"Epidemiologic observations of sex differences in the onset and course of schizophrenia prompted exploration of oestrogen's role in schizophrenia," the authors wrote.

Jayashri Kulkarni, PhD, The Alfred and Monash University and The Alfred Hospital, Melbourne, Australia, and colleagues, conducted a randomised, double-blind study involving 102 women of child-bearing age with schizophrenia.

For 28 days, 56 women were randomly assigned to receive oestradiol 100 mcg QD via a skin patch and 46 women received a placebo skin patch in addition to their regular medications. Psychotic symptoms were assessed weekly with a commonly used scale.

The group of women taking oestradiol exhibited a greater improvement in psychotic symptoms over time than did the women taking antipsychotic medications alone. They also experienced a decline in positive symptoms. No difference was observed between the 2 groups regarding negative symptoms.

"Oestrogen's neuroprotective and psychoprotective actions may be mediated by a variety of routes, ranging from rapid actions, including antioxidant effects and enhancement of cerebral blood flow and cerebral glucose utilisation, to slower, genomic mechanisms, which may include permanent modification of neural circuits," the authors wrote.

"The lack of effect for negative symptoms is consistent with literature reporting that negative symptoms are less responsive to treatment than other symptoms of schizophrenia. It is possible that longer-term treatment is required for negative symptoms to respond to treatment. Alternatively, brain regions implicated in negative symptoms may be less responsive to gonadal hormone effects."

Oestrogen may have a preventive role in women with schizophrenia who undergo hormonal changes shown to cause a deterioration of their condition, such as those following childbirth and menopause, the authors noted.

"Oestrogen treatment is a promising new area for future treatment of schizophrenia and potentially for other severe mental illnesses," wrote the authors.


SOURCE: Journal of the American Medical Association

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