CAN ESTRADIOL MODULATE SCHIZOPHRENIC SYMPTOMATOLOGY

Using epidemiologic data, in an earlier study we formulated the hypoth esis that estrogens can delay the onset of schizophrenia in females by raising the vulnerability threshold for this disease. In animal exper iments, Hafner and colleagues found evidence that chronic estradiol tr eatment reduces the sensitivity of dopamine (D-2) receptors in the bra in. In the clinical study presented in this article, as a further step we examined the antipsychotic properties of estradiol in human female s by testing whether schizophrenic symptomatology varies with estradio l serum levels throughout the menstrual cycle. We examined 32 acutely admitted female schizophrenia patients (Present State Examination/CATE GO diagnosis, ICD-9) with a history of regular menstrual cycles, ages 18 to 43 (mean = 30.5), during their hospital stays (3-8 weeks), analy zing hormonal parameters and applying various rating scales for psycho pathology every 7 days. In all patients, estradiol serum levels were m arkedly reduced as compared with the normal population, and fluctuatio ns throughout the cycle were dampened. Nevertheless, a significant ass ociation emerged between estradiol levels, on the one hand, and psycho pathology scores, on the other-that is, the psychiatric symptomatology as assessed by the clinical psychiatrist (Brief Psychiatric Rating Sc ale, p less than or equal to 0.01), behavior on the ward as assessed b y the nursing staff (Nurses' Observation Scale for Inpatient Evaluatio n p less than or equal to 0.01), paranoid tendencies and general well- being as assessed by the patients themselves (Paranoid-Depressivitats- Skala paranoid score p less than or equal to 0.05; Befindlichkeits-Ska la p less than or equal to 0.05). Psychopathology seems to improve whe n estradiol levels rise, and vice versa. These findings can be interpr eted as further evidence for a protective effect of estrogens in schiz ophrenia, possibly due to the known antidopaminergic activities of the se hormones.