Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Brand, Sommer, Gangadin); Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tanskanen, Tiihonen, Taipale); Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Tanskanen, Tiihonen, Taipale); Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tanskanen, Tiihonen, Taipale).
Am J Psychiatry. 2024 Oct 1;181(10):893-900. doi: 10.1176/appi.ajp.20230850. Epub 2024 Sep 12.
Antipsychotic effectiveness in preventing relapse declines around menopausal age in women with schizophrenia or schizoaffective disorder (SSD). It is not known whether systemic menopausal hormone therapy (MHT) can help to prevent psychosis relapse.
A within-subject study design was used to study the effectiveness of MHT in preventing relapse in a Finnish nationwide cohort of women with SSD between 40 and 62 years of age who used MHT during follow-up (1994-2017). Hazard ratios adjusted for age and psychotropic drug use were calculated for psychosis relapse as main outcome and any psychiatric hospitalization as secondary outcome.
The study population comprised 3,488 women using MHT. Use of MHT was associated with a 16% lower relapse risk (adjusted hazard ratio [aHR]=0.84, 95% CI=0.78-0.90) when compared to non-use. Stratified by age, MHT was associated with decreased relapse risks when used between ages 40-49 (aHR=0.86, 95% CI=0.78-0.95) and ages 50-55 (aHR=0.74, 95% CI=0.66-0.83), but not between ages 56-62 (aHR=1.11, 95% CI=0.91-1.37). Similar effectiveness was found for estrogen alone or combined with fixed or sequential progestogens (aHRs between 0.79 and 0.86), transdermal and oral formulations (aHRs 0.75-0.87), and for most specific formulations (aHRs 0.75-0.85), except tibolone (aHR=1.04, 95% CI=0.75-1.44) and formulations with dydrogesterone (aHR=1.05, 95% CI=0.85-1.30). Similar results were observed with any psychiatric hospitalization as outcome measure.
The findings underscore the potential value of MHT in preventing psychosis relapse among women with SSD of menopausal age. These findings translate clinical evidence on the neuroprotective effects of estrogens to real-world settings, encompassing a group of women for whom current antipsychotic treatment options may be insufficient.
抗精神病药物在预防精神分裂症或分裂情感障碍（SSD）女性绝经年龄左右的复发方面效果下降。目前尚不清楚全身绝经激素治疗（MHT）是否有助于预防精神病复发。
采用自身对照研究设计，研究了芬兰全国范围内年龄在 40 至 62 岁之间的 SSD 女性在随访期间（1994 年至 2017 年）使用 MHT 对预防复发的有效性。主要结局为精神病复发，次要结局为任何精神科住院治疗，计算调整年龄和精神药物使用的危险比。
研究人群包括 3488 名使用 MHT 的女性。与未使用者相比，MHT 使用者的复发风险降低了 16%（调整后的危险比[aHR]=0.84，95%CI=0.78-0.90）。按年龄分层，MHT 在 40-49 岁（aHR=0.86，95%CI=0.78-0.95）和 50-55 岁（aHR=0.74，95%CI=0.66-0.83）时与降低复发风险相关，但在 56-62 岁时不相关（aHR=1.11，95%CI=0.91-1.37）。仅使用雌激素或与固定或序贯孕激素联合使用（aHRs 在 0.79 至 0.86 之间）、经皮和口服制剂（aHRs 在 0.75-0.87 之间）以及大多数特定制剂（aHRs 在 0.75-0.85 之间）都发现了类似的效果，除了替勃龙（aHR=1.04，95%CI=0.75-1.44）和含有地屈孕酮的制剂（aHR=1.05，95%CI=0.85-1.30）。使用任何精神科住院治疗作为测量指标也得到了类似的结果。
这些发现强调了 MHT 在预防围绝经期 SSD 女性精神病复发方面的潜在价值。这些发现将雌激素的神经保护作用的临床证据转化为现实环境，涵盖了一组当前抗精神病药物治疗选择可能不足的女性。
