Oestrogens and schizophrenia

Current Opinion in Psychiatry

Volumn 16, Issue 2, 2003, Pages 187-192

  Riecher Rössler, Anita ^a  

^a UNIVERSITY HOSPITAL BASEL   (Switzerland)

Author keywords

Gonadal dysfunction; Hyperprolactinaemia; Oestrogens; Schizophrenia; Women

Indexed keywords

ESTRADIOL; ESTROGEN;

EPIDEMIOLOGICAL DATA; ESTROGEN DEFICIENCY; HUMAN; HYPOTHALAMUS HYPOPHYSIS ADRENAL SYSTEM; MENTAL HEALTH; PATHOGENESIS; PSYCHOSIS; REVIEW; SCHIZOPHRENIA;

EID: 0037335172     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001504-200303000-00008     Document Type: Review

References (62)

1. Riecher-Rössler A, Häfner H. Schizophrenia and oestrogens: is there an association? Eur Arch Psychiatry Clin Neurosci 1993; 242:323-328.
2. Cyr M, Calon F, Morissette M, Di Paolo T. Estrogenic modulation of brain activity: implications for schizophrenia and Parkinson's disease. J Psychiatry Neurosci 2002; 27:12-27. A comprehensive review on the evidence for oestrogenic modulation of brain activity that is relevant to schizophrenia, especially regarding oestrogenic modulation of neurotransmitters. It also covers novel synthetic compounds with oestrogenic activity, such as the selective oestrogen receptor modulators. Implications for further research are discussed.
3. Goldstein JM, Seidman LJ, O'Brien LM, et al. Impact of normal sexual dimorphisms on sex differences in structural brain abnormalities in schizophrenia assessed by magnetic resonance imaging. Arch Gen Psychiatry 2002; 59:154-164. This excellent and well controlled magnetic resonance imaging study takes into account normal patterns of sexual dimorphism. A highly sophisticated and interesting discussion is provided on the implications of results regarding theories of early prenatal and perinatal brain insults as risk factors for schizophrenia. It is among the few papers that discuss potential early 'organizational' effects of oestrogens on brain development.
4. Oesterlund MK. The role of estrogens in neuropsychiatric disorders. Curr Opin Psychiatry 2002; 15:307-312. An excellent review of the most important findings in the research area of oestrogenic effects in neuropsychiatric disorders published throughout the year 2001.
5. Vedder H, Behl C. Estrogens in neuropsychiatric disorders. In: Bergemann N, Riecher-Rössler A, editors. Estrogen effects in psychiatric disorders. Wien, New York: Springer; 2003. (in press).
6. Garcia-Segura LM, Azcoitia I, DonCarlos LL. Neuroprotection by estradiol. Prog Neurobiol 2001; 63:29-60. This is a very important review that highlights recent evidence from clinical and basic science studies supporting a role for oestrogens in neuroprotection.
7. Stahl SM. Effects of estrogen on the central nervous system. J Clin Psychiatry 2001; 62:317-318. This brief 'brainstorm' article provides an illustrated update and summary of novel concepts of effects of oestrogens on the brain emerging from neuroscience.
8. Stahl SM. Why drugs and hormones may interact in psychiatric disorders. J Clin Psychiatry 2001; 62:225-226. A short, very interesting summary of a very important topic.
9. McEwen B. Interplay between membrane and genomic actions of estrogens [abstract]. Int J Neuropsychopharmacol 2002; 5 (Suppl 1):S12.
10. Oesterlund MK, Keller E, Hurd YL. The human forebrain has discrete estrogen receptor α-messenger RNA expression: high levels in the amygdaloid complex. Neuroscience 2000; 95:333-342.
11. Häfner H, Riecher-Rössler A, an der Heiden W, et al. Generating and testing a causal explanation of gender difference in age at first onset of schizophrenia. Psychol Med 1993; 23:925-940.
12. Riecher-Rössler A, Löffler W, Munk-Jorgensen P. What do we really know about late-onset schizophrenia? Eur Arch Psychiatry Clin Neurosci 1997; 247:195-208.
13. Könneke R, Häfner H, Maurer K, et al. Main risk factors for schizophrenia: increased familial loading and pre- and peri-natal complications antagonize the protective effect of oestrogen in women. Schizophr Res 2000; 44:81-93.
14. Häfner H. Gender differences in schizophrenia. In: Bergemann N, Riecher-Rössler A, editors. Estrogen effects in psychiatric disorders. Wien, New York: Springer; 2003. (in press).
15. Riecher-Rössler A. Estrogen effects in schizophrenia and their potential therapeutic implications: review. Arch Women's Mental Health 2002; 5: 111-118. This review is very relevant to the topic addressed in the present review; it also covers older literature.
16. Cohen RZ, Seeman MV, Gotowiec A, Kopala L. Earlier puberty as a predictor of later onset of schizophrenia in women. Am J Psychiatry 1999; 156:1059-1064.
17. Cohen RZ, Seeman MV. Puberty and schizophrenia onset. In: Bergemann N, Riecher-Rössler A, editors. Estrogen effects in psychiatric disorders. Wien, New York: Springer; 2003 (in press).
18. Seeman MV. The role of estrogen in schizophrenia. J Psychiatry Neurosci 1996; 21:123-127.
19. Mahé V, Dumaine A. Oestrogen withdrawal associated psychoses. Acta Psychiatr Scand 2001; 104:323-331. A very interesting review of the literature on reported associations between phases of oestrogen withdrawal and psychotic disorders.
20. Choi SH, Kang SB, Joe SH. Changes in premenstrual symptoms in women with schizophrenia: a prospective study. Psychosom Med 2001; 6:822-829. These authors, although measuring oestradiol serum levels, did not calculate direct correlations with symptomatology. Furthermore, because they examined chronically ill patients, variation in psychotic symptoms was possibly not sufficiently strong to find associations with the menstrual cycle.
21. Althaus G, Pfuhlmann B, Franzek E. The effect of the menstruation cycle on manifestations of psychiatric diseases [in German]. Fortschr Neurol Psychiat 2000; 68:357-362.
22. Harris AH. Menstrually related symptom changes in women with schizophrenia. Schizophr Res 1997; 27:93-99.
23. Riecher-Rössler A, Häfner H, Stumbaum M, et al. Can estradiol modulate schizophrenic symptomatology? Schizophr Bull 1994; 20:203-214.
24. Hoff AL, Kremen WS, Wieneke MH, et al. Association of estrogen levels with neuropsychological performance in women with schizophrenia. Am J Psychiatry 2001; 158:1134-1139. This report covers a wide age range of women and correlates average oestrogen levels over 4 weeks with psychopathology and neuropsychological performance. Short-term menstrual fluctuations of the cycle are not analysed.
25. Riecher-Rössler A, Rössler W. The course of schizophrenic psychoses: what do we really know? A selective review from an epidemiological perspective. Eur Arch Psychiatry Clin Neurosci 1998; 248:189-202.
26. Lindamer LA, Lohr JB, Harris MJ, et al. Gender, estrogen, and schizophrenia. Psychopharmacol Bull 1997; 33:221-228.
27. Korhonen S, Saarijarvi S, Aito M. Successful estradiol treatment of psychotic symptoms in the premenstrual phase: a case report. Acta Psychiatr Scand 1995; 92:237-238.
28. Kulkarni J, de Castella A, Smith D, et al. A clinical trial of the effects of estrogen in acutely psychotic women. Schizophr Res 1996; 20:247-252.
29. Kulkarni J, Riedel A, de Castella AR, et al. Estrogen: a potential treatment for schizophrenia. Schizophr Res 2001; 48:137-144. This is one of the first intervention studies with oestrogens in schizophrenia. Women of the fertile age group were studied in a well-controlled design using transdermal 17β-oestradiol.
30. Kulkarni J, de Castella A, Taffe J. Clinical adjunctive estrogen trial in men with schizophrenia: a pilot study. Schizophr Res 1999; 36:286.
31. Lindamer LA, Buse DC, Lohr JB, Jeste DV. Hormone replacement therapy in postmenopausal women with schizophrenia: positive effect on negative symptoms? Biol Psychiatry 2001; 49:47-51. This is one of the rare studies to examine the effects of hormone replacement therapy on psychopathology in postmenopausal women with schizophrenia.
32. Ahokas A, Aito M, Rimón R. Positive treatment effect of estradiol in postpartum psychosis: a pilot study. J Clin Psychiatry 2000; 61:166-169.
33. Yonkers KA, Kando JC, Cole JO, Blumenthal S. Gender differences in pharmacokinetics and pharmacodynamics of psychotropic medication. Am J Psychiatry 1992; 149:587-595.
34. Riecher-Rössler A, Häfner H, Dütsch-Strobel A, Stumbaum M. Gonadal function and its influence on psychopathology. A comparison of schizophrenic and non-schizophrenic female inpatients. Arch Women's Mental Health 1998; 1:15-26.
35. Bergemann N, Parzer P, Nagl I, et al. Acute psychiatric admission and menstrual cycle phase in women with schizophrenia. Arch Women's Mental Health 2002; 5:119-126. This is a very interesting report on two samples of premenopausal patients regarding hypo-oestrogenism, providing a comprehensive review on this question at the same time.
36. Huber TJ, Rollnik J, Wilhelms J, et al. Estradiol levels in psychotic disorders. Psychoneuroendocrinology 2001; 26:27-35. An open, prospective study on hypo-oestrogenism in women with schizophrenia is presented. It is among the few studies conducted in psychiatric patients and healthy control individuals.
37. Canuso CM, Goldstein JM, Wojcik J, et al. Antipsychotic medication, prolactin elevation, and ovarian function in women with schizophrenia and schizoaffective disorder. Psychiatry Res 2002; 111:11-20. Although this study is small, it is of great clinical relevance.
38. Smith S, Wheeler MJ, Murray R, O'Keane V. The effects of antipsychotic-induced hyperprolactinaemia on the hypothalamic-pituitary-gonadal axis. J Clin Psychopharmacol 2002; 22:109-114. This is a well designed study conducted in chronically ill outpatients on typical antipsychotics and their side effects on the gonadal axis. A clinically very relevant discussion of practical consequences is provided.
39. Zhang-Wong J, Seeman MV. Antipsychotic drugs, menstrual regularity, and osteoporosis risk. Arch Women's Mental Health 2002; 5:93-98. This paper discusses possible short-term and long term influences of antipsychotics, including atypicals, such as osteoporosis; it also provides preliminary results of an ongoing study.
40. Maguire GA. Prolactin elevation with antipsychotic medications: mechanisms of action and clinical consequences. J Clin Psychiatry 2002; 63 (Suppl 4):56-62. A clinically relevant overview of neuroleptic-induced hyperprolactinaemia and its adverse short-term and long term consequences is presented.
41. Warner MD, Walker AM, d'Souza DC, et al. Lower prolactin bioactivity in unmedicated schizophrenic patients. Psychiatry Res 2001; 102:249-254. This is one of the few studies to investigate prolactin levels in unmedicated schizophrenia patients. It may even provide insight into the pathogenesis of schizophrenia.
42. Wolf OT, Schommer NC, Hellhamer DH, et al. The relationship between stress induced cortisol levels and memory differs between men and women. Psychoneuroendocrinology 2001; 26:711-720.
43. Carlson LE, Sherwin BB. Relationship among cortisol (CRT), dehydroepiandrosterone-sulfate (DHEAS), and memory in a longitudinal study of healthy elderly men and women. Neurobiol Aging 1999; 20:315-324.
44. Hogervorst E, Williams J, Budge M, et al. The nature of the effect of female gonadal hormone replacement therapy on cognitive function in postmenopausal women: a meta-analysis. Neuroscience 2000; 101:485-512.
45. Ehrenreich H, Heyer A, Siren AL. Future perspectives of gender hormones in neuroprotection [abstract]. Eur Psychiatry 2002; 17 (Suppl 1):42S.
46. Kahn L, Halbreich U. Estrogen's effect on depression. In: Bergemann N, Riecher-Rössler A, editors. Estrogen effects in psychiatric disorders. Wien, New York: Springer; 2003. (in press).
47. Ahokas A, Kaukoranta J, Wahlbeck K, Aito M. Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17β-estradiol: a preliminary study. J Clin Psychiatry 2001; 62:332-336. This is a very well designed study, which presents convincing results in postpartum depression with sustained oestrogen deficiency.
48. Lawrie TA, Herxheimer A, Dalton K. Oestrogens and progestogens for preventing and treating postnatal depression (Cochrane Review). In: The Cochrane Library Issue 3. Oxford: Update Software; 2001. A high-quality Cochrane review is presented.
49. Zweifel JE, O'Brien WH. A meta-analysis of the effect of hormone replacement therapy upon depressed mood. Psychoneuroendocrinology 1997; 22:189-212.
50. de Noaves Soares C, Almeida OP, Joffe H, Cohen LS. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women. Arch Gen Psychiatry 2001; 58:529-534. A well designed study with very promising results is presented.
51. Freeman MP, Wosnitzer Smith K, Freeman SA, et al. The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatry 2002; 63:284-287. This is among the first studies on the potential association of oestrogens with bipolar disorder.
52. Carlson LE, Sherwin BB, Chertkow MH. Relationship between mood and estradiol (E-2) levels in Alzheimer's disease (AD) patients. J Gerontol B Psychol Sci Soc Sci 2000; 55:P47-P53.
53. Kyomen HH, Hennen J, Gottlieb GL, Wei JY. Estrogen therapy and noncognitive psychiatric signs and symptoms in elderly patients with dementia. Am J Psychiatry 2002; 259:1225-1227. This is among the few studies to concentrate on noncognitive symptoms in dementia, especially aggressive behaviour, with potential implications for schizophrenia.
54. Riecher-Rössler A. Oestrogene und Schizophrenie: Patientinnen an der Schnittstelle zwischen Psychiatrie und Gynäkologie (Estrogens and schizophrenia - female patients at the intersection of psychiatry and gynaecology) [in German]. Geburtshilfe Frauenheilkunde 2002; 62:429-435.
55. Neumann NU, Frasch K. Olanzapine and pregnancy. 2 case reports [in German]. Nervenarzt 2001; 72:876-878. These interesting case reports increase one's awareness of risk for unwanted pregnancy when switching to prolactin-sparing neuroleptics.
56. Braendle W, Breckwoldt M, Kuhl H, et al. Sexualhormone und Psyche: Ergebnisse des 2. Interdisziplinären Frankfurter Gesprächs zur Kontrazeption (Sex hormones and psyche: results of the 2nd interdisciplinary Frankfurt dialogues on contraception) [in German]. Frauenarzt 2001; 42:154-160. The results of an interdisciplinary expert consensus meeting are presented.
57. Barrett-Connor E, Stuenkel CA. Hormone replacement therapy (HRT): risks and benefits. Int J Epidemiol 2001; 30:423-426. This is a clinically highly relevant overview on the risks associated with hormone replacement therapy, but additional findings have been published since (see [58]).
58. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 2002; 288:321-333. The findings presented here are clinically highly relevant to the debate on the potential risks associated with hormone replacement therapy, especially concerns regarding combinations of oestrogens with progestins.
59. Halbreich U. The spectrum of estrogens, estrogen agonists and serms [abstract]. Int J Neuropsychopharmacol 2002; 5 (Suppl 1):S12.
60. Davis SR. The effects of tibolone on mood and libido. Menopause 2002; 9:162-170.
61. Grigoriadis S, Seeman MV. The role of estrogen in schizophrenia: implications for schizophrenia practice guidelines for women. Can J Psychiatry 2002; 47:437-442. Known oestrogen effects on symptoms and treatment response are integrated into schizophrenia guidelines for women by highly competent authors - highly relevant for clinical practice.
62. North American Menopause Society. A decision tree for the use of estrogen replacement therapy or hormone replacement therapy in postmenopausal women: consensus opinion of the North American Menopause Society. Menopause 2000; 7:76-86.