Do Sex/Gender and Menopause Influence the Psychopathology and Comorbidity Observed in Delusional Disorders?

Abstract

Background: While sex differences and gonadal hormone levels are taken seriously in the understanding and treatment of schizophrenia, their influence in the psychopathology of delusional disorders (DD) remains unknown. Methods: Our strategy was to conduct a narrative review of the effects of (a) sex/gender difference and (b) menopause on delusional content, affective and anxiety-related comorbidity, substance use disorders, cognition, aggressivity, and suicide risk in DD. Results: Because the literature is scarce, our results are tentative. We found that erotomania was more prevalent in women than in men, and especially in women with premenopausal onset. In contrast, jealous and somatic delusions were more commonly seen in DD women with postmenopausal onset. With respect to depressive comorbidity, women with premenopausal onset appear more vulnerable to depression than those with later onset. Age at menopause is reported to correlate positively with intensity of suicidal ideation. Anxiety symptoms may be related to estrogen levels. Men present with higher rates of substance use disorders, particularly alcohol use. Conclusions: Many male/female differences in DD may be attributable to sociocultural factors but menopause, and, therefore, levels of female hormones, influence symptom expression in women and mediate the expression of psychiatric comorbidities. Further research in this area promises to lead to improved individualized treatment.

Improving treatment of women with schizophrenia: a review of the recent literature

“…Menopause correlates with 1) increased severity of psychosis [74] and 2) antipsychotic resistance [74][75][76][77][78][79][80][81][82] Breast cancer-incidence and mortality…”

“…Sommer and collaborators [75] carried out a nationwide cohort study of 61,889 individuals investigating clinical outcomes in schizophrenia/schizoaffective disorders. The sample was divided into two groups according to: age < 45 years, and > 45 years.…”

Use of Long-Acting Injectable Antipsychotics in a Clinical Sample of Community-Dwelling Patients with Schizophrenia-Spectrum Disorders in Rural Greece

“…Moreover, there may be gender differences with regard to delusional themes, depression and anxiety comorbidity (more common in women), and substance use disorders (more common in men) that could be attributable to sociocultural factors. Interestingly, menopause may influence symptom expression and comorbidities in women [ 24 ]. A recent observational Swedish registry study found that treatment with antipsychotics was associated with a reduced risk of hospitalization due to psychosis and work disability in delusional disorder and that LAI or clozapine treatment was the most effective treatment in this regard [ 25 ].…”