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Women with Schizophrenia-Spectrum Disorders After Menopause: A Vulnerable Group for Relapse.
- Source :
-
Schizophrenia bulletin [Schizophr Bull] 2023 Jan 03; Vol. 49 (1), pp. 136-143. - Publication Year :
- 2023
-
Abstract
- Background and Hypothesis: Throughout the life stages of women with schizophrenia-spectrum disorders (SSD), lower estrogen levels are associated with more severe disease course. At perimenopause in the mid-forties, estrogen levels decline to remain persistently low after menopause. This period is hypothesized to increase relapse risk and reduce antipsychotic effectiveness in preventing relapse.<br />Study Design: The cohort of persons with schizophrenia/schizoaffective disorder was identified from Finnish nationwide registers (N = 61 889) and stratified by sex and age <45 vs. ≥45 years. Hospitalizations for psychosis were defined per 5-year age group during the follow-up 1996-2017. Risk of psychosis hospitalization (Adjusted Hazard Ratio, aHR) was assessed using within-individual design, by comparing antipsychotic monotherapy use to nonuse periods in the same individuals for seven dose categories in defined daily doses (DDDs/day).<br />Results: Starting at age 45-50, women were consistently more often hospitalized for psychosis than their male peers. Women ≥45 had significantly higher aHRs than women <45 at antipsychotic monotherapy >0.6 DDDs/day, and than men at >1.1 DDDs/day. This female-specific age-dependent decrease in effectiveness was present for clozapine doses >0.6 DDDs/day, olanzapine doses >1.4 DDDs/day, and for specific doses of quetiapine (0.9-1.1 DDDs/day) and risperidone (0.6-0.9 DDDs/day).<br />Conclusions: While younger women have a lower risk of relapse and generally need a lower antipsychotic dose to prevent rehospitalization than men, antipsychotic effectiveness declines in women after the age of 45. Starting in mid-forties, older women with SSD should be regarded as a vulnerable group that deserve special attention.<br /> (© The Author(s) 2022. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.)
Details
- Language :
- English
- ISSN :
- 1745-1701
- Volume :
- 49
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Schizophrenia bulletin
- Publication Type :
- Academic Journal
- Accession number :
- 36198044
- Full Text :
- https://doi.org/10.1093/schbul/sbac139