P.1.e.001 Have sex hormones a role in the pathogenesis of psychotic symptoms in major psychoses?

Abstract

Purpose of the Study: Sex hormones act as modulators of neurotransmitters in the brain and appear to be implicated in the pathogenesis and prognosis of mood disorders and schizophrenia. Preliminary data would indicate high levels of progesterone to be protective against psychotic symptoms [1,2], while, with regard to dehydroepiandrosterone (DHEA), results are discordant. If in one study DHEA appeared to protect bipolar patients against paranoid delusions, in another this hormone was found to be higher in schizophrenia patients compared with healthy controls [2,3]. Aim of this study is to compare the levels of progesterone and DHEA between patients with different diagnosis and in relation to the presence of psychotic symptoms. Methods: Fifty-five male patients, consecutively hospitalized in our patients’ clinic, were included into the study. Inclusion criteria consisted of: (1) a diagnosis of a mood or psychotic disorder and (2) lack of clinical conditions affecting hormonal plasma concentrations. Progesterone and DHEA plasma dosages were always measured at the admission in the morning and patients had to be drug free for at least two weeks Two analyses of variance (ANOVAs) were performed: in the first one plasma progesterone and DHEA plasma levels were compared according to diagnostic subgroups (schizophrenia, mood disorders, substance induced psychosis); in the second one the plasma levels of the two hormones were compared according to the presence of psychotic symptoms. Finally a binary logistic regression was performed to find if clinical variables were associated with abnormal plasma levels of DHEA or progesterone. In particular, age at onset, duration of illness, duration of untreated illness, BPRS mean total score, BPRS (unusual thought content) mean score, BPRS (hallucinations) mean score and the sum of mean scores of the two BPRS items were considered as independent variables, while the presence of abnormal DHEA/progesterone plasma levels as the dependent variable. Results: 20% of total sample (N= 55) presented abnormal values of DHEA and 32.7% of progesterone. Higher plasma levels of DHEA were found in patients with a history of psychotic symptoms (F = 8.454, p = 0.005), and plasma levels of progesterone showed only a trend (F = 3.772, p = 0.058). In contrast no significant differences of the plasma levels of the two hormones emerged between diagnostic groups (F = 0.859, p = 0.43). A longer duration of untreated illness was found to be positively associated with abnormal plasma levels of DHEA (OR= 1.193, p = 0.032), while a significant negative association was found between BPRS (unusual thought content) scores and abnormal plasma levels of DHEA (OR= 0.544, p = 0.04). Conclusions: Higher plasma levels of DHEA appear to be associated with the occurrence of psychotic symptoms, but less prominent delusional symptoms in acute phase. These results could indicate that high plasma levels of DHEA would be an index of chronicity independently from the diagnosis, but they could be protective against the acute psychotic exacerbation. Previous conflicting data can be explained on the basis of these findings.