Abstract
While the early identification of insomnia in patients with schizophrenia is of clinical relevance, the use of specific compounds to treat insomnia has been studied less in postmenopausal women with schizophrenia. We aimed to explore the effects of melatonin, sex hormones, and raloxifene for the treatment of insomnia in these populations. Although melatonin treatment improved the quality and efficiency of the sleep of patients with schizophrenia, few studies have explored its use in postmenopausal women with schizophrenia. The estrogen and progesterone pathways are dysregulated in major psychiatric disorders, such as in schizophrenia. While, in the context of menopause, a high testosterone-to-estradiol ratio is associated with higher frequencies of depressive symptoms, the effects of estradiol and other sex hormones on sleep disorders in postmenopausal women with schizophrenia has not been sufficiently investigated. Raloxifene, a selective estrogen receptor modulator, has shown positive effects on sleep disorders in postmenopausal women. Future studies should investigate the effectiveness of hormonal compounds on insomnia in postmenopausal women with schizophrenia.
Highlights
Schizophrenia is a severe mental illness, with an estimated prevalence of 1% in the global population [1], and a high burden of disease [2]
Melatonin (N-acetyl-5-methoxytryptamine) is an endogenouSsleheoprmdoynsfeutnhcatitoins sheacsrebteedeninwthideeplyinreeaclogglnanizde,danads iat hcoams emxtoennscilvineilcyabl epernobshleomwninto pehoapvleendeiuargonporsoetdecwtivitehasncdhiaznotpiohxreidnaian.t Mpreolpateorntiiens ([N27-]a.cAetydlo-5u-bmlee-tbhloinxdytprylapcteabmo-incoen) tirsoallned enedigohgte-wnoeueks throiarlminovneesttihgateids tsheecreeftfiecdaciynotfhreampienleteaolngfloanr dth, eatnrdeatitmheanst oefxoteuntspiavteielyntbsewenith shsochwinzotpohhreanviea n[2e8u]r.oRparmotelctteivone iasnadnaangtoionxisidt athnat tparcotpsesrotlielsy[o2n7]t.hAe mdoeulabtloen-binlinMdTp(1la)caen-d bo-controlled eight-week trial investigated the efficacy of ramelteon for the treatment of outpatients with schizophrenia [28]
Hormonal changes during the menopausal transition may have an impact on sleep, including in those women diagnosed with psychosis
Summary
Schizophrenia is a severe mental illness, with an estimated prevalence of 1% in the global population [1], and a high burden of disease [2]. The authors conclude that sleep disturbances are common in patients with schizophrenia and are associated with the risk of suicide, a fact that highlights the need for more clinical attention, as well as the need for an urgent intervention into sleep disturbances in patients with schizophrenia [6]. This is in agreement with a recent study by Miller et al, that recruited 108 patients with nonaffective psychosis, including schizophrenic individuals. The results were quite interesting, as the patients with severe insomnia were more likely to have lifetime histories of suicide attempts than patients without insomnia, which suggests, once again, that an assessment of insomnia may be a marker of suicide risk and the severity of the symptoms
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