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Tiwari S, Prasad R, Wanjari MB, Sharma R. Understanding the Impact of Menopause on Women With Schizophrenia-Spectrum Disorders: A Comprehensive Review. Cureus 2023; 15:e37979. [PMID: 37223185 PMCID: PMC10202668 DOI: 10.7759/cureus.37979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Menopause is a physiological event in women's lives that typically transpires in midlife, denoting the cessation of ovarian function and ultimately leading to the end of reproductive capacity. However, women with schizophrenia-spectrum disorders may encounter unique challenges during this period because of the interaction between hormonal changes and their pre-existing mental health conditions. This literature review aims to investigate the consequences of menopause on women with schizophrenia-spectrum disorders, including modifications in symptomatology, cognitive function, and quality of life. Potential interventions will also be examined, including hormone replacement therapy and psychosocial support. The study findings suggest that menopause can worsen symptoms, such as hallucinations and delusions, and may also impair cognitive function, resulting in memory and executive function difficulties. Nevertheless, hormone replacement therapy and psychosocial support could offer potential avenues to manage symptoms and improve the quality of life for women with schizophrenia-spectrum disorders during menopause.
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Affiliation(s)
- Swasti Tiwari
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ranjana Sharma
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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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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González-Rodríguez A, Seeman MV. The association between hormones and antipsychotic use: a focus on postpartum and menopausal women. Ther Adv Psychopharmacol 2019; 9:2045125319859973. [PMID: 31321026 PMCID: PMC6610461 DOI: 10.1177/2045125319859973] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/01/2019] [Indexed: 12/17/2022] Open
Abstract
During the postpartum and menopausal periods of women's lives, there is a well-established and significant drop of circulating estrogens. This may be the reason why both these periods are associated with an increased risk for onset or exacerbation of psychiatric disorders. Whether symptoms are mainly affective or mainly psychotic, these disorders are frequently treated with antipsychotic medications, which calls for an examination of the relationship between hormone replacement and antipsychotic agents at these time periods. The aim of this narrative review is to summarize what is known about the association of hormones and antipsychotics in the postnatal period and at menopause. In the review, we focus on estrogen and oxytocin hormones and include, for the most part, only papers published within the last 10 years. Both estradiol and oxytocin have at various times been implicated in the etiology of postpartum disorders, and estrogens, sometimes combined with progesterone, have been tested as potential treatments for these conditions. The role of estradiol as an adjunct to antipsychotics in the prevention of postpartum relapses is currently controversial. With respect to oxytocin, studies are lacking. Psychosis in menopausal and postmenopausal women has been successfully treated with estrogens and selective estrogen-receptor modulators, mainly raloxifene, in addition to antipsychotics. Some symptoms appear to respond better than others. No oxytocin study has specifically targeted postmenopausal women. Because of feedback mechanisms, there is a theoretical danger of therapy with exogenous hormones interfering with endogenous secretion and disturbing the balance among inter-related hormones. When used with antipsychotics, hormones may also affect the metabolism and, hence, the brain level of specific antipsychotics. This makes treatment with antipsychotics plus hormones complicated. Dose, timing and route of intervention may all prove critical to efficacy. While much remains unknown, this literature review indicates that, within standard dose ranges, the combination of hormones and antipsychotics for postnatal and menopausal women suffering severe mental distress can be beneficial, and is safe.
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Affiliation(s)
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto,
260 Heath Street West, Suite 605, Toronto, Ontario M5P 3L6, Canada
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González-Rodríguez A, Seeman MV. Pharmacotherapy for schizophrenia in postmenopausal women. Expert Opin Pharmacother 2018; 19:809-821. [PMID: 29676942 DOI: 10.1080/14656566.2018.1465563] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Reduced estrogen levels at menopause mean a loss of the neuroprotection that is conferred, from puberty until menopause, on women with schizophrenia. The postmenopausal stage of schizophrenia requires therapeutic attention because women with this diagnosis almost invariably experience increased symptoms and increased side effects at this time. So far, few targeted therapies have been successfully developed. AREAS COVERED This non-systematic, narrative review is based on the relevant published literature indexed in PubMed. A digital search was combined with a manual check of references from studies in the field of gender differences, menopause and schizophrenia. Aside from the inclusion of a few early classic papers, the review focuses on 21st century basic, psychopharmacologic, and clinical literature on the treatment of women with schizophrenia after menopause. EXPERT OPINION Beyond a relatively low dose threshold, all antipsychotic medications have adverse effects, which become more prominent for women at the time of menopause. Estrogen modulators may not help all symptoms of schizophrenia but are, nevertheless, relatively safe and, when used as adjuncts, help to keep antipsychotic doses low, thus reducing the side effect burden. The field is currently moving towards precision medicine and individual genetic profiles will help to determine the efficacy of available treatments in the future.
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Affiliation(s)
| | - Mary V Seeman
- b Department of Psychiatry , University of Toronto , Toronto , Canada
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Frissen A, van Os J, Peeters S, Gronenschild E, Marcelis M. Evidence that reduced gray matter volume in psychotic disorder is associated with exposure to environmental risk factors. Psychiatry Res Neuroimaging 2018; 271:100-110. [PMID: 29174764 DOI: 10.1016/j.pscychresns.2017.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 10/26/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to examine whether cannabis use, childhood trauma and urban upbringing are associated with total gray matter volume (GMV) in individuals with (risk for) psychotic disorder and whether this is sex-specific. T1-weighted MRI scans were acquired from 89 patients with a psychotic disorder, 95 healthy siblings of patients with psychotic disorder and 87 controls. Multilevel random regression analyses were used to examine main effects and interactions between group, sex and environmental factors in models of GMV. The three-way interaction between group, sex and cannabis (χ2 =12.43, p<0.01), as well as developmental urbanicity (χ2 = 6.29, p = 0.01) were significant, indicating that cannabis use and developmental urbanicity were associated with lower GMV in the male patient group (cannabis: B= -32.54, p < 0.01; developmental urbanicity: B= -10.23, p=0.03). For childhood trauma, the two-way interaction with group was significant (χ2 = 5.74, p = 0.02), indicating that childhood trauma was associated with reduced GMV in the patient group (B=-9.79, p=0.01). The findings suggest that reduction of GMV in psychotic disorder may be the outcome of differential sensitivity to environmental risks, particularly in male patients.
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Affiliation(s)
- Aleida Frissen
- Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands; King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Sanne Peeters
- Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands
| | - Ed Gronenschild
- Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands.
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Esteves M, Marques P, Magalhães R, Castanho T, Soares J, Almeida A, Santos N, Sousa N, Leite-Almeida H. Structural laterality is associated with cognitive and mood outcomes: An assessment of 105 healthy aged volunteers. Neuroimage 2017; 153:86-96. [DOI: 10.1016/j.neuroimage.2017.03.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/05/2017] [Accepted: 03/20/2017] [Indexed: 12/13/2022] Open
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Wang J, Cao H, Liao Y, Liu W, Tan L, Tang Y, Chen J, Xu X, Li H, Luo C, Liu C, Ries Merikangas K, Calhoun V, Tang J, Shugart YY, Chen X. Three dysconnectivity patterns in treatment-resistant schizophrenia patients and their unaffected siblings. NEUROIMAGE-CLINICAL 2015; 8:95-103. [PMID: 26106532 PMCID: PMC4473730 DOI: 10.1016/j.nicl.2015.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 01/17/2023]
Abstract
Among individuals diagnosed with schizophrenia, approximately 20%–33% are recognized as treatment-resistant schizophrenia (TRS) patients. These TRS patients suffer more severely from the disease but struggle to benefit from existing antipsychotic treatments. A few recent studies suggested that schizophrenia may be caused by impaired synaptic plasticity that manifests as functional dysconnectivity in the brain, however, few of those studies focused on the functional connectivity changes in the brains of TRS groups. In this study, we compared the whole brain connectivity variations in TRS patients, their unaffected siblings, and healthy controls. Connectivity network features between and within the 116 automated anatomical labeling (AAL) brain regions were calculated and compared using maps created with three contrasts: patient vs. control, patient vs. sibling, and sibling vs. control. To evaluate the predictive power of the selected features, we performed a multivariate classification approach. We also evaluated the influence of six important clinical measures (e.g. age, education level) on the connectivity features. This study identified abnormal significant connectivity changes of three patterns in TRS patients and their unaffected siblings: 1) 69 patient-specific connectivity (PCN); 2) 102 shared connectivity (SCN); and 3) 457 unshared connectivity (UCN). While the first two patterns were widely reported by previous non-TRS specific studies, we were among the first to report widespread significant connectivity differences between TRS patient groups and their healthy sibling groups. Observations of this study may provide new insights for the understanding of the neurophysiological mechanisms of TRS. We first compared global functional connectivity in treatment-resistant schizophrenia and their unaffected siblings. Widespread unshared significant functional connectivity in unaffected siblings of treatment-resistant schizophrenia We studied the association of brain connectivity to clinical measures.
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Affiliation(s)
- Jicai Wang
- Institute of Mental Health, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan 410011, China ; Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province 650032, China
| | - Hongbao Cao
- Unit on Statistical Genomics, National Institute of Mental Health, NIH, Bethesda 20892, USA
| | - Yanhui Liao
- Institute of Mental Health, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan 410011, China
| | - Weiqing Liu
- Institute of Mental Health, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan 410011, China ; Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province 650032, China
| | - Liwen Tan
- Institute of Mental Health, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan 410011, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning Province 110001, China
| | - Jindong Chen
- Institute of Mental Health, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan 410011, China
| | - Xiufeng Xu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province 650032, China
| | - Haijun Li
- Department of radiology, the first people's hospital of Kunming, Kunming, Yunnan province, China, 650011
| | - Chunrong Luo
- Department of radiology, the first people's hospital of Kunming, Kunming, Yunnan province, China, 650011
| | - Chunyu Liu
- State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan 410078, China
| | - Kathleen Ries Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD 20892, USA
| | - Vince Calhoun
- Mind Research Network, Albuquerque, NM 87131, USA ; Department of Electrical and Computer Engineering at the University of New Mexico, Albuquerque, NM 87106, USA
| | - Jinsong Tang
- Institute of Mental Health, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan 410011, China ; Unit on Statistical Genomics, National Institute of Mental Health, NIH, Bethesda 20892, USA
| | - Yin Yao Shugart
- Unit on Statistical Genomics, National Institute of Mental Health, NIH, Bethesda 20892, USA
| | - Xiaogang Chen
- Institute of Mental Health, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan 410011, China ; State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan 410078, China ; National Technology of Institute of Psychiatry, Central South University, Changsha, Hunan 410011, China
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Jiang J, Sachdev P, Lipnicki DM, Zhang H, Liu T, Zhu W, Suo C, Zhuang L, Crawford J, Reppermund S, Trollor J, Brodaty H, Wen W. A longitudinal study of brain atrophy over two years in community-dwelling older individuals. Neuroimage 2013; 86:203-11. [PMID: 23959201 DOI: 10.1016/j.neuroimage.2013.08.022] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/26/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022] Open
Abstract
Most previous neuroimaging studies of age-related brain structural changes in older individuals have been cross-sectional and/or restricted to clinical samples. The present study of 345 community-dwelling non-demented individuals aged 70-90years aimed to examine age-related brain volumetric changes over two years. T1-weighted magnetic resonance imaging scans were obtained at baseline and at 2-year follow-up and analyzed using the FMRIB Software Library and FreeSurfer to investigate cortical thickness and shape and volumetric changes of subcortical structures. The results showed significant atrophy across much of the cerebral cortex with bilateral transverse temporal regions shrinking the fastest. Atrophy was also found in a number of subcortical structures, including the CA1 and subiculum subfields of the hippocampus. In some regions, such as left and right entorhinal cortices, right hippocampus and right precentral area, the rate of atrophy increased with age. Our analysis also showed that rostral middle frontal regions were thicker bilaterally in older participants, which may indicate its ability to compensate for medial temporal lobe atrophy. Compared to men, women had thicker cortical regions but greater rates of cortical atrophy. Women also had smaller subcortical structures. A longer period of education was associated with greater thickness in a number of cortical regions. Our results suggest a pattern of brain atrophy with non-demented people that resembles a less extreme form of the changes associated with Alzheimer's disease (AD).
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Affiliation(s)
- Jiyang Jiang
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Haobo Zhang
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Tao Liu
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Wanlin Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Chao Suo
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Lin Zhuang
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - John Crawford
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Julian Trollor
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Department of Development Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Aged Care Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
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