Delusional Disorder over the Reproductive Life Span: The Potential Influence of Menopause on the Clinical Course.

Alexandre González-Rodríguez,Marina Garriga,Alexandre Pons,Rafael Penadés,Rosa Catalán,Miguel Bernardo,Oriol Molina-Andreu

doi:10.1155/2015/979605

Alexandre González-Rodríguez, Marina Garriga + Show 5 more

Open Access

https://doi.org/10.1155/2015/979605

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Abstract

Background and Objectives. Recent evidence supports an association between estrogen levels and severity of psychopathology in schizophrenia women. Our main goal was to investigate whether delusional disorder (DD) women with premenopausal onset and those with postmenopausal onset differ in demographic and clinical features. Methods. Psychopathological symptoms were assessed in 80 DD women (DSM-IV-TR), at baseline and after six and 24 months. Scores in the PANSS, PSP for functionality, HRSD 17 items, C-SSRS for suicide, and the SUMD were considered outcome variables. For comparison purposes, t- and χ 2-tests were performed and nonparametric tests when necessary. Analysis of Covariance (ANCOVA) was conducted for multivariate comparisons. Results. 57 out of 80 DD women completed the study. When unadjusted, DD with premenopausal onset had a longer DUP, higher educational level, and a tendency toward higher rates of gynaecological disorders. Erotomanic type was most frequent in DD women premenopausal onset, and somatic and jealous types were most frequent in those with postmenopausal onset. After 24 months, DD women with premenopausal onset showed higher depressive symptoms and a tendency toward higher rates of psychotic relapses. Conclusions. Our results support that some aspects of psychopathology and insight may differ according to the onset of DD and the reproductive status.

Highlights

In recent years, an increasing scientific evidence highlighted an influence of estrogens on the psychopathology in women diagnosed with chronic psychosis [1, 2]
Bergemann and colleagues investigated the effects of the menstrual cycle phase and estradiol levels on psychotic symptoms by using the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) [1]
Seventy-four participants from the initial sample completed the 6-month assessment and 57 were evaluated after 24 months, being 28.75% of patients lost at follow-up

Summary

Introduction

An increasing scientific evidence highlighted an influence of estrogens on the psychopathology in women diagnosed with chronic psychosis [1, 2]. Most of the existing studies support an inverse correlation between estrogen levels and severity of psychopathology in these women [1, 3], and estradiol has been postulated to have specific antipsychoticlike effects on these populations. Bergemann and colleagues investigated the effects of the menstrual cycle phase and estradiol levels on psychotic symptoms by using the Positive and Negative Syndrome Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS) [1]. The authors found a significant improvement in psychotic symptoms during the luteal phase of the menstrual cycle In this line of clinical and epidemiological findings, and based on animal models, two hypotheses have been proposed: “the estrogen protection hypothesis” and “the hypothesis of hypoestrogenism” [4, 5]. After 24 months, DD women with premenopausal onset showed higher depressive symptoms and a tendency toward higher rates of psychotic relapses. Our results support that some aspects of psychopathology and insight may differ according to the onset of DD and the reproductive status

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Discussion

Conclusion