Do we need sex-oriented clinical practice guidelines for the treatment of schizophrenia?

Fernando, Piyumi; Sommer, Iris; Hasan, Alkomiet

doi:10.1097/yco.0000000000000597

Cited by 30 publications

(29 citation statements)

References 83 publications

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“…Clinical practice guidelines for schizophrenia rarely identify sex-specific requirements [8] although attention is being paid in the more recent literature to sexually dimorphic features of drug efficacy and tolerability [9]. Hormonal effects on drugs have led to a more general appreciation of hormonal influence on the dimorphic expression of schizophrenia in women and men [10].…”

Section: Introduction: Health Care For Women With Schizophreniamentioning

confidence: 99%

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

González-Rodríguez

Guàrdia²,

Pedrero

et al. 2020

IJERPH

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Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life—paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods—while constituting vulnerable time periods for the mother—require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.

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Section: Introduction: Health Care For Women With Schizophreniamentioning

confidence: 99%

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

González-Rodríguez

Guàrdia²,

Pedrero

et al. 2020

IJERPH

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“…Other reproductive stages (late luteal menstrual phases, pregnancy, the postpartum period) in women's lives require special prescribing considerations as well [68][69][70]. Recently, sex-specific treatments for psychoses and other central nervous disorders have been proposed [71,72].…”

Section: Antipsychotic Drug Response 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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“…Epidemiological data show that, in the majority of psychiatric disorders, rates of illness in men and women differ, clinical presentations differ, and treatment response differs [ 1 , 2 , 3 ]. Sexual dimorphism in the developmental course of cortical maturation results in differences in ages at onset [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Stratification by Sex and Hormone Level When Contrasting Men and Women in Schizophrenia Trials Will Improve Personalized Treatment

Seeman

González-Rodríguez

2021

JPM

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Background: Sex and gender differences have been reported in the prevalence, expression, treatment response, and outcome of schizophrenia, but most reports are based on relatively small samples that have not been stratified for the impact of sex hormone levels. This literature review aims to show how women’s hormone levels can impact the results of male/female comparisons. Methods: This is a narrative review of data from publications of the last decade. Results: Epidemiologic evidence, reports of the impact of hormones on cognition, results of sexually dimorphic responses to treatment, and male/female trajectories of illness over time all suggest that female hormone fluctuations exert major effects on male/female differences in schizophrenia. Conclusions: Information on hormonal status in women participants is rarely available in clinical studies in schizophrenia, which makes male/female comparisons largely uninterpretable. These are the current challenges. Opportunities for individualized treatment are growing, however, and will undoubtedly result in improved outcomes for both women and men in the future.

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Do we need sex-oriented clinical practice guidelines for the treatment of schizophrenia?

Abstract: A. (2020). Do we need sex-oriented clinical practice guidelines for the treatment of schizophrenia? Current opinion in psychiatry, 33(3), 192-199.

Cited by 30 publications

References 83 publications

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

Schizophrenia Psychosis in Women

Stratification by Sex and Hormone Level When Contrasting Men and Women in Schizophrenia Trials Will Improve Personalized Treatment

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