Menstrual exacerbation of schizophrenia symptoms

Abstract

Clinical recommendations• Clinicians treating women with schizophrenia need to inquire about menstrual exacerbation of symptoms.• The nature of the symptoms that are premenstrually exacerbated will determine the correct intervention.• Raising the dose of prolactin-raising antipsychotics can be counterproductive because estrogen levels can fall and ovulation can be inhibited. Additional comments• There are inherent safety risks to treatment with estrogens, but selective estrogen receptor modulators (SERMs) may prove to be effective.• SERMs, like oral estrogens, can affect CYP enzymes that metabolize individual antipsychotics.

Sex/gender differences in the brain and cognition in schizophrenia

“…Some studies have also observed negative correlations between estradiol and visospatial abilities in women [206]. Sex steroid hormones have been also implicated in the pathophysiology of schizophrenia [58, [207][208][209].…”

Sex and schizophrenia: a review of gender differences

“…Functionally, estrogen may exert a neuroleptic effect by altering post-synaptic dopaminergic signal transduction and, consequently, inhibiting dopamine-mediated psychotic symptoms (Seeman, 2008). The estrogen hypothesis may explain, at least in part, the reduced early-onset and preponderance of late-onset schizophrenia in women (Seeman, 2012). Clinically, the estrogen hypothesis may also explain the greater psychotic symptomatology and worse neurocognitive performance in women after menopause and during low estrogen phases of menstruation (Seeman, 2012).…”

“…The estrogen hypothesis may explain, at least in part, the reduced early-onset and preponderance of late-onset schizophrenia in women (Seeman, 2012). Clinically, the estrogen hypothesis may also explain the greater psychotic symptomatology and worse neurocognitive performance in women after menopause and during low estrogen phases of menstruation (Seeman, 2012). Cortisol has also been linked to gender differences, and Pruessner et al (2008) were the first to report that men -but not women -with recent onset psychosis experience blunted cortisol release, compared to healthy controls, after awakening: subsequent work found this was also true during mental challenges (Steen et al, 2011).…”

The evolution of genomic stability to a mechanism in reproduction and psychiatry

“…Women suffering PMS are not only suffering from mental disease but also from fluid retention, edema in their ankles through increase of aldosterone [57]: Edema and aldosterone are always concomitantly increased in severe mental disease (Figure 7) [20]. Women suffering from PMS report suffering from anxiety, which is related to increased aldosterone [43].…”

“…Androstenediol stimulates innate immune cell function in nerve system cells and in healthy cells reduces DNA damage and induces genes that modulate genes related to the innate immunity in nerve cells [61]. It has been reported, in vitro, that in severe mental disease the formation of new healthy cells is inhibited and that the reduction of androstenediol is a key steroidal hormone promoting neurogenesis and a reduction may cause severe mental diseases [57,61,62].…”