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January 2011



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Estrogen May Prevent Psychosis

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on January 21, 2010

New laboratory evidence on an animal model suggests hormone replacement therapy may protect women from schizophrenia.

Estrogen is widely used to mitigate negative effects of menopause including bone loss and mood swings.

Prof. Ina Weiner of Tel Aviv University’s Department of Psychology and colleagues report on findings that suggest restoring normal levels of estrogen may work as a protective agent in menopausal women vulnerable to schizophrenia.

Their work, based on an animal model of menopausal psychosis, is found in the journal Psychopharmacology.

“We’ve known for some time that when the level of estrogen is low, vulnerability to psychotic symptoms increases and anti-psychotic drugs are less likely to work. Now, our pre-clinical findings show why this might be happening,” says Prof. Weiner.

In their study, Weiner and Arad removed the ovaries of female rats to induce menopause-like low levels of estrogen and showed that this led to schizophrenia-like behavior. The researchers then tried to eliminate this abnormal behavior with an estrogen replacement treatment or with the antipsychotic drug haloperidol.

Estrogen replacement therapy effectively alleviated schizophrenia-like behavior but haloperidol had no effect on its own. Haloperidol regained its effect in these rats when supplemented by estrogen.

“When the level of estrogen was low, we could see psychotic-like behavior in the animals. Moreover, the sensitivity to psychosis-inducing drugs went up, while the sensitivity to anti-psychotic drugs went down,” Prof. Weiner says. This is exactly what we observe in women with low estrogen levels,” she says.

“But we also found that estrogen, all by itself, combats psychosis in both male and female rats.” Furthermore, in low amounts estrogen increases the effectiveness of anti-psychotic drugs.

Prof. Weiner points out that the medical community is hotly debating the pros and cons of estrogen replacement as an add-on to conventional treatment in schizophrenia. Detractors point to higher chances of cervical cancer and heart attacks in those who receive estrogen supplements.

But according to her study, which looked at very specific factors possibly related to schizophrenia, estrogen replacement therapy could have positive behavioral effects, she concludes.

During the course of a woman’s lifetime, estrogen levels do not remain constant. During her reproductive years, these levels are affected by the menstrual cycle. There are also dramatic changes in the levels of estrogen just after a woman gives birth — a change, which can trigger “post-partum blues,” and in extreme cases lead to clinical depression and psychosis.

As a preventative therapy, estrogen could be given to women at certain points in time when they are most at risk for schizophrenia, Prof. Weiner suggests: in their mid-twenties and later during the menopausal years.

“Antipsychotic drugs are less effective during low periods of estrogen in the body, after birth and in menopause,” says Prof. Weiner.

“Our research links schizophrenia and its treatment to estrogen levels. Men seem less likely to begin schizophrenia after their 40s, which also suggests that estrogen is the culprit.”

Source: American Friends of Tel Aviv University

By National Institute of Mental Health

Psychotic features are often present during the manic phase of bipolar I disorder. Aspects of psychosis may also manifest during extreme episodes of depression. They are also present in schizophrenia and schizoaffective disorder. These features include delusions (false ideas about what is taking place or who one is) and hallucinations (seeing or hearing things which aren’t there).


Here is a brief but comprehensive definition of Catatonia and catatonic features – which may be present in bipolar disorder – schizoaffective disorder – or schizophrenia.

Delusion of Reference

Delusions of Reference refers to the strongly held belief that random events, objects, behaviors of others, etc., have a particular and unusual significance to oneself.


Delusions are false beliefs that are firmly held. They are one aspect of the psychotic features of bipolar disorder, schizophrenia and schizoaffective disorder.


Hallucinations are most often associated with mental illness schizophrenia. However, they may also occur for those with bipolar disorder when either depression or mania has psychotic features.


Negativism is a trait of catatonic stupor.


Found here is a brief but comprehensive definition of paranoia – which may be present in bipolar disorder or schizophrenia as well as several other mental illnesses.


Psychosis is a loss of contact with reality, typically including delusions (false ideas about what is taking place or who one is) and hallucinations (seeing or hearing things which aren’t there).

Source:   http://psychcentral.com/lib/2007/bipolar-disorder-with-psychotic-features/


Psychotic Depression

By National Institute of Mental Health

There’s depression, which if you have depression, most people have. And then there’s psychotic depression, or more technically known as major depressive disorder with psychotic features. This is a far less common disorder than simple depression.

Psychotic depression is characterized by not only depressive symptoms, but also by hallucinations (seeing or hearing things that aren’t really there) or delusions (irrational thoughts and fears). Often psychotically depressed people become paranoid or come to believe that their thoughts are not their own (thought insertion) or that others can ‘hear’ their thoughts (thought broadcasting).

While people with other mental illness, like schizophrenia also experience these symptoms, those with psychotic depression are usually aware that these thoughts aren’t true. They may be ashamed or embarrassed and try to hide them, sometimes making this variation difficult to diagnose. Risk of bipolar depression, recurring episodes of psychotic depression and suicide are increased after its onset.

Researchers aren’t exactly sure what causes major depressive disorder with psychotic features (psychotic depression), but it’s frequently associated with high levels in the blood of a hormone called cortisol ( Cortisol is an important steroid hormone produced by the adrenal glands. The blood levels of this hormone typically follow a pattern throughout the day, with the lowest levels occurring around 4 in the afternoon. More cortisol is released during times of stress — biological and psychological).

There are no obvious risk factors, though it is known that those with a family history of depression or psychotic illness will be more susceptible.

Symptoms of Psychotic Depression

Symptoms that occur more commonly in psychotically depressed patients include:

  • Anxiety
  • Agitation
  • Hypochondria
  • Insomnia
  • Physical immobility
  • Constipation
  • Cognitive impairment

Treatment of Psychotic Depression

Treatment for psychotic depression requires a longer hospital stay and close follow-up by a mental health professional. Combinations of tricyclic antidepressants and antipsychotic medications have been most effective in easing symptoms. The addition of lithium to this combination can be beneficial for those with bipolar disorder. Electroconvulsive therapy is very effective for this condition, but it is generally a second line treatment.

Researchers are also studying the effectiveness of RU-486 (the “abortion pill” and “emergency contraceptive”), which is said to dramatically relieve psychotic depression.

Prognosis of Psychotic Depression

Treatment is very effective for psychotic depression and people are able to recover, usually within a year, but continual medical follow-up may be necessary. Generally, the depressive symptoms have a much higher rate of recurrence than the psychotic symptoms. It is important, however, that a person experiencing these symptoms be properly diagnosed because treatment is different than for other major depressive illnesses and risk of suicide is greater.

What Psychotic Depression Is Like

Susan probably suffered from a form of depression since she was about 7 years old. Then one day, things changed dramatically for the worse.

“My marriage fell apart when I was 24. For two years after that I was ‘crazy’. Angry all the time. Tired, but I couldn’t afford to be. I had a 5 year old son to support and the rent to pay and the housework to do etc etc. I was prone to bursting into tears. I was suffering from pain in my back – my period pain was excruciating. I went to doctors, of course. I was told I probably had soft tissue damage to my back from child birth. My period pain was supposedly fixed with “the pill”. My tiredness was treated with comments like, ‘it’s probably stress, you need to relax more, here listen to this tape, or do yoga, or have you tried hypnotherapy’.”

“Then one day at work, one of my bosses made a passing comment about my “delinquent son”. He meant nothing by it, just a tease. But I started to cry. I couldn’t stop. Not even having a cup of coffee or a cigarette in my mouth could stop the tears from falling. I was still crying at 2.00pm at the end of lunch hour, so I went home. I sat in the middle of my living room floor and continued to cry.”

“As the days passed, I started to believe that the people at work were after me and were going to take my son away. When I watched the newscasts on tv, the reporters were whispering special messages warning me of impending doom and telling me what to do.”

“My mother was very worried about me and finally she said ‘you’ve gone over the edge girl – you need help’ and off to the hospital I went.”

Source:  http://psychcentral.com/lib/2007/psychotic-depression/

Team Finds Childhood Clues to Adult Schizophrenia

ScienceDaily (Jan. 22, 2010) — Years before adults develop schizophrenia, there is a pattern of cognitive difficulties they experience as children, including problems with verbal reasoning, working memory, attention and processing speed.

Drawing on a long-term study of more than 1,000 New Zealanders born from 1972 to 1973, a team led by Duke researchers has found a consistent pattern of developmental difficulties that first appeared when adult study subjects with schizophrenia were 7 years old.

“The proportion of kids who don’t score well on these tests is big, and the number of kids who develop schizophrenia is tiny,” said study co-author Terrie E. Moffitt, the Knut Schmidt Nielsen professor of psychology and neuroscience at Duke. But now that the study subjects are in their late 30s and mental illnesses have been identified, “we looked backwards to understand more about how schizophrenia may develop.”

By age 32, 1 percent of the study participants met the formal criteria for schizophrenia and had been hospitalized and put on antipsychotic medication. Another 2.5 percent met the diagnostic criteria for the disorder, but hadn’t received treatment.

Knowing what they know now, the researchers were able to track the progress of these cognitive deficits as the subjects went through testing at ages 3, 5, 7, 9, 11 and 13 as part of the Dunedin Multidisciplinary Health and Development Study.

“These kids are lagging behind to begin with and they continue to fall behind,” said study co-author Richard Keefe, director of Duke’s Schizophrenia Research Group. Their verbal skills are initially poor, and then they develop other problems along the way, including difficulties with memory and verbal processing, key factors in learning.

For each year between the ages of 7 and 13, the children who later received a diagnosis of schizophrenia lost between 0.17 and 0.26 years in mental age when compared with the other children.

Two patterns emerged: The children who developed adult schizophrenia had early deficits in verbal and visual learning, reasoning and conceptualization that remained with them as they grew. They also showed slower development than their peers in processing speed, attention, visual-spatial problem-solving and working memory. The data argues against one theory that schizophrenia stems from a deterioration of cognitive abilities. The minds of these children grew, they just didn’t grow as well.

Adults with schizophrenia have been known to lag about 8 points behind the average person in IQ tests, but this study puts a finer point on where and how they might differ. The article will appear in the February issue of the American Journal of Psychiatry and was published online Jan. 4.

How or why schizophrenia later develops is still a mystery, but this new evidence provides some valuable clues, said co-author Avshalom Caspi, the Edward M. Arnett Professor of psychology and neuroscience at Duke. It’s possible that a child who struggles to make sense of the world becomes more socially isolated or more delusional, Caspi said. “How does a brain that’s ill-equipped to deal with novel sensations deal with the stresses of adolescence?”

With this new evidence in hand, it may be tempting to try to somehow prevent schizophrenia by treating younger patients with anti-psychotic medications, said Keefe. But you’d be treating 20 percent of kids to prevent the 1 percent occurrence of schizophrenia, meaning 19 patients were treated unnecessarily, risking side effects.

“Of course, eventually we hope we’d be able to intervene, maybe even without drugs,” Keefe said. Knowing more about the early clues to schizophrenia could lead to better studies of possible cognitive interventions, he said.

The findings suggest that adult psychosis doesn’t just emerge fully-formed. It probably comes from a developmental process. “What we think of as adult psychiatric disorders have their roots much earlier in life,” Caspi said.

Journal Reference:

  1. Reichenberg et al. Static and Dynamic Cognitive Deficits in Childhood Preceding Adult Schizophrenia: A 30-Year Study. American Journal of Psychiatry, 2010; DOI: 10.1176/appi.ajp.2009.09040574


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