusted model of the ≥ 50 age group confirmed the association of prolactin with MetS in all (OR = 1.016, 95%CI:1.002-1.029, p = 0.023), and older female schizophrenia patients (OR = 1.04, 95%CI: 1.01-1.07, p = 0.008). High serum levels of prolactin in older patients (age ≥ 50) were strongly correlated with the risk of developing MetS among female schizophrenia patients.