The Menopausal Transition
Interface between Gynecology and PsychiatryEditor(s): Soares C.N. (Hamilton, Ont.)
Warren M. (New York, N.Y.)
Psychotic Disorders and Menopause: The Untold StoryRiecher-Rössler A.
Psychiatric Outpatient Department, University Hospital Basel, Basel, Switzerland
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This chapter aims to give an overview on the influence of menopause on psychotic disorders.Menopause is associated with a loss of estrogens; estrogen has important neuro- and psychoprotec-tive activities, thus its decline and/or instability may trigger or aggravate mental disorders includingpsychotic ones. As a result, perimenopause may lead to an enhanced risk of first onset of schizophrenic psychoses or ‘late-onset schizophrenia’. Women with pre-existing chronic schizophreniatend to have a deterioration of their illness after menopause and a higher demand for antipsychoticmedication. Apart from the psychotic symptoms, many other conditions can be aggravated by theloss of estrogens, including sleep disturbances, irritability, depression, cognitive impairment andsexual problems. In addition, many females with diagnosis of schizophrenia may present with premature menopause due to antipsychotic or stress-induced hyperprolactinamia and the subsequentgonadal suppression. Apart from psychotherapy and social measures, replacement of 17β-estradiolmay be helpful in women with schizophrenia in the perimenopause and early postmenopause, butits use might also carry some risks. More research is needed on the indications and contraindicationsfor hormone replacement in this context.
© 2009 S. Karger AG, Basel
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