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Ishikura IA, Hachul H, Moysés-Oliveira M, Fernandes GL, Tufik S, Andersen ML. Sleep is altered during menstruation but not inflammatory parameters: Results from polysomnography of EPISONO database. J Sleep Res 2025; 34:e14380. [PMID: 39448073 DOI: 10.1111/jsr.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/16/2024] [Accepted: 09/24/2024] [Indexed: 10/26/2024]
Abstract
Menstruation is an inflammatory process that involves changes in women's physiology leading to mental and physical complaints. Sleep is essential for optimal hormonal release, immune response, and wellbeing, becoming an important factor to be evaluated. We compared sleep, inflammatory mediators, fatigue, anxiety and depression symptoms, and quality of life in menstruating and non-menstruating women. We used the polysomnographic data of 232 women from EPISONO 2007, an epidemiological study from São Paulo city, Brazil. Women were distributed into menstruating (N = 61) and non-menstruating groups (N = 171). We applied questionnaires related to sleep quality, sleepiness, insomnia, fatigue, anxiety and depression symptoms, and quality of life. The serum levels of interleukin 6, tumour necrosis factor-alpha, and C-reactive protein were analysed. For statistical analysis the significance level adopted was p < 0.05. Sleep efficiency was statistically lower in menstruating women (81% ± 13) compared with the non-menstruating group (84.2% ± 13.3, p < 0.023). No statistical differences between the two groups were found in respect to the other parameters analysed. Both groups scored for fatigue symptoms, but no statistical significance was observed between the groups. Our findings indicate that menstruation was associated with lower objective sleep efficiency, suggesting that menstruation may be a physiological factor impairing sleep. Further studies evaluating menstrual variables, and each phase of the menstrual cycle, should be undertaken to detect the main factors associated with sleep complaints, fatigue, and objective parameters of sleep.
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Affiliation(s)
- Isabela A Ishikura
- Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Helena Hachul
- Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Department of Gynecology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Sergio Tufik
- Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Sleep Institute, Research Incentive Fund Association (AFIP), São Paulo, Brazil
| | - Monica L Andersen
- Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Sleep Institute, Research Incentive Fund Association (AFIP), São Paulo, Brazil
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2
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Costa TA, Menezes MDPN. The biological and psychological impact of the Coronavirus disease-19 pandemic on the characteristics of the menstrual cycle. J Turk Ger Gynecol Assoc 2024; 25:259-265. [PMID: 39658940 PMCID: PMC11632643 DOI: 10.4274/jtgga.galenos.2024.2023-6-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/05/2024] [Indexed: 12/12/2024] Open
Abstract
The Coronavirus disease-19 (COVID-19) pandemic was declared in March 2020 by the World Health Organization. The severe acute respiratory syndrome-coronavirus-2 virus enters host cells through angiotensin-converting enzyme 2 receptors and transmembrane serine protease type II that are expressed in pulmonary alveoli, as well as in hepatocytes, endothelium, ovaries, uterus, vagina, thyroid, and other tissues. In addition to viral injury, the COVID-19 pandemic, through protective measures such as social isolation and lockdown, has promoted a scenario of psychosocial stress, especially in women. In this context of isolation, anxiety, fear, and mental distress, there is dysregulation of the hypothalamic-pituitary-adrenal axis and subsequent gonadal side effects. Furthermore, studies report an association between COVID-19 and temporary menstrual cycle alterations such, as increased cycle duration, decreased cycle duration, increased menstrual flow, dysmenorrhea, and amenorrhea. Regarding COVID-19 vaccination, menstrual irregularities have been observed in about half of the women, predominantly with a decrease in cycle duration and increased menstrual flow, but without fertility sequelae. The aim of this study was to review the most up-to-date information on the relationship between the COVID-19 pandemic and menstrual irregularities.
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Affiliation(s)
- Tiago Almeida Costa
- Department of Obstetrics and Gynecology, 8 COREME of the São Paulo Municipal Health Department, São Paulo, Brazil
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3
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van Staden D, Gerber M, Lemmer HJR. The Application of Nano Drug Delivery Systems in Female Upper Genital Tract Disorders. Pharmaceutics 2024; 16:1475. [PMID: 39598598 PMCID: PMC11597179 DOI: 10.3390/pharmaceutics16111475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 11/11/2024] [Accepted: 11/15/2024] [Indexed: 11/29/2024] Open
Abstract
The prevalence of female reproductive system disorders is increasing, especially among women of reproductive age, significantly impacting their quality of life and overall health. Managing these diseases effectively is challenging due to the complex nature of the female reproductive system, characterized by dynamic physiological environments and intricate anatomical structures. Innovative drug delivery approaches are necessary to facilitate the precise regulation and manipulation of biological tissues. Nanotechnology is increasingly considered to manage reproductive system disorders, for example, nanomaterial imaging allows for early detection and enhances diagnostic precision to determine disease severity and progression. Additionally, nano drug delivery systems are gaining attention for their ability to target the reproductive system successfully, thereby increasing therapeutic efficacy and decreasing side effects. This comprehensive review outlines the anatomy of the female upper genital tract by highlighting the complex mucosal barriers and their impact on systemic and local drug delivery. Advances in nano drug delivery are described for their sustainable therapeutic action and increased biocompatibility to highlight the potential of nano drug delivery strategies in managing female upper genital tract disorders.
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Affiliation(s)
| | | | - Hendrik J. R. Lemmer
- Centre of Excellence for Pharmaceutical Sciences (PharmacenTM), North-West University, Potchefstroom 2531, South Africa; (D.v.S.); (M.G.)
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Kuhathasan N, Ballester PL, Minuzzi L, MacKillop J, Frey BN. Predictors of perceived symptom change with acute cannabis use for mental health conditions in a naturalistic sample: A machine learning approach. Compr Psychiatry 2023; 122:152377. [PMID: 36787672 DOI: 10.1016/j.comppsych.2023.152377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Despite limited clinical evidence of its efficacy, cannabis use has been commonly reported for the management of various mental health concerns in naturalistic field studies. The aim of the current study was to use machine learning methods to investigate predictors of perceived symptom change across various mental health symptoms with acute cannabis use in a large naturalistic sample. METHODS Data from 68,819 unique observations of cannabis use from 1307 individuals using cannabis to manage mental health symptoms were analyzed. Data were extracted from Strainprint®, a mobile app that allows users to monitor their cannabis use for therapeutic purposes. Machine learning models were employed to predict self-perceived symptom change after cannabis use, and SHapley Additive exPlanations (SHAP) value plots were used to assess feature importance of individual predictors in the model. Interaction effects of symptom severity pre-scores of anxiety, depression, insomnia, and gender were also examined. RESULTS The factors that were most strongly associated with perceived symptom change following acute cannabis use were pre-symptom severity, age, gender, and the ratio of CBD to THC. Further examination on the impact of baseline severity for the most commonly reported symptoms revealed distinct responses, with cannabis being reported to more likely benefit individuals with lower pre-symptom severity for depression, and higher pre-symptom severity for insomnia. Responses to cannabis use also differed between genders. CONCLUSIONS Findings from this study highlight the importance of several factors in predicting perceived symptom change with acute cannabis use for mental health symptom management. Mental health profiles and baseline symptom severity may play a large role in perceived responses to cannabis. Distinct response patterns were also noted across commonly reported mental health symptoms, emphasizing the need for placebo-controlled cannabis trials for specific user profiles.
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Affiliation(s)
- Nirushi Kuhathasan
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Pedro L Ballester
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Luciano Minuzzi
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L8N 3K7, Canada.
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5
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Nolan LN, Hughes L. Premenstrual exacerbation of mental health disorders: a systematic review of prospective studies. Arch Womens Ment Health 2022; 25:831-852. [PMID: 35867164 DOI: 10.1007/s00737-022-01246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Mental health disorders can be exacerbated during periods of hormonal fluctuation (e.g. pregnancy, menopause), and the risk factors for sensitivity to these fluctuations are similar to those of mental disorders (e.g. trauma). However, the extent to which hormonal fluctuations during the menstrual cycle impact symptoms of preexisting mental disorders remains unclear. Prospective methodology is considered the gold standard for measuring symptoms across the menstrual cycle. Thus, the aim of the review was to address this knowledge gap by summarising all available studies prospectively measuring symptoms of mental disorders across the menstrual cycle. A systematic review with narrative synthesis was conducted; meta-analysis was precluded due to methodological heterogeneity of included studies. Electronic databases MEDLINE, Embase, PyschINFO and CINAHL were systematically searched from inception. Risk of bias for individual studies was assessed using a modified version of the Newcastle-Ottawa Scale. The search identified 629 studies from which 35 met inclusion criteria. There was clear evidence of symptom exacerbation during the perimenstrual phase for psychotic disorders, panic disorder, eating disorders, depression and borderline personality disorder. Less consistent evidence was found for anxiety, and a different pattern of symptom exacerbation was observed in bipolar disorder. Sample size and methodology varied considerably amongst studies. Overall, there was mixed evidence for perimenstrual exacerbation across mental disorders, which could be partly explained by methodological limitations of the studies. However, hormonal fluctuations during the menstrual cycle may exacerbate psychiatric symptoms in a subgroup of individuals who are hormone sensitive.
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Affiliation(s)
| | - Liz Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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6
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Kim HJJ, Zagzoog A, Black T, Baccetto SL, Ezeaka UC, Laprairie RB. Impact of the mouse estrus cycle on cannabinoid receptor agonist-induced molecular and behavioral outcomes. Pharmacol Res Perspect 2022; 10:e00950. [PMID: 35466560 PMCID: PMC9035509 DOI: 10.1002/prp2.950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/05/2022] [Indexed: 12/14/2022] Open
Abstract
Sexual dimorphisms are observed in cannabinoid pharmacology. It is widely reported that female animals are more sensitive to the cataleptic, hypothermic, antinociceptive, and anti‐locomotive effects of cannabinoid receptor agonists such as CP55,940. Despite awareness of these sex differences, there is little consideration for the pharmacodynamic differences within females. The mouse estrus cycle spans 4–5 days and consists of four sex hormone‐mediated phases: proestrus, estrus, metestrus, and diestrus. The endocannabinoid system interacts with female sex hormones including β‐estradiol, which may influence receptor expression throughout the estrus cycle. In the current study, sexually mature female C57BL/6 mice in either proestrus or metestrus were administered either 1 mg/kg i.p. of the cannabinoid receptor agonist CP55,940 or vehicle. Mice then underwent the tetrad battery of behavioral assays measuring catalepsy, internal body temperature, thermal nociception, and locomotion. Compared with female mice in metestrus, those in proestrus were more sensitive to the anti‐nociceptive effects of CP55,940. A similar trend was observed in CP55,940‐induced catalepsy; however, this difference was not significant. As for cannabinoid receptor expression in brain regions underlying antinociception, the spine tissue of proestrus mice that received CP55,940 exhibited increased expression of cannabinoid receptor type 1 relative to treatment‐matched mice in metestrus. These results affirm the importance of testing cannabinoid effects in the context of the female estrus cycle.
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Affiliation(s)
- Hye Ji J Kim
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ayat Zagzoog
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tallan Black
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sarah L Baccetto
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Udoka C Ezeaka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert B Laprairie
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Department of Pharmacology, College of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Brand BA, Haveman YRA, de Beer F, de Boer JN, Dazzan P, Sommer IEC. Antipsychotic medication for women with schizophrenia spectrum disorders. Psychol Med 2022; 52:649-663. [PMID: 34763737 PMCID: PMC8961338 DOI: 10.1017/s0033291721004591] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.
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Affiliation(s)
- Bodyl A. Brand
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yudith R. A. Haveman
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Franciska de Beer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janna N. de Boer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Iris E. C. Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Discuss and outline the general and overlapping effects of the menstrual cycle on women's mental health. ABSTRACT A growing body of research demonstrates menstrual cycle-dependent fluctuations in psychiatric symptoms; these fluctuations can therefore be considered as prevalent phenomena. Possible mechanisms underlying these fluctuations posit behavioral, psychological, and neuroendocrine influences. Recent reviews document cyclic exacerbation of symptoms and explore these mechanisms in the context of specific and often single disorders. The question remains, however, as to whether there are general and overlapping effects of the menstrual cycle on women's mental health. To address this gap, we synthesized the literature examining the exacerbation of a variety of psychiatric symptoms across the menstrual cycle in adult women. Results show that the premenstrual and menstrual phases are most consistently implicated in transdiagnostic symptom exacerbation. Specifically, strong evidence indicates increases in psychosis, mania, depression, suicide/suicide attempts, and alcohol use during these phases. Anxiety, stress, and binge eating appear to be elevated more generally throughout the luteal phase. The subjective effects of smoking and cocaine use are reduced during the luteal phase, but fewer data are available for other substances. Less consistent patterns are demonstrated for panic disorder, symptoms of posttraumatic stress disorder, and borderline personality disorder, and it is difficult to draw conclusions for symptoms of generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and trichotillomania because of the limited data. Future research should focus on developing standardized approaches to identifying menstrual cycle phases and adapting pharmacological and behavioral interventions for managing fluctuations in psychiatric symptoms across the menstrual cycle.
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Abstract
A first step towards personalized medicine is to consider whether, for some disorders, the safest and most effective treatment of women needs to differ from standard guideline recommendations developed on the basis of clinical trials conducted, for the most part, in men. A second step is to consider how women’s reproductive stages—pre-pubertal years, menstrual phases, pregnancy trimesters, lactation and postpartum periods, menopausal and postmenopausal/aging status—affect the optimal choice of treatment. This review focuses on these two steps in the treatment of psychosis, specifically schizophrenia. It discusses genetics, precursors and symptoms of schizophrenia, reproductive and associated ethical issues, antipsychotic drug response and adverse effects, substance abuse, victimization and perpetration of violence, and issues of immigration and of co-morbidity. The conclusions, while often based on clinical experience and theoretical considerations rather than strictly on the evidence of randomized controlled trials, are that clinical recommendations need to consider clinical and role differences that exist between men and women and make appropriate correction for age and reproductive status.
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10
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González-Rodríguez A, Guàrdia A, Álvarez Pedrero A, Betriu M, Cobo J, Acebillo S, Monreal JA, Seeman MV, Palao D, Labad J. Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:5594. [PMID: 32756418 PMCID: PMC7432627 DOI: 10.3390/ijerph17155594] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life-paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods-while constituting vulnerable time periods for the mother-require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Autonomous University of Barcelona (UAB), 08280 Sabadell, Barcelona, Spain; (A.Á.P.); (J.C.); (S.A.); (J.A.M.); (D.P.); (J.L.)
| | - Armand Guàrdia
- Department of Mental Health, Parc Taulí University Hospital, 08280 Sabadell, Barcelona, Spain; (A.G.); (M.B.)
| | - Aida Álvarez Pedrero
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Autonomous University of Barcelona (UAB), 08280 Sabadell, Barcelona, Spain; (A.Á.P.); (J.C.); (S.A.); (J.A.M.); (D.P.); (J.L.)
| | - Maria Betriu
- Department of Mental Health, Parc Taulí University Hospital, 08280 Sabadell, Barcelona, Spain; (A.G.); (M.B.)
| | - Jesús Cobo
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Autonomous University of Barcelona (UAB), 08280 Sabadell, Barcelona, Spain; (A.Á.P.); (J.C.); (S.A.); (J.A.M.); (D.P.); (J.L.)
| | - Sidharta Acebillo
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Autonomous University of Barcelona (UAB), 08280 Sabadell, Barcelona, Spain; (A.Á.P.); (J.C.); (S.A.); (J.A.M.); (D.P.); (J.L.)
| | - José Antonio Monreal
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Autonomous University of Barcelona (UAB), 08280 Sabadell, Barcelona, Spain; (A.Á.P.); (J.C.); (S.A.); (J.A.M.); (D.P.); (J.L.)
| | - Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON M5P 3L6, Canada;
| | - Diego Palao
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Autonomous University of Barcelona (UAB), 08280 Sabadell, Barcelona, Spain; (A.Á.P.); (J.C.); (S.A.); (J.A.M.); (D.P.); (J.L.)
| | - Javier Labad
- Department of Mental Health, Parc Taulí University Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Autonomous University of Barcelona (UAB), 08280 Sabadell, Barcelona, Spain; (A.Á.P.); (J.C.); (S.A.); (J.A.M.); (D.P.); (J.L.)
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11
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Ragazan DC, Eberhard J, Berge J. Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study. Front Psychiatry 2020; 11:598946. [PMID: 33262715 PMCID: PMC7688467 DOI: 10.3389/fpsyt.2020.598946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Long-term pharmacological maintenance therapy is often essential among people with bipolar disorder to reduce the need for inpatient care. Sex-specific responses to maintenance therapies are expected but remain largely unknown. Here, we examined for sex-specific associations between common maintenance therapies for bipolar disorder with inpatient rehospitalizations following patients' index discharges during 2006-2014. Methods: Population-based data on maintenance therapies and rehospitalizations were extracted from Swedish national registries. We adopted the within-individual design to compare the time on- vs. off- maintenance therapy for males and females, respectively. Extended stratified Cox proportional hazards regression models were employed to quantify the rate of rehospitalization as a function of common maintenance drugs and other important time-varying control variables. Results: Our primary analysis included 22,681 bipolar disorder rehospitalizations by 6,400 males and 9,588 (60.0%) females over an observation time of 62,813 person-years. The time spent on- vs. off- maintenance lithium, lamotrigine, quetiapine, or olanzapine was statistically significant upon adjustment among either sex for reducing the rate of bipolar rehospitalizations. Adjusted sex-specific statistically significant associations were also observed. Among females, the time on- (vs. off-) long-acting injectable risperidone reduced the rate of bipolar rehospitalizations by 73% (56-84%), carbamazepine by 44% (18-62%), aripiprazole by 29% (13-42%), and valproate by 23% (11-33%); whereas among males, ziprasidone by 65% (41-79%). Conclusion: The effectiveness of most maintenance therapies is generally comparable and uniform among both males and females. Despite some statistically significant sex-specific associations, estimates for each drug were fairly consistent between sexes.
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Affiliation(s)
- Dragos C Ragazan
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Vancouver Coastal Health Authority, University of British Columbia Hospital Detwiller Pavilion, Vancouver, BC, Canada
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden
| | - Jonas Berge
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, Sweden
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