Psychotic episode secondary to gonadotrophins

Psychopharmacological interventions among people who use Assisted Reproductive Technology (ART) - a scoping review

BACKGROUND

One in six people experience infertility, often leading couples to seek Assisted Reproductive Technology (ART), which can be emotionally taxing. Anxiety and depression are common among individuals undergoing ART, highlighting the need for integrated mental health support, especially for women who face heightened risk of psychiatric disorders during their reproductive years. Despite the importance of psychiatric care, there is limited knowledge regarding the use of psychiatric medications among individuals undergoing ART.

METHODS

Following a pre-written protocol (osf.io/egxw8/), we systematically searched electronic databases (Ovid MEDLINE, Embase, CENTRAL, Web of Science, PsycInfo, Scopus) up to 15.02.2025 to identify any study focused on psychopharmacotherapy among people undergoing ART. Two independent reviewers screened titles, abstracts, and full texts, performed data extraction, and resolved conflicts through discussion or consultation with a third reviewer. We synthesized data using descriptive analysis and performed analysis within the following subgroups: (1) group of medication according to Neuroscience-based Nomenclature (NbN) classes; (2) indication for using a specific medication (psychiatric / non-psychiatric).

RESULTS

We included 29 studies published in 31 papers. Psychiatric medications were primarily administered for the treatment of depression (n=12/29 studies, 41.38%) and anxiety disorders (n=8/29, 27.59%). Among all groups of medication serotonin reuptake inhibitors were the most commonly studied class of medications (n=15/29 studies, 51.72%), with fluoxetine being the most frequently used medication (n=8/29, 27.59%). Among medications for anxiety, GABA Positive Allosteric Modulators with midazolam occurred the most frequently (n=6/29, 20.69%). Medications for psychosis included single drugs: olanzapine, clozapine, risperidone, quetiapine, aripiprazole, haloperidol, and promethazine. Among medications that could be used in bipolar disorder there were: valproic acid, lithium, and lamotrigine. The most commonly reported endpoints in the studies were psychiatric symptom severity (n=11/29, 37.93%) and ART efficacy (n=10/29, 34.48%).

CONCLUSION

Evidence on the use of psychopharmacotherapy in ART primarily concerns women. Available literature indicates that psychopharmacotherapy for individuals undergoing ART frequently involves medications commonly used in general psychiatric practice, with a tendency toward lower dosing and a preference for serotonin reuptake inhibitors. However, this observation should be interpreted cautiously, as current evidence remains limited and further research is warranted to establish treatment patterns more conclusively. The variability in study designs and reporting standards further highlights the need for standardized methodologies and improved adherence to reporting guidelines to enhance the quality and applicability of future research.

TRIAL REGISTRATION

Review registration number: osf.io/egxw8/.

Perimenstrual psychiatric hospitalization: case report and literature review

Despite the fact that menstrual psychosis has been described since the eighteenth century, there are only about 80 cases reported in the literature. The knowledge and awareness about the disorder remain poor, leading to inaccurate diagnoses and suboptimal treatment. This is the case of a 25-year-old woman with recurrent hospitalizations for mental status changes including psychotic phenomena and catatonia that appeared to follow a cyclical pattern that correlated with her menstrual periods, with complete symptom resolution and return to her usual level of functioning between episodes despite continued treatment with antipsychotic medications. This pattern remitted only after hormonal therapy was initiated. Through this case report, the authors review the literature on the menstrual psychoses, exemplified by this case, and discuss treatment options and prognosis. Menstrual psychosis is an underrecognized condition where psychotic symptoms recur cyclically with menses. Given the poor response that this entity shows to antipsychotic treatment, hormonal therapies have a prominent role.