Magazine article Clinical Psychiatry News

Estrogen's Role in Schizophrenia Remains Uncertain. (Small Trials, Inconsistent Findings)

Magazine article Clinical Psychiatry News

Estrogen's Role in Schizophrenia Remains Uncertain. (Small Trials, Inconsistent Findings)

Article excerpt

ORLANDO, FLA. -- A growing body of evidence suggests that estrogen is involved in the onset, presentation, and course of schizophrenia in women.

But it remains uncertain whether the hormone may have a useful adjunctive role in treatment, Laurie A. Lindamer, Ph.D., said at the annual meeting of the American Association for Geriatric Psychiatry.

Several studies have found that estrogen augmentation reduces positive or negative symptoms, but the numbers are small and the findings inconsistent.

The most robust gender difference in schizophrenia is age of onset: The overall prevalence is the same--roughly 1%--for both men and women. But men outnumber women in the classical presentation, at late adolescence or young adulthood.

A second incidence peak, in which women predominate, occurs in the mid-40s, which is "suspiciously around the age of menopause," said Dr. Lindamer of the Geriatric Psychiatry Intervention Research Center, University of California, San Diego.

Generally, female patients with schizophrenia have less severe negative symptoms, more affective symptoms, better premorbid functioning, and a milder course. But no consistent gender differences have been seen in family history or neuropsychiatric performance measures, and magnetic resonance imaging studies suggest that males and females have similar pathophysiology.

On balance, "there is no clear evidence for male and female subtypes of schizophrenia," she said.

Rather, gender differences may reflect hormonal influences. Several studies point to possible connections between symptoms and estrogen in women. In pre-menopausal women, rising estrogen levels during the menstrual cycle are associated with reduced psychopathology and the need for lower doses of neuroleptics. Psychotic symptoms improve during pregnancy and worsen in the postpartum period, and a small open-label study found that estrogen improved symptoms in women with postpartum psychosis. …

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