Schizophrenia and Sex Hormones: What Is the Link?

Brzezinski-Sinai, Noa A; Brzezinski, Amnon

doi:10.3389/fpsyt.2020.00693

Cited by 57 publications

(31 citation statements)

References 55 publications

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“…Emerging research indicates that early menarche correlates with higher estrogen levels [28]. In the case of women with psychosis, there seems to be an association between early puberty and a later onset of symptoms, which is consistent with the estrogenic hypothesis [29,30]. Furthermore, symptoms seem to fluctuate throughout the menstrual cycle and are heightened during the late luteal and early follicular phases.…”

Section: Introductionmentioning

confidence: 52%

Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis

Barrau-Sastre

Birulés

Verdaguer-Rodríguez

et al. 2022

Women

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A protective effect has traditionally been attributed to estrogen in psychotic disorders. The aim of this study was to investigate cumulative lifetime estrogen by assessing the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and the age of menarche, measuring their effects on symptoms, cognition, social cognition, and metacognition. As it was not possible to directly measure cumulative estrogen levels over the lifetime of a patient, the study sample was composed of 42 women with first-episode psychosis; estrogen levels were inferred by the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and menarche. All patients were assessed with a battery of questionnaires using the BDI, PSYRATS, PANSS, STROOP, TAVEC, WSCT, IPSAQ, and BCIS questionnaires. The results related to menstrual cycle length showed a relationship with memory; specifically, shorter cycles with semantic strategies (p = 0.046) and longer cycles with serial strategies in the short term (p = 0.005) as well as in the long term (p = 0.031). The results also showed a relationship with perseverative errors (p = 0.035) and self-certainty (p = 0.049). Only personalized bias (p = 0.030) was found to be significant in relation to the age at menarche. When analyzing the differences in years of difference between the age at menarche and the onset of psychotic symptoms, the results indicated lower scores in women with a smaller difference between both events in memory (short-term (p = 0.050), long-term (p = 0.024), intrusions (p = 0.013), and recognition (p = 0.043)) and non-perseverative errors (p = 0.024). No relationship was found between symptoms and menstrual characteristics. The investigatory outcomes seem to indicate a relationship between estrogen cumulative effects and the memory domain. More in-depth investigations in the field are necessary in order to improve personalized treatment in women with psychosis.

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Section: Introductionmentioning

confidence: 52%

Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis

Barrau-Sastre

Birulés

Verdaguer-Rodríguez

et al. 2022

Women

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“…Besides the above, women are more likely to develop obesity, metabolic syndrome, cardiovascular diseases, and tardive dyskinesia after long-term with antipsychotic drugs. This is probably due to the fact that women respond to acute stressors in a more pro-inflammatory manner compared to men, with increased immune response and decreased glucocorticoid sensitivity; in addition, gender difference of sex hormones profile and fluctuations, particularly during reproductive years, partly contribute to the increased burden of physical comorbidity observed in young female patients with a diagnosis of psychosis [38]. It has been noticed that chronic physical illnesses, although preventable and treatable, are the leading cause of premature mortality in patients with schizophrenia spectrum disorder [32].…”

Section: Discussionmentioning

confidence: 99%

Psychosis in Women: Time for Personalized Treatment

Mazza

Caroppo

Berardis

et al. 2021

JPM

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Early detection and prompt treatment of psychosis is of the utmost importance. The great variability in clinical onset, illness course, and response to pharmacological and psychosocial treatment is in great part gender-related. Our aim has been to review narratively the literature focusing on gender related differences in the psychoses, i.e., schizophrenia spectrum disorders. We searched the PubMed/Medline, Scopus, Embase, and ScienceDirect databases on 31 July 2021, focusing on recent research regarding sex differences in early psychosis. Although women, compared to men, tend to have better overall functioning at psychotic symptom onset, they often present with more mood symptoms, may undergo misdiagnosis and delay in treatment and are at a higher risk for antipsychotic drug-induced metabolic and endocrine-induced side effects. Furthermore, women with schizophrenia spectrum disorders have more than double the odds of having physical comorbidities than men. Tailored treatment plans delivered by healthcare services should consider gender differences in patients with a diagnosis of psychosis, with a particular attention to early phases of disease in the context of the staging model of psychosis onset.

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“…Women constitute approximately 80% of first onset patients who are over age 60. This has been attributed to the dramatic endocrine changes of menopause, the relative longevity of women, and the stresses of the caretaking roles often assumed by aging women [24].…”

Section: Gender Aspects Of Onset Agementioning

confidence: 99%

“…Many women with schizophrenia experience fluctuations in their psychotic symptoms related to the menstrual stage, with symptom severity increasing premenstrually [24,30,31].…”

Section: Hormone-related Periodicity In Womenmentioning

confidence: 99%

Schizophrenia Psychosis in Women

Seeman

2020

Women

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A first step towards personalized medicine is to consider whether, for some disorders, the safest and most effective treatment of women needs to differ from standard guideline recommendations developed on the basis of clinical trials conducted, for the most part, in men. A second step is to consider how women’s reproductive stages—pre-pubertal years, menstrual phases, pregnancy trimesters, lactation and postpartum periods, menopausal and postmenopausal/aging status—affect the optimal choice of treatment. This review focuses on these two steps in the treatment of psychosis, specifically schizophrenia. It discusses genetics, precursors and symptoms of schizophrenia, reproductive and associated ethical issues, antipsychotic drug response and adverse effects, substance abuse, victimization and perpetration of violence, and issues of immigration and of co-morbidity. The conclusions, while often based on clinical experience and theoretical considerations rather than strictly on the evidence of randomized controlled trials, are that clinical recommendations need to consider clinical and role differences that exist between men and women and make appropriate correction for age and reproductive status.

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Schizophrenia and Sex Hormones: What Is the Link?

Cited by 57 publications

References 55 publications

Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis

Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis

Psychosis in Women: Time for Personalized Treatment

Schizophrenia Psychosis in Women

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