Peri- and Post-Menopausal Women with Schizophrenia and Related Disorders Are a Population with Specific Needs: A Narrative Review of Current Theories

Alexandre González-Rodríguez,Armand Guàrdia,José Antonio Monreal

doi:10.3390/jpm11090849

Abstract

Background: While gender differences in antipsychotic response have been recognized, the potential role of menopause in changing drug efficacy and clinical outcome in schizophrenia related disorders has been understudied. We aimed to review the relevant literature to test whether optimizing menopausal and post-menopausal treatment and addressing specific health needs of this stage in life will improve outcome. Methods: Non-systematic narrative review using the PubMed database (1900–July 2021) focusing on randomized controlled trial results addressing our question. Forty-nine studies met our criteria. Results: Premenopausal women show significantly better antipsychotic response than postmenopausal women. Hormone replacement therapies (HRT) should be used in postmenopausal women with schizophrenia with caution. Raloxifene, combined with antipsychotics, is effective for psychotic and cognitive symptoms in postmenopausal women with schizophrenia and related disorders. Medical comorbidities increase after menopause, but the influence of comorbidities on clinical outcomes has been poorly investigated. Preventive strategies include weighing risks and benefits of treatment, preventing medical comorbidities, and enhancing psychosocial support. Ideal treatment settings for this population warrant investigation. Conclusions: Antipsychotic dose adjustment at menopause is recommended for schizophrenia. Raloxifene may play an important role in permitting dose reduction and lessening adverse effects. Prevention of comorbidities will help to reduce the mortality rate.

Highlights

Aside from the all-important chromosomal difference between the sexes, levels of gonadal hormones are that which most distinguish males and females
Of antipsychotic in postmenopausal women with choice of antipsychotic in postmenopausal women schizophrenia and related disorders, (2) antipsychotic dose adjustment, (3) addition of with schizophrenia and related disorders, (2) antipsychotic dose adjustment, (3) addition hormone replacement therapy, (4) addition of therapeutic oestrogen or selective oestrogen of hormone replacement therapy, (4) addition of therapeutic oestrogen or selective oesmodulators, (5) impact of menopausal symptoms and comorbidities on treatment decisions, trogen modulators, impact of menopausal and comorbidities treatment impact of family (5)
The term neuroleptic refers to the extrapyramidal symptoms or neurological side effects associated with antipsychotic use

Summary

Introduction

Aside from the all-important chromosomal difference between the sexes, levels of gonadal hormones are that which most distinguish males and females. Using an animal model of psychosis (reversing disrupted latent inhibition), Arad and Weiner have shown that, in ovariectomized rats, co-administration of 17 beta-estradiol with haloperidol and clozapine increases the antipsychotic-like effect, the effect on positive symptoms, as evaluated in animal models [8]. This suggests that the treatment of women with schizophrenia requires a post-reproductive stage focus that differs from that called for in standard treatment guidelines [9].

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