- Email: [email protected]
Assessment of menstrual cycle phase in women with schizophrenia
188
described as a young men disturbance. Currently, there are many evidences the course is different in men and women: its onset is later in women, they have a better premorbid functioning and better clinical course. These differences may be due to oestrogen action in schizophrenia symptoms: there is a worsening of symptoms and a increased onset of schizophrenia after menopause and variations in symptoms severity in schizophrenia during menstrual cycle are seen in some studies. Methods: We interviewed 38 female schizophrenic patients when they were admitted as inpatients due to psychotic relapse, evaluated their psychotic symptoms with BPRS and, during this interview or during the admission the day of menstrual cycle they were admitted was determined. Results. 18 patients were admitted in the first 9 days of the cycle, 7 in the l0 following days, and 14 in the 9 last days of the cycle, showing an increase of admissions in the beginning and end of the cycle (p = 0.049) when oestrogen levels are lower. Com'htsions: Oestrogen seems to modulate psychotic symptoms and relapses in schizophrenic women.
MENSTRUAL
CYCLE
CHANGES
IN
SCHIZOPHRENIA J. K u l k a r n i , A. de Castella, K. T h o m p s o n Monash UniversiO' Research Ck,ntre /br Women's Mental Health, Dandenong Hospital. 134 (7eehmd Street, Dandenon~, IGctoria 3175. Australia Using the Menstrual Cycle Interview (MCI) ( Kulkarni et al. 1994), 81 women with schizophrenia and 57 normal controls were studied. 32 neuroleptic free patients and 29 controls had their cycle phase estimated by the MCI plus serum estrogen. progesterone, LH and FSH values. 49 patients and 28 controls had their cycle phase estimated by using the MCI only. There was no significant difference in age between the two groups. 41.9% of the total patient population were not able to be menstrual cycle phased using the MCI only compared with 7% of controls. 37 out of 81 patients had regular cycles compared with 48 out of 57 controls. Hence more patients than controls had irregular cycles. Of the 44 patients who had irregular cycles, 70.4% had amenorrhoea, mostly for greater than 4 months. 54.3'7,, of the neuroleptic-free group of female patients experienced menstrual irregularities compared with 60.8%, of female patients receiving antipsychotic medication. Patients and controls equally experienced premenstrual syndrome symptoms. In general, controls experienced more
somatic symptoms while patients experienced more premenstrual changes in mood. A family history of menstrual problems was more prevalent in the control group than in the patient group. Overall, the standard of information about menstrual cycles was high in both the patient and control groups. Menstrual cycle abnormalities in psychotic women may reflect alterations in the hypothalamic-pituitary-gonadal axis function caused by the illness itself and also by antipsychotic drug treatment.
ASSESSMENT PHASE
OF MENSTRUAL
IN WOMEN
WITH
CYCLE
SCHIZOPHRENIA
J. K u l k a r n L A. de Castella, K. T h o m p s o n Monash UnirersiO" R¢~'earch Centre./br Women's Mental Health. Dandenone Hospital 134 Ch,eland Street, DandenonA,. Victoria 3175, Australia Biological research in schizophrenia, particularly neurochemical and neuroendocrinological research rarely includes female subjects. Even if women are included in studies, the contributing role of menstrual phase is often ignored. Yet, menstrual effects have been shown to occur in many biochemical systems that significantly impact on psychophysiological responses that may be altered in psychotic states (Parkes 1983, Collins et ah 1985). The main needs of researchers attempting to determine menstrual cycle phase in order to include women in biological research in schizophrenia, appear to be: (a) The reliable definition of cycle phase: (b) A reliable history-taking questionnaire: (c) Biological validation of the information obtained from history: (d) Adequate comparison with normal controls. We have developed a Menstrual Cycle Interview (MCI) which is a self-reporting, interview-assisted questionnaire. The questionnaire contains 14 questions and is conducted in conjunction with a blood test to measure serum estrogen, progesterone, lutenising hormone and follicle stimulating hormone. Using both the questionnaire information and hormonal assessment. the menstrual cycle phase can be assessed as either follicular or luteal phase. This procedure has been trialled in 81 women with schizophrenia and 57 control subjects. Overall, this process should allow better inclusion of women into biological studies of schizophrenia and enable the variable of menstrual cycle phase to be compared with control subjects across the follicular and luteal cycle phases.
described as a young men disturbance. Currently, there are many evidences the course is different in men and women: its onset is later in women, they have a better premorbid functioning and better clinical course. These differences may be due to oestrogen action in schizophrenia symptoms: there is a worsening of symptoms and a increased onset of schizophrenia after menopause and variations in symptoms severity in schizophrenia during menstrual cycle are seen in some studies. Methods: We interviewed 38 female schizophrenic patients when they were admitted as inpatients due to psychotic relapse, evaluated their psychotic symptoms with BPRS and, during this interview or during the admission the day of menstrual cycle they were admitted was determined. Results. 18 patients were admitted in the first 9 days of the cycle, 7 in the l0 following days, and 14 in the 9 last days of the cycle, showing an increase of admissions in the beginning and end of the cycle (p = 0.049) when oestrogen levels are lower. Com'htsions: Oestrogen seems to modulate psychotic symptoms and relapses in schizophrenic women.
MENSTRUAL
CYCLE
CHANGES
IN
SCHIZOPHRENIA J. K u l k a r n i , A. de Castella, K. T h o m p s o n Monash UniversiO' Research Ck,ntre /br Women's Mental Health, Dandenong Hospital. 134 (7eehmd Street, Dandenon~, IGctoria 3175. Australia Using the Menstrual Cycle Interview (MCI) ( Kulkarni et al. 1994), 81 women with schizophrenia and 57 normal controls were studied. 32 neuroleptic free patients and 29 controls had their cycle phase estimated by the MCI plus serum estrogen. progesterone, LH and FSH values. 49 patients and 28 controls had their cycle phase estimated by using the MCI only. There was no significant difference in age between the two groups. 41.9% of the total patient population were not able to be menstrual cycle phased using the MCI only compared with 7% of controls. 37 out of 81 patients had regular cycles compared with 48 out of 57 controls. Hence more patients than controls had irregular cycles. Of the 44 patients who had irregular cycles, 70.4% had amenorrhoea, mostly for greater than 4 months. 54.3'7,, of the neuroleptic-free group of female patients experienced menstrual irregularities compared with 60.8%, of female patients receiving antipsychotic medication. Patients and controls equally experienced premenstrual syndrome symptoms. In general, controls experienced more
somatic symptoms while patients experienced more premenstrual changes in mood. A family history of menstrual problems was more prevalent in the control group than in the patient group. Overall, the standard of information about menstrual cycles was high in both the patient and control groups. Menstrual cycle abnormalities in psychotic women may reflect alterations in the hypothalamic-pituitary-gonadal axis function caused by the illness itself and also by antipsychotic drug treatment.
ASSESSMENT PHASE
OF MENSTRUAL
IN WOMEN
WITH
CYCLE
SCHIZOPHRENIA
J. K u l k a r n L A. de Castella, K. T h o m p s o n Monash UnirersiO" R¢~'earch Centre./br Women's Mental Health. Dandenone Hospital 134 Ch,eland Street, DandenonA,. Victoria 3175, Australia Biological research in schizophrenia, particularly neurochemical and neuroendocrinological research rarely includes female subjects. Even if women are included in studies, the contributing role of menstrual phase is often ignored. Yet, menstrual effects have been shown to occur in many biochemical systems that significantly impact on psychophysiological responses that may be altered in psychotic states (Parkes 1983, Collins et ah 1985). The main needs of researchers attempting to determine menstrual cycle phase in order to include women in biological research in schizophrenia, appear to be: (a) The reliable definition of cycle phase: (b) A reliable history-taking questionnaire: (c) Biological validation of the information obtained from history: (d) Adequate comparison with normal controls. We have developed a Menstrual Cycle Interview (MCI) which is a self-reporting, interview-assisted questionnaire. The questionnaire contains 14 questions and is conducted in conjunction with a blood test to measure serum estrogen, progesterone, lutenising hormone and follicle stimulating hormone. Using both the questionnaire information and hormonal assessment. the menstrual cycle phase can be assessed as either follicular or luteal phase. This procedure has been trialled in 81 women with schizophrenia and 57 control subjects. Overall, this process should allow better inclusion of women into biological studies of schizophrenia and enable the variable of menstrual cycle phase to be compared with control subjects across the follicular and luteal cycle phases.