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Kulkarni J, Worsley R, Gilbert H, Gavrilidis E, Van Rheenen TE, Wang W, McCauley K, Fitzgerald P. Correction: A Prospective Cohort Study of Antipsychotic Medications in Pregnancy: The First 147 Pregnancies and 100 One Year Old Babies. PLoS One 2023; 18:e0290614. [PMID: 37624837 PMCID: PMC10456127 DOI: 10.1371/journal.pone.0290614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0094788.].
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Kulkarni J, Gurvich C, Gilbert H, Worsley R, Li Q, Karimi L. The use of first and second-generation antipsychotic drugs and the potential to develop gestational diabetes mellitus among perinatal patients with psychosis. Schizophr Res 2023; 254:22-26. [PMID: 36758325 DOI: 10.1016/j.schres.2023.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
There is limited knowledge about the effects of antipsychotic exposure on the development of gestational diabetes mellitus (GDM) in women with mental illness. Studies have demonstrated an association between antipsychotic medications and metabolic problems such as weight gain and diabetes mellitus in non-pregnant patients with psychiatric disorders. GDM increases the risk of adverse maternal outcomes, including pregnancy-induced hypertension, antepartum and postpartum haemorrhage, and caesarean delivery. The National Register of Antipsychotic Medication in Pregnancy (NRAMP) is a prospective Australian cohort study that observed women who took antipsychotics during pregnancy. Data from 205 women were extracted for the final analysis and included women who took first or second-generation antipsychotics (FGA,SGA) during the first trimester of pregnancy (at minimum) and had a diagnosis of a psychotic disorder (n = 180). The comparison (non-exposed) group (n = 25) were women with psychosis who chose not to take any antipsychotic during the first trimester (at minimum). The comparison groups were not matched, although groups were homogenous in terms of sex, age range, diagnosis and perinatal status. The results of logistic regression analysis revealed that women who were exposed to FGAs, SGAs were seven and five times, respectively, more likely to develop GDM compared to non-exposed groups. When adjusted for confounding variables such as BMI and family history of diabetes, the potential of developing GDM decreased for women taking SGAs. In conclusion, the risk of developing GDM is lower in women taking SGAs compared with women taking FDAs. In addition, family history of diabetes and BMI adds to the risk.
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Affiliation(s)
- Jayashri Kulkarni
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia.
| | - Caroline Gurvich
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Heather Gilbert
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Roisin Worsley
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Qi Li
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia.
| | - Leila Karimi
- The Monash Alfred Psychiatry research centre, The Alfred and Monash University Central Clinical School, Monash University, Melbourne, Australia
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Gurvich C, Warren AM, Worsley R, Hudaib AR, Thomas N, Kulkarni J. Effects of Oral Contraceptive Androgenicity on Visuospatial and Social-Emotional Cognition: A Prospective Observational Trial. Brain Sci 2020; 10:brainsci10040194. [PMID: 32218215 PMCID: PMC7226060 DOI: 10.3390/brainsci10040194] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Oral contraceptives (OCs) containing estrogen and progesterone analogues are widely used amongst reproductive-aged women, but their neurocognitive impact is poorly understood. Preliminary studies suggest that OCs improve verbal memory and that OCs with greater androgenic activity may improve visuospatial ability. We sought to explore the cognitive impact of OCs by assessing performance of OC users at different stages of the OC cycle, and comparing this performance between users of different OC formulations according to known androgenic activity. We conducted a prospective, observational trial of OC users, evaluating cognitive performance with CogState software on two occasions: days 7-10 of active hormonal pill phase, and days 3-5 of the inactive pill phase (coinciding with the withdrawal bleed resembling menstruation). Thirty-five OC users (18 taking androgenic formulations, 17 taking anti-androgenic) were assessed. Analysis by androgenic activity showed superior performance by users of androgenic OCs, as compared to anti-androgenic OCs, in visuospatial ability and facial affect discrimination tasks. A growing understanding of cognitive effects of OC progestin androgenicity may have implications in choice of OC formulation for individuals and in future OC development.
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Gurvich C, Hudaib A, Gavrilidis E, Worsley R, Thomas N, Kulkarni J. Raloxifene as a treatment for cognition in women with schizophrenia: the influence of menopause status. Psychoneuroendocrinology 2019; 100:113-119. [PMID: 30299258 DOI: 10.1016/j.psyneuen.2018.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023]
Abstract
Cognitive impairments cause significant functional issues for people with schizophrenia, often emerging before the onset of hallucinations, delusions and other psychosis symptoms. Current pharmacological treatments do not target cognitive dysfunction. Several lines of evidence support the beneficial effects of estrogens on cognition. Raloxifene hydrochloride, a selective estrogen receptor modulator, has been associated with cognitive improvements in healthy postmenopausal women and in schizophrenia, although findings are inconsistent. Using pooled data from two clinical trials, the aim of the current study was to compare the efficacy of 120 mg/day adjunctive raloxifene to placebo for 12 weeks on cognitive performance in women with schizophrenia who were stratified by menopause status (pre-menopausal; peri-menopausal or post-menopausal). A total of sixty-nine participants with a diagnosis of schizophrenia or schizoaffective disorder were included. Cognition was assessed at baseline and study end using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Results indicated that after stratifying for menopause status (strata) and adjusting for endogenous hormone levels (estrogen, progesterone, follicle stimulating hormone and luteinising hormone), semantic fluency, picture naming and list recognition change from baseline scores for the raloxifene group differed significantly from the placebo group. The findings from the current study highlight the importance of considering menopause status when interpreting the effects of hormonal treatments.
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Affiliation(s)
- C Gurvich
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia.
| | - A Hudaib
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
| | - E Gavrilidis
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
| | - R Worsley
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
| | - N Thomas
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
| | - J Kulkarni
- Monash Alfred Psychiatry research centre, Monash University and The Alfred Hospital, Central Clinical School, Melbourne, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kulkarni J, Gavrilidis E, Thomas N, Hudaib AR, Worsley R, Thew C, Bleeker C, Gurvich C. Tibolone improves depression in women through the menopause transition: A double-blind randomized controlled trial of adjunctive tibolone. J Affect Disord 2018; 236:88-92. [PMID: 29723767 DOI: 10.1016/j.jad.2018.04.103] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/26/2018] [Accepted: 04/08/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many women with no past psychiatric history experience severe mood symptoms for the first time in their life during the menopausal transition, with debilitating long-term consequences. Women with a history of depression can experience a relapse or worsening of symptoms during the menopause transition. Traditional antidepressants, SSRIs or SNRIs, are commonly prescribed as the first line response. However, such treatment has shown only small improvements with side effects. Hormone therapies directly targeting the perimenopausal fluctuations in reproductive hormonal systems such as tibolone, have significant potential to treat perimenopausal depression. Our study investigated the use of adjunctive tibolone, selective tissue estrogenic activity regulator, to treat de-novo or relapsing depression occurring during the menopause transition period. METHODS Women who were going through the menopause transition with depressive symptoms were invited to participate in a double-blind, 12 week randomized control trial with two arms: tibolone (2.5 mg oral/day) or oral placebo (NCT01470092). Forty-four women met inclusion/exclusion criteria; 22 were randomized to tibolone and 22 were randomized to oral placebo. Symptoms were measured with the 'Montgomery- Asberg depression rating scale' (MADRS) as the primary outcome measure. Latent growth curve analysis was used to assess the MADRS scores change over time. RESULTS Participants in the tibolone group demonstrated a significant improvement in depression scores, as compared to the placebo group, without any significant side effects. LIMITATIONS This trial only monitored tibolone's effects over 12 weeks. Future research should be conducted over an extended timeframe and explore whether the benefits of tibolone extend to other symptoms of perimenopausal depression. CONCLUSIONS The use of hormone therapies such as tibolone provide exciting innovations for the treatment of depression during the menopause transition.
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Affiliation(s)
- Jayashri Kulkarni
- Monash Alfred Psychiatry Research Center (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Emorfia Gavrilidis
- Monash Alfred Psychiatry Research Center (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Natalie Thomas
- Monash Alfred Psychiatry Research Center (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Abdul-Rahman Hudaib
- Monash Alfred Psychiatry Research Center (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Roisin Worsley
- Monash Alfred Psychiatry Research Center (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Caroline Thew
- Monash Alfred Psychiatry Research Center (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Caitlin Bleeker
- Monash Alfred Psychiatry Research Center (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Center (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
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Kulkarni J, Gavrilidis E, Hudaib AR, Bleeker C, Worsley R, Gurvich C. Development and validation of a new rating scale for perimenopausal depression-the Meno-D. Transl Psychiatry 2018; 8:123. [PMID: 29955034 PMCID: PMC6023883 DOI: 10.1038/s41398-018-0172-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/04/2018] [Accepted: 04/22/2018] [Indexed: 12/28/2022] Open
Abstract
The menopause transition is a time when women experience an increased risk for new onset depression, as well as relapse of depression. While there are overlapping symptoms between major depression and depression during menopause, differences suggest 'perimenopausal depression' may be a unique subtype of depression associated with characteristic symptoms. There is currently no validated scale designed to measure perimenopausal depression. The aim of the current study was to develop and validate the 'Meno-D', a self-reporting or clinician rated questionnaire, designed to rate the severity of symptoms of perimenopausal depression. The development phase of the Meno-D involved literature review, clinical observation, and focus groups. A 12-item questionnaire was developed and clinically reviewed for face validity for content. The Meno-D was administered to women experiencing symptoms of perimenopausal depression as part of a larger baseline assessment battery. Validation involved confirmatory factor analysis (CFA). The development of the Meno-D resulted in 12 items. A total of 93 participants with perimenopausal depression were involved in the baseline assessments, 82 completed the Meno-D. Factor analysis identified five sub-scales of the Meno-D "somatic; cognitive; self; sleep; sexual" with high-internal consistency; discriminant validity and a good construct and convergent validity. The Meno-D provides a unique tool for clinicians and researchers to measure the presence of perimenopausal depression.
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Affiliation(s)
- Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Emorfia Gavrilidis
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Abdul-Rahman Hudaib
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Caitlin Bleeker
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Roisin Worsley
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Victoria, Australia
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Grigg J, Worsley R, Thew C, Gurvich C, Thomas N, Kulkarni J. Antipsychotic-induced hyperprolactinemia: synthesis of world-wide guidelines and integrated recommendations for assessment, management and future research. Psychopharmacology (Berl) 2017; 234:3279-3297. [PMID: 28889207 DOI: 10.1007/s00213-017-4730-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/22/2017] [Indexed: 01/25/2023]
Abstract
RATIONALE Hyperprolactinemia is a highly prevalent adverse effect of many antipsychotic agents, with potentially serious health consequences. Several guidelines have been developed for the management of this condition; yet, their concordance has not been evaluated. OBJECTIVES The objectives of this paper were (1) to review current clinical guidelines; (2) to review key systematic evidence for management; and (3) based on our findings, to develop an integrated management recommendation specific to male and female patients who are otherwise clinically stabilised on antipsychotics. METHODS We performed searches of Medline and EMBASE, supplemented with guideline-specific database and general web searches, to identify clinical guidelines containing specific recommendations for antipsychotic-induced hyperprolactinemia, produced/updated 01/01/2010-15/09/2016. A separate systematic search was performed to identify emerging management approaches described in reviews and meta-analyses published ≥ 2010. RESULTS There is some consensus among guidelines relating to baseline PRL screening (8/12 guidelines), screening for differential diagnosis (7/12) and discontinuing/switching PRL-raising agent (7/12). Guidelines otherwise diverge substantially regarding most aspects of screening, monitoring and management (e.g. treatment with dopamine agonists). There is an omission of clear sex-specific recommendations. Systematic literature on management approaches is promising; more research is needed. An integrated management recommendation is presented to guide sex-specific clinical response to antipsychotic-induced hyperprolactinemia. Key aspects include asymptomatic hyperprolactinemia monitoring and fertility considerations with PRL normalisation. CONCLUSION Further empirical work is key to shaping robust guidelines for antipsychotic-induced hyperprolactinemia. The integrated management recommendation can assist clinician and patient decision-making, with the goal of balancing effective psychiatric treatment while minimising PRL-related adverse health effects in male and female patients.
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Affiliation(s)
- Jasmin Grigg
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Roisin Worsley
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Caroline Thew
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Caroline Gurvich
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Natalie Thomas
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Jayashri Kulkarni
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia.
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Worsley R, Bell RJ, Gartoulla P, Davis SR. Prevalence and Predictors of Low Sexual Desire, Sexually Related Personal Distress, and Hypoactive Sexual Desire Dysfunction in a Community-Based Sample of Midlife Women. J Sex Med 2017; 14:675-686. [DOI: 10.1016/j.jsxm.2017.03.254] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 01/23/2023]
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Affiliation(s)
- Jasmin Grigg
- 1 The Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Roisin Worsley
- 1 The Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia.,2 Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- 1 The Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
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Goldstein I, Kim NN, Clayton AH, DeRogatis LR, Giraldi A, Parish SJ, Pfaus J, Simon JA, Kingsberg SA, Meston C, Stahl SM, Wallen K, Worsley R. Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review. Mayo Clin Proc 2017; 92:114-128. [PMID: 27916394 DOI: 10.1016/j.mayocp.2016.09.018] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/16/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administration-approved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments.
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Affiliation(s)
- Irwin Goldstein
- Department of Sexual Medicine, Alvarado Hospital, San Diego, CA.
| | - Noel N Kim
- Institute for Sexual Medicine, San Diego, CA
| | - Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences and Obstetrics and Gynecology, University of Virginia, Charlottesville
| | - Leonard R DeRogatis
- Maryland Center for Sexual Health, Johns Hopkins University School of Medicine, Baltimore
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - James Pfaus
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | | | - Sheryl A Kingsberg
- Division of Behavioral Medicine, Department of Obstetrics/Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH
| | - Cindy Meston
- Department of Psychology, University of Texas at Austin
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, and the Neuroscience Education Institute, San Diego
| | - Kim Wallen
- Department of Psychology and Yerkes National Primate Research Center, Emory University, Atlanta, GA
| | - Roisin Worsley
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
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Davis SR, Worsley R, Miller KK, Parish SJ, Santoro N. Androgens and Female Sexual Function and Dysfunction--Findings From the Fourth International Consultation of Sexual Medicine. J Sex Med 2016; 13:168-78. [PMID: 26953831 DOI: 10.1016/j.jsxm.2015.12.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/20/2015] [Accepted: 12/22/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Androgens have been implicated as important for female sexual function and dysfunction. AIM To review the role of androgens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of androgen therapy for female sexual dysfunction (FSD). METHODS We searched the literature using online databases for studies pertaining to androgens and female sexual function. Major reviews were included and their findings were summarized to avoid replicating their content. MAIN OUTCOME MEASURES Quality of data published in the literature and recommendations were based on the GRADES system. RESULTS The literature supports an important role for androgens in female sexual function. There is no blood androgen level below which women can be classified as having androgen deficiency. Clinical trials have consistently demonstrated that transdermal testosterone (T) therapy improves sexual function and sexual satisfaction in women who have been assessed as having hypoactive sexual desire disorder. The use of T therapy is limited by the lack of approved formulations for women and long-term safety data. Most studies do not support the use of systemic dehydroepiandrosterone therapy for the treatment of FSD in women with normally functioning adrenals or adrenal insufficiency. Studies evaluating the efficacy and safety of vaginal testosterone and dehydroepiandrosterone for the treatment of vulvovaginal atrophy are ongoing. CONCLUSION Available data support an important role of androgens in female sexual function and dysfunction and efficacy of transdermal T therapy for the treatment of some women with FSD. Approved T formulations for women are generally unavailable. In consequence, the prescribing of T mostly involves off-label use of T products formulated for men and individually compounded T formulations. Long-term studies to determine the safety of T therapy for women and possible benefits beyond that of sexual function are greatly needed.
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Affiliation(s)
- Susan R Davis
- The Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University Melbourne, VIC, Australia.
| | - Roisin Worsley
- The Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University Melbourne, VIC, Australia
| | - Karen K Miller
- Neuroendocrine Research Program in Women's Health and Neuroendocrine and Pituitary Clinical Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Worsley R, Santoro N, Miller KK, Parish SJ, Davis SR. Hormones and Female Sexual Dysfunction: Beyond Estrogens and Androgens--Findings from the Fourth International Consultation on Sexual Medicine. J Sex Med 2016; 13:283-90. [PMID: 26944460 DOI: 10.1016/j.jsxm.2015.12.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/18/2015] [Indexed: 01/20/2023]
Abstract
INTRODUCTION In recent years, multiple hormones have been investigated in relation to female sexual function. Because consumers can easily purchase products claiming to contain these hormones, a clear statement regarding the current state of knowledge is required. AIM To review the contribution of hormones, other than estrogens and androgens, to female sexual functioning and the evidence that specific endocrinopathies in women are associated with female sexual dysfunction (FSD) and to update the previously published International Society of Sexual Medicine Consensus on this topic. METHODS The literature was searched using several online databases with an emphasis on studies examining the physiologic role of oxytocin, prolactin, and progesterone in female sexual function and any potential therapeutic effect of these hormones. The association between common endocrine disorders, such as polycystic ovary syndrome, pituitary disorders, and obesity, and FSD also was examined. MAIN OUTCOME MEASURES Quality of data published in the literature and recommendations were based on the Grading of Recommendations Assessment, Development and Education system. RESULTS There is no evidence to support the use of oxytocin or progesterone for FSD. Treating hyperprolactinemia might lessen FSD. Polycystic ovary syndrome, obesity, and metabolic syndrome could be associated with FSD, but data are limited. There is a strong association between diabetes mellitus and FSD. CONCLUSION Further research is required; in particular, high-quality, large-scale studies of women with common endocrinopathies are needed to determine the impact of these prevalent disorders on female sexual function.
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Affiliation(s)
- Roisin Worsley
- The Women's Health Research Program, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Karen K Miller
- Neuroendocrine Research Program in Women's Health, Massachusetts General Hospital; Massachusetts General Hospital Neuroendocrine and Pituitary Clinical Center; Harvard Medical School, Boston, MA, USA
| | - Sharon J Parish
- Departments of Clinical Psychiatry Clinical Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Susan R Davis
- The Women's Health Research Program, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
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Kulkarni J, Gavrilidis E, Gwini SM, Worsley R, Grigg J, Warren A, Gurvich C, Gilbert H, Berk M, Davis SR. Effect of Adjunctive Raloxifene Therapy on Severity of Refractory Schizophrenia in Women: A Randomized Clinical Trial. JAMA Psychiatry 2016; 73:947-54. [PMID: 27438995 DOI: 10.1001/jamapsychiatry.2016.1383] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE A substantial proportion of women with schizophrenia experience debilitating treatment-refractory symptoms. The efficacy of estrogen in modulating brain function in schizophrenia has to be balanced against excess exposure of peripheral tissue. Raloxifene hydrochloride is a selective estrogen receptor modulator (mixed estrogen agonist/antagonist) with potential psychoprotective effects and fewer estrogenic adverse effects. OBJECTIVE To determine whether adjunctive raloxifene therapy reduces illness severity in women with refractory schizophrenia. DESIGN, SETTING, AND PARTICIPANTS This 12-week, double-blind, placebo-controlled, randomized clinical trial with fortnightly assessments was performed at an urban tertiary referral center and a regional center from January 1, 2006, to December 31, 2014. Participants included 56 women with schizophrenia or schizoaffective disorder and marked symptom severity despite substantial and stable antipsychotic doses. Data were analyzed using intention to treat as the basis. INTERVENTIONS Adjunctive raloxifene hydrochloride, 120 mg/d, or placebo for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the change in the Positive and Negative Syndrome Scale (PANSS) total score. Clinical response (defined as a ≥20% decrease in PANSS total score from baseline) and change in PANSS subscale scores, mood, cognition, reproductive hormone levels, and adverse events were also assessed. RESULTS Of the 56 participants (mean [SD] age, 53 [7.7] years; age range, 40-70 years; mean [SD] duration of psychotic illness, 24 [11] years), 26 were randomized to raloxifene and 30 were randomized to placebo. Raloxifene produced a greater reduction in the PANSS total score relative to placebo (β = -6.37; 95% CI, -11.64 to -1.10; P = .02) and resulted in an increased probability of a clinical response (hazard ratio, 5.79; 95% CI, 1.46 to 22.97; P = .01). A significant reduction was found in the PANSS general symptom scores for the raloxifene compared with the placebo (β = -3.72; 95% CI, -6.83 to -0.61; P = .02) groups. For patients who completed the full 12-week trial, there was not a statistically significant treatment effect on PANSS positive symptom scores (β for change in raloxifene vs placebo, -1.92; 95% CI, -3.83 to 0.00; P = .05). Change in mood, cognition, and reproductive hormone levels and the rate of adverse events did not differ between groups. CONCLUSIONS AND RELEVANCE Raloxifene hydrochloride, 120 mg/d, reduces illness severity and increases the probability of a clinical response in women with refractory schizophrenia. This large trial of raloxifene in this patient population offers a promising, well-tolerated agent that has potential application in clinical practice. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00361543.
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Affiliation(s)
- Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Emorfia Gavrilidis
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Stella M Gwini
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Roisin Worsley
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Jasmin Grigg
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Annabelle Warren
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Heather Gilbert
- Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Monash University, Melbourne, Australia
| | - Michael Berk
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Chow YY, Worsley R, Topliss DJ. Lessons from the bedside: ketoacidosis and SGLT2 inhibitors. Med J Aust 2016; 205:191-2. [DOI: 10.5694/mja16.00435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
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Abstract
OBJECTIVE Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms. METHOD Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery-Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays. RESULTS Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery-Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%). CONCLUSION Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia.
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Affiliation(s)
- Pia C Gleeson
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roisin Worsley
- Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Emorfia Gavrilidis
- Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Shainal Nathoo
- Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Elisabeth Ng
- Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Stuart Lee
- Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- Alfred Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
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Gartoulla P, Bell RJ, Worsley R, Davis SR. Menopausal vasomotor symptoms are associated with poor self-assessed work ability. Maturitas 2016; 87:33-9. [DOI: 10.1016/j.maturitas.2016.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
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Affiliation(s)
- Roth Trisno
- The Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Roisin Worsley
- The Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
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Santoro N, Worsley R, Miller KK, Parish SJ, Davis SR. Role of Estrogens and Estrogen-Like Compounds in Female Sexual Function and Dysfunction. J Sex Med 2016; 13:305-16. [DOI: 10.1016/j.jsxm.2015.11.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/13/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
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20
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Gartoulla P, Davis SR, Worsley R, Bell RJ, Gartoulla P, Davis SR, Worsley R, Bell RJ. Use of complementary and alternative medicines for menopausal symptoms in Australian women aged 40–65 years. Med J Aust 2015. [DOI: 10.5694/mja14.01723] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Worsley R, Jane F, Robinson PJ, Bell RJ, Davis SR. Metformin for overweight women at midlife: a double-blind, randomized, controlled trial. Climacteric 2014; 18:270-7. [DOI: 10.3109/13697137.2014.954997] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Davis SR, Jane F, Robinson PJ, Davison SL, Worsley R, Maruff P, Bell RJ. Transdermal testosterone improves verbal learning and memory in postmenopausal women not on oestrogen therapy. Clin Endocrinol (Oxf) 2014; 81:621-8. [PMID: 24716847 DOI: 10.1111/cen.12459] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/05/2014] [Accepted: 03/23/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effects of testosterone on verbal learning and memory in postmenopausal women. DESIGN Randomized, placebo-controlled trial in which participants were randomized (1:1) to transdermal testosterone gel 300 mcg/day, or identical placebo, for 26 weeks. PATIENTS Ninety-two postmenopausal women aged 55-65 years, on no systemic sex hormone therapy. MEASUREMENTS The primary outcome was the score for the International Shopping List Task (ISLT) of CogState. Secondary outcomes included other CogState domains, the Psychological General Well-Being Index (PGWB) and safety variables. RESULTS Eighty-nine women, median age 60 years, were included in the primary analysis. Testosterone treatment resulted in statistically significantly better performance for the ISLT (improved verbal learning and memory) compared with placebo, adjusted for age and baseline score (mean difference 1·57; 95%CI 0·13, 3·01) P = 0·03). There were no significant differences for other CogState domains or the PGWB scores. At 26 weeks, the median total testosterone was 1·7 nm (interquartile range (IQR) 1·1, 2·4) in the testosterone group and 0·4 nm (IQR 0·3, 0·5) in the placebo group. CONCLUSIONS The small but statistically significant effect of testosterone treatment on verbal learning and memory in postmenopausal women provides the basis for further clinical trials.
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Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Australia
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Affiliation(s)
- Chee Cheen Yeong
- Central Clinical School,Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - Roisin Worsley
- The Monash Alfred Psychiatry Research Centre, Melbourne, Australia
| | - Heather Gilbert
- The Monash Alfred Psychiatry Research Centre, Melbourne, Australia
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Abstract
Testosterone is physiologically important for women. Serum testosterone levels decline with age, with the most precipitous fall being prior to menopause. There is no level of testosterone which defines a woman as being testosterone deficient. However, there is substantial high quality evidence to support the use of testosterone for the treatment of hypoactive sexual desire disorder in postmenopausal women. Although preliminary data suggests testosterone has favorable effects on bone and muscle mass, cognitive function and the cardiovascular system, further research regarding its therapeutic effects in these domains is warranted. As no testosterone product has been approved for women there is extensive off-label prescribing of testosterone products for women as well as the prescription of compounded therapy. This raises serious safety concerns and together with the evidence for the negative impact of FSD on quality of life, highlights the need for an approved testosterone formulation for women. This article is part of a Special Issue entitled 'Menopause'.
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Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Roisin Worsley
- Women's Health Research Program, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia
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Kulkarni J, Worsley R, Gilbert H, Gavrilidis E, Van Rheenen TE, Wang W, McCauley K, Fitzgerald P. A prospective cohort study of antipsychotic medications in pregnancy: the first 147 pregnancies and 100 one year old babies. PLoS One 2014; 9:e94788. [PMID: 24787688 PMCID: PMC4008497 DOI: 10.1371/journal.pone.0094788] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/19/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Many women diagnosed with varying psychiatric disorders take antipsychotic medications during pregnancy. The safety of antipsychotic medications in pregnancy is largely unknown. METHODS We established the National Register of Antipsychotic Medications in Pregnancy in 2005. Women who are pregnant and taking an antipsychotic medication are interviewed every 6 weeks during pregnancy and then followed until their babies are one year old. The baby's progress is closely followed for the first year of life. FINDINGS As of April 18 2012, 147 pregnancies had been followed through to completion. There were 142 live births and data is available for 100 one year old babies. 18% of babies were born preterm, with a higher dose of antipsychotic medication correlating to an increased likelihood of premature delivery; 43% of babies required special care nursery or intensive care after birth; 37% had any degree of respiratory distress and 15% of babies developed withdrawal symptoms. Congenital anomalies were seen in eight babies. Most pregnancies resulted in the birth of live, healthy babies. The use of mood stabilisers or higher doses of antipsychotics during pregnancy increased the likelihood of babies experiencing respiratory distress or admission to Special Care Nursery or Neonatal Intensive Care Units. CONCLUSION There is a great need for safety and efficacy information about the use of antipsychotic medications in pregnancy. Live, healthy babies are the most common outcome following the use of antipsychotic medication in pregnancy, but clinicians should be particularly mindful of neonatal problems such as respiratory distress.
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Affiliation(s)
- Jayashri Kulkarni
- Monash Alfred Psychiatry research centre, Monash University & Alfred Hospital, Melbourne, Victoria, Australia
| | - Roisin Worsley
- Monash Alfred Psychiatry research centre, Monash University & Alfred Hospital, Melbourne, Victoria, Australia
| | - Heather Gilbert
- Monash Alfred Psychiatry research centre, Monash University & Alfred Hospital, Melbourne, Victoria, Australia
| | - Emorfia Gavrilidis
- Monash Alfred Psychiatry research centre, Monash University & Alfred Hospital, Melbourne, Victoria, Australia
| | - Tamsyn E. Van Rheenen
- Monash Alfred Psychiatry research centre, Monash University & Alfred Hospital, Melbourne, Victoria, Australia
| | - Wei Wang
- Monash Alfred Psychiatry research centre, Monash University & Alfred Hospital, Melbourne, Victoria, Australia
| | - Kay McCauley
- School of Nursing and Midwifery, Monash University, Clayton, Victoria Australia
| | - Paul Fitzgerald
- Monash Alfred Psychiatry research centre, Monash University & Alfred Hospital, Melbourne, Victoria, Australia
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Kulkarni J, Berk M, Wang W, Mu L, Scarr E, Van Rheenen TE, Worsley R, Gurvich C, Gavrilidis E, de Castella A, Fitzgerald P, Davis SR. A four week randomised control trial of adjunctive medroxyprogesterone and tamoxifen in women with mania. Psychoneuroendocrinology 2014; 43:52-61. [PMID: 24703170 DOI: 10.1016/j.psyneuen.2014.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
Emerging research has suggested that hormone treatments such as selective oestrogen receptor modulators (SERMs) or progestins may be useful in the treatment of mania. The current pilot study compared the use of the SERM tamoxifen and the progestin medroxyprogesterone acetate (MPA), as an adjunct to mood stabiliser medications, for the treatment of mania symptoms in 51 women in a 28-day double blind, placebo controlled study. The primary outcome was the change between baseline and day 28 mania scores as measured by the Clinician Administered Rating Scale for Mania (CARS-M). Adjunctive MPA treatment provided greater and more rapid improvement in mania symptoms compared with adjunctive placebo and tamoxifen treatment. Adjunctive therapy with MPA may be a potentially useful new treatment for persistent mania, leading to a greater and more rapid resolution of symptoms compared with mood stabiliser treatment alone.
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Affiliation(s)
- Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia.
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Ryrie Street, Geelong, Victoria 3220, Australia
| | - Wei Wang
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Ling Mu
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Elizabeth Scarr
- The Florey Institute of Neuroscience and Mental Health Victoria, Parkville, Victoria 3052, Australia
| | - Tamsyn E Van Rheenen
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Roisin Worsley
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia; Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University and Alfred Hospital, Victoria 3004, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Emorfia Gavrilidis
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Anthony de Castella
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Paul Fitzgerald
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and the Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University and Alfred Hospital, Victoria 3004, Australia
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Worsley R, Bell R, Kulkarni J, Davis SR. The association between vasomotor symptoms and depression during perimenopause: A systematic review. Maturitas 2014; 77:111-7. [DOI: 10.1016/j.maturitas.2013.11.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 11/24/2013] [Indexed: 01/22/2023]
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Kulkarni J, Gavrilidis E, Worsley R, Van Rheenen T, Hayes E. The role of estrogen in the treatment of men with schizophrenia. Int J Endocrinol Metab 2013; 11:129-36. [PMID: 24348584 PMCID: PMC3860106 DOI: 10.5812/ijem.6615] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/20/2012] [Accepted: 09/28/2012] [Indexed: 12/23/2022] Open
Abstract
Schizophrenia is a debilitating and pervasive mental illness with devastating effects on many aspects of psychological, cognitive and social wellbeing. Epidemiological and life-cycle data point to significant differences in the incidence and course of schizophrenia between men and women, suggesting that estrogen plays a "protective" role . Adjunctive estrogen therapy has been shown to be effective in enhancing the treatment of schizophrenia in women. In men, consideration of estrogen therapy has been impacted by concerns of feminisation, however, clinical trials using estrogen to treat prostate cancer, bone density loss and even aggression in men with dementia or traumatic brain injury, show estrogen to be a safe and effective therapy. Findings do, however, suggest that further exploration of a therapeutic role for adjunctive estradiol treatment in men with schizophrenia is warranted. The development of the new estrogen compounds - Selective Estrogen Receptor Modulators (SERMs) which do not cause feminisation - opens up the possibility of using a different type of estrogen for a longer period of time at higher doses. Estrogen could therefore prove to be an important component in the treatment of psychotic symptoms in men with schizophrenia. This review explains the scientific rationale behind the estrogen hypothesis and how it can be clinically utilised to address concerns unique to the care of men with schizophrenia.
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Affiliation(s)
- Jayashri Kulkarni
- The Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Australia
- Corresponding author: Jayashri Kulkarni, Monash Alfred Psychiatry Research Centre, Level One, Old Baker Building, The Alfred Hospital, Commercial Rd, Melbourne 3004, Australia. Tel: +61-39076 6924, Fax:+ 61-39076 8545, E-mail:
| | - Emmy Gavrilidis
- The Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Australia
| | - Roisin Worsley
- The Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Australia
| | - Tamsyn Van Rheenen
- The Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Australia
| | - Emily Hayes
- The Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Melbourne, Australia
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Kulkarni J, Gavrilidis E, Hayes E, Heaton V, Worsley R. Special biological issues in the management of women with schizophrenia. Expert Rev Neurother 2012; 12:823-33. [PMID: 22853790 DOI: 10.1586/ern.12.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Schizophrenia is a debilitating and pervasive mental illness with devastating effects on psychological, cognitive and social wellbeing, and for which current treatment options are far from ideal. Gender differences and the influence of the female reproductive life cycle on the onset, course and symptoms of schizophrenia and the discovery of estrogen's remarkable psychoprotective properties in animal models led to the proposal of the 'estrogen protection hypothesis' of schizophrenia. This has fueled the recent successful investigation of estradiol as a potential adjuvant therapeutic agent in the management of schizophrenia in women. This review explains the scientific rationale behind the estrogen hypothesis and how it can be clinically utilized to address concerns unique to the care of women with schizophrenia.
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Affiliation(s)
- Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Level One, Old Baker Building, The Alfred Hospital, Commercial Road, Melbourne 3004, Australia.
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Affiliation(s)
- Roisin Worsley
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
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Worsley R, Davis SR, Gavrilidis E, Gibbs Z, Lee S, Burger H, Kulkarni J. Hormonal therapies for new onset and relapsed depression during perimenopause. Maturitas 2012; 73:127-33. [DOI: 10.1016/j.maturitas.2012.06.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 01/08/2023]
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Abstract
Increasing evidence from epidemiological, preclinical and clinical studies suggests that estrogens may exert psychoprotective effects in schizophrenia. Observations of gender differences in the onset and course of schizophrenia have prompted exploration of the effects of estrogen on the CNS. The aim of this paper is to provide an overview of different applications of adjunctive estrogen as a possible treatment for symptoms of schizophrenia in both men and women. Recent trials have suggested that estrogen augmentation therapy may be able to enhance the management of schizophrenia; however, the clinical application of estrogen as a treatment has been limited by potential side effects, the most worrying being breast and uterine cancer in women, and feminization in men. Selective estrogen receptor modulators (SERMs), however, may offer therapeutic benefits for both men and women with schizophrenia without posing threat to breast and uterine tissue and without feminizing effects. The use of estrogen opens up new possibilities for both men and women in the treatment of severe mental illnesses such as schizophrenia. With further preclinical and clinical research, it is hoped that this promising field of hormone modulation can continue to evolve and eventually be translated into real therapeutic potential.
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Affiliation(s)
- Jayashri Kulkarni
- The Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University Faculty of Medicine, Nursing and Health Sciences - Central Clinical School, Melbourne, VIC, Australia.
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Worsley R, Gavrilidis E, Kulkarni J. Raloxifene may have further benefits in women on hemodialysis. Int J Endocrinol Metab 2012; 10:644-5. [PMID: 23843841 PMCID: PMC3693644 DOI: 10.5812/ijem.6580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/04/2012] [Accepted: 06/06/2012] [Indexed: 11/23/2022] Open
Affiliation(s)
- Roisin Worsley
- Monash Alfred Psychiatry Research Centre, Monash University, Australia
- Corresponding author: Roisin Worsley, Monash Alfred Psychiatry Research Centre, Monash University, Australia. Tel.: +44-39076 6294, Fax: +44-390768545, E-mail:
| | | | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University, Australia
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Enderby DH, Hughes R, Payne JP, Worsley R. Proceedings: Assessment of neuromuscular blockade in man by use of tetanic and single twitch contractions of the adductor pollicis muscle. Br J Pharmacol 1976; 56:390P. [PMID: 177143 PMCID: PMC1666974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Abstract
The tetanic force development of the human adductor pollicis muscle was studied under light anesthesia with nitrous oxide, oxygen, and Demerol, by the use of tetanic stimulation of the ulnar nerve at frequencies ranging from 10 to 100 Hz. The time necessary for the tetanic contraction to reach a plateau was longest at frequencies between 15 and 20 Hz. Fusion of tetanus occurred between 40 and 45 Hz. The mean maximal force of 6.92 kg was developed at a mean frequency of approximately 75 Hz. The maximal force was well maintained up to a stimulation frequency of 100 Hz. The results indicate that in lightly anesthetized man, the maximal force is developed at higher stimulation frequencies than those observed in conscious man and that it is well sustained at higher frequencies.
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Perry IR, Worsley R, Sugai N, Payne JP. The use of a digital computer for the on-line real-time assessment of neuromuscular blockade in anaesthetized man. Br J Anaesth 1975; 47:1097-1100. [PMID: 1203140 DOI: 10.1093/bja/47.10.1097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A computer program written mainly in a high level language (ALGOL), but with the sampling routine and certain calculations written in assembly language (SIR), has been developed to assess neuromuscular blockade in anaesthetized man by means of an Elliott 903 digital computer. The program allows the on-line real-time analysis of a range of variables including twitch height, maximum slope of twitch and twitch pulse widths, peak height of tetanic contraction, end-height of tetanic contraction, the tetanic tension ratio and the percentage tetanic transmission. The program has been used to investigate the pattern of action of neuromuscular blocking drugs and has particular value in the study of the pharmacokinetic action of these drugs.
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Hill DW, Mable SE, Payne JP, Worsley R. A three-channel telephone data link for the transmission of physiological variables. Br J Pharmacol 1970; 40:598P-599P. [PMID: 5497849 PMCID: PMC1703109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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