Thursday, May 23, 2019

Experts Argue for Addition of Suicide-Specific Diagnoses in DSM

A discrete, specific diagnosis of suicidal behavior disorder is included in DSM-5 Section III, which contains “conditions for further study.” Such a diagnosis could be enormously clinically useful, helping to identify at-risk patients for treatment and aiding in research on suicide, according to former APA President Maria A. Oquendo, M.D., Ph.D. (pictured at left), chair of the Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine and a director on the National Board of the American Foundation for Suicide Prevention. She was the chair and a presenter at the Tuesday Annual Meeting session “The Argument for Suicide-Specific Diagnoses in the DSM.”

Inclusion of a diagnosis for suicidal behavior disorder would help solve a number of clinical and systemic problems associated with identifying patients at risk for suicide. Oquendo said that during an assessment, clinicians seek to make the primary diagnosis responsible for the chief complaint and use overview questions to identify comorbid conditions. If they do not find evidence for a major depressive episode or borderline personality disorder—two conditions for which DSM criteria specifically note a risk of suicide—questions about suicidal behavior may not be asked.

“While institutions today generally require suicide screening for psychiatric cases, many patients are seen in other settings that may not,” she said.

Moreover, since the Mental Status Examination targets the patients’ present condition, those denying suicidal ideation may not be asked about past suicidal acts, which results in underestimating the number of suicidality cases. In addition, current diagnostic algorithms may lead clinicians to overlook suicidal ideation or behavior in high-risk individuals, especially those with posttraumatic stress disorder or alcohol use disorder.

Most important, clinical studies demonstrate that suicide risk is often lost when patients are “handed off” in inpatient settings—that is, when a patient is passed from one treatment team or clinician to another. She also pointed out that electronic medical records encourage stilted, standardized patient descriptions, leading clinicians to rely more heavily on diagnostic codes in devising treatment plans.

Oquendo said the existence of a suicide-specific diagnosis would compel clinical and administrative structures to determine the suicide risk status of individuals assessed in psychiatric settings. “The presence of suicidal behavior can be documented in the medical record with the prominence that it deserves in written reports, allowing for treatment planning for vulnerable patients,” she said.

“For research purposes, a diagnosis would more reliably identify cases and controls or predictors of suicidal behavior in big-data analyses based on claims data or electronic medical records,” Oquendo added. “It would help to harness large cohorts with genomic and biologic data to study suicide and facilitate development of a registry to more accurately estimate the number of suicide attempters in specific cohorts to inform policy and prevention strategies.”

She was joined at the session by Igor Galynker, M.D., Ph.D., a professor of psychiatry at the Icahn School of Medicine at Mount Sinai, who described a proposal to include criteria for suicidal crisis syndrome in DSM. Thomas Joiner, Ph.D., a professor of psychology at Florida State University, outlined the case for creating the diagnosis of acute suicidal affective disorder. Both proposed diagnoses would be distinct from suicidal behavior disorder; they describe a discrete, highly acute and extremely high-risk pre-suicidal mental state marked by “frantic anxiety” and a feeling of entrapment, among other symptoms.

For related information, see the Psychiatric News article “Preventing Suicide Begins With Regular Assessments” and the book Clinical Manual for the Assessment and Treatment of Suicidal Patients, Second Edition, by APA Publishing.

(Image: David Hathcox)

Wednesday, May 22, 2019

Highlights From APA Annual Meeting: Day Five

The final day of APA’s Annual Meeting featured an animated, case-based session on ECT and a review of strategies to help prevent suicide in youth. Experts also offered practical guidance on how to treat pregnant women with psychiatric conditions and important insights on why migrant children face a long, slow recovery when they are separated from their families.

Look for future coverage of APA’s 2019 Annual Meeting in upcoming issues of Psychiatric News.

Expert Outlines Practical Tactics Parents, Practitioners Can Use to Help Teens Overcome Suicidal Urges

Increasing suicide rates among adolescents call for immediate approaches to reducing the risk. Michele Berk, Ph.D., offers seven practical tactics that parents and psychiatrists can use today.
Read More >

Panelists Discuss Difficult ECT Questions, From Patient Selection to Treatment Completion

In a lively, interactive session on Wednesday participants debated patients most likely to benefit from ECT, how to place electrodes, and whether to use lithium before and after treatment.  Read More >

Nine Tips for Managing Psychiatric Conditions Before, During, and After Pregnancy

Four perinatal psychiatry experts remind that treatment during pregnancy requires a risk-risk discussion with women: the risks of treating versus not treating.
Read More >

NIMH Research Seeks to Harness Power of Technology, says Gordon

Applying machine learning and other technologies to better understand risk factors for suicide were among the topics addressed by NIMH director Joshua Gordon, M.D., Ph.D., during the 175th History Track session.
Read More >

Considerations for Treating Migrant Children Separated From Parents

Building trust is an important first step to helping migrant children separated from parents begin a path to recovery, says child trauma expert Alicia Lieberman, M.D. Read More >

Panel Questions Evidence on Deep Brain Stimulation for Depression

While some studies show DBS to be effective, experts warn against “therapeutic enthusiasm,” saying the body of evidence does not sufficiently support the treatment. Read More >

From Patient to Inmate: Session Highlights Complex Interactions Between Social Policies and Mental Health Care Delivery

Experts explore how upstream social institutions and policies on homelessness and incarceration can drive downstream breakdowns in the delivery of public mental health services. Read More >

Join Us Next Year in Philadelphia

Be sure to save the date for next year's Annual Meeting, April 25 through 29, 2020, in Philadelphia, the city where APA was founded.

Highlights From APA Annual Meeting: Day Four

Day four of APA’s Annual Meeting included the release of an AJP study and commentary on esketamine, an inspiring lecture by the winner of this year’s Fryer Award, and a discussion on psychiatric assessment of patients seeking physician-assisted death in states where it is legal.

Through May 22, Psychiatric News will deliver an evening digest of important highlights from the meeting.

800 Psychiatrists and Guests Celebrate APA’s 175th Anniversary in Historic Venue

APA celebrated its place in history as the country's first medical association at a party that won't soon be forgotten.
Read More >

Intranasal Esketamine Found to Be Safe, Effective but Questions Remain

Findings from an AJP study released at the Annual Meeting Tuesday confirm that the controversial drug improves symptoms in treatment-resistant depression, but when should it be used and for how long?  Read More >

NIDA Director Outlines Institute’s Efforts to Improve Pain Management, OUD Treatment

Nora Volkow, M.D., described the agency’s efforts to diversify treatments for opioid use disorder (OUD), integrate OUD care into a variety of settings, and incentivize pharmaceutical companies to develop new drugs to treat pain.
Read More >

Measuring Capacity in Cases of Physician-Assisted Dying: Advice to Psychiatrists

Faced with a request for PAD, psychiatrists must go beyond the traditional consent criteria and develop a “decision-optimizing” relationship with the patient.
Read More >

Fryer Award Winner Urges Continued Advocacy for LGBTQ Community

Shannon Minter, Esq., commends mental health experts for their role in successes achieved through the modern LGBTQ rights movement and warns why today more than ever we need the courage and commitment of John Fryer to protect those gains. Read More >

Family-Centered Program Reduces Stigma, Speeds Recovery of Patients With Borderline Personality Disorder

Psychiatrists are increasingly realizing that a critical element of treatment for BPD is a family commitment to improving their interpersonal relationships. Read More >

Intimate Partner Homicide Least Studied, Most Common Form of Family Murder

Up to half of murdered women are killed by a past or present male intimate partner. In one of the Annual Meeting's most popular sessions, experts dove into the psychopathology and risk factors for these crimes. Read More >

Interventions That Promote Wisdom May Help Patients With Psychiatric Conditions

While the study of wisdom is still in its infancy, researchers believe understanding the biological and psychosocial variables associated with wisdom can inform treatments. Read More >

Experts Highlight Community-Based Solutions to Help Break Cycle of Gun Violence

Gun control measures may be an essential part of the solution, but communities can initiate locally driven, disruptive approaches today that have been proven to reduce gun violence. Read More >

Monday, May 20, 2019

Highlights From APA Annual Meeting: Day Three

Day three of APA’s Annual Meeting included a call to psychiatrists to lead in efforts to improve the lives of children, the release of APA poll results showing mental health stigma remains a major challenge in the workplace, and conversation around the ways psychiatrists can help people of differing political backgrounds find common ground.

Through May 22, Psychiatric News will deliver an evening digest of important highlights from the meeting.

Kellogg CEO Urges Psychiatrists to Advocate for Trauma-Informed Care for Children

During the William C. Menninger Memorial Lecture on Monday, La June Montgomery Tabron called on psychiatrists to promote racial healing and to integrate social determinants of health into medical care so all people have an equal opportunity to living a healthy life.
Read More >

Poll Draws Attention to Mental Health Stigma in Workplace, Concerns Over Social Media

Although most respondents to a national poll by APA said they know how to access mental health services through work, more than one-third worry that seeking mental health care might impact their job. Those surveyed also agreed that social media may be contributing to feelings of loneliness and social isolation. Read More >

Simpler Blood Monitoring, Sharing Clinical Experiences Critical to Expanding Clozapine Use

Speaking to a packed house, schizophrenia experts share their experiences with clozapine to increase psychiatrists’ comfort in using the highly effective but underutilized treatment.
Read More >

Black Psychiatrists Persevered Despite Discrimination in Education, Organized Medicine

Speakers at a 175th Anniversary History Track session described how black psychiatrists sought equal treatment and the need to continue working to eliminate racial discrimination.
Read More >

Women Making Strides in Academic Psychiatry but Gender Bias, Discrimination Still Too Common

The number of women entering psychiatry continues to increase, but a gender gap persists in compensation, advancement, and research funding. Session attendees offer up several practical solutions. Read More >

Factors to Keep in Mind When Prescribing to Pregnant Patients

Most psychiatric medications can be safely continued in pregnancy, but changes that occur during pregnancy may affect absorption, distribution, and metabolism of these medications. Read More >

Psychiatrists Have Role to Play in Building Bridges Between Today’s Polarized Society

A sociologist explores the psychological reasonings that fuel the divergent views of those on the right and the left. Read More >

Stay Tuned for Coverage of 175th Anniversary Gala

APA’s 175th Anniversary Gala at the magnificent San Francisco City Hall got under way as this issue of the APA Daily went to press. More than 700 people were expected to attend. Proceeds will support the work of the APA Foundation. Coverage of the gala will appear in a future issue.

Sunday, May 19, 2019

Highlights From APA Annual Meeting: Day Two

Day two of APA’s Annual Meeting included an address by psychiatrist and incoming AMA President Patrice Harris, M.D., to APA’s Board of Trustees; a discussion of the challenges that international medical graduate students face; and a recommendation that psychiatrists consider ways their own mindfulness could benefit their patients.

Through May 22, Psychiatric News will deliver an evening digest of important highlights from the meeting.

Incoming AMA President and Former APA Board Member Lays Out Plans for Presidential Year

Psychiatrist Patrice Harris, M.D., told trustees that the integration of mental health and general medical care and promoting diversity across organized medicine would be among her priorities for the year.
Read More >

Valerie Jarrett Shares Insights From Her Years in the White House

In a wide-ranging “fireside chat” with APA President Altha Stewart, M.D., Valerie Jarrett talked about the experience of serving as President Obama’s longest-serving senior adviser. Read More >

Childhood Trauma Changes Biology of Brain

Advances in neurobiology and genetics explain the links between early life adversity and increased risk for psychiatric and medical conditions later in life, but how and when does psychiatry intervene?
Read More >

Why Psychiatrists Must 'Mindfully' Embrace Nutritional Wellness for Themselves and Their Patients

As the obesity epidemic expands, psychiatrists must go beyond telling patients how to lose weight to helping them live a healthy and fit life. Applying mindfulness to eating is one technique both physicians and their patients can benefit from.
Read More >

History Track Session Focuses on Challenges Faced by IMGs

A panel discussion of IMGs described the insensitivity and isolation—ranging from cultural misunderstandings to frank discrimination—that these trainees face in the workplace. Read More >

Overlap Between PTSD, TBI Symptoms Creates Challenges for Diagnosing Patients

Experts on Saturday discussed similarities in the causes and symptoms of PTSD and TBI, which can be critical for the determination of disability. Read More >

Winners of Resident/Medical Student Poster Competition Announced

Winners were recognized for their research focused on building resilience and addressing burnout in medical students and residents, reducing agitation, and more. Read More >

Highlights From APA’s 2019 Annual Meeting Day One

Welcome to San Francisco!

APA’s 2019 Annual Meeting began in San Francisco Saturday. From now through May 22, Psychiatric News will deliver an evening digest of some of the day’s highlights. Whether you are here in San Francisco or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

Stewart Brings a Robust and Eventful Presidential Year to a Close

During the Opening Session on Saturday, Altha Stewart, M.D., described how APA renewed its global reach while laying the groundwork for a more diverse and inclusive profession and responding to several national emergencies.
Read More >

Schwartz: APA Must Lead the Way to End Stigma, Improve Care

Incoming APA President Bruce Schwartz, M.D., vowed during his Opening Session address on Saturday to focus on three crucial areas: increasing access to care, improving quality of care, and continuing the fight against the stigma and discrimination attached to mental illness. Read More >

Levin Speaks to Future of a 'Noble' Profession

The 2019 APA Annual Meeting can offer a blueprint for the future, said APA CEO and Medical Director Saul Levin, M.D., M.P.A., during the Opening Session on Saturday. “For all the progress we’ve made, there are still some areas where we must improve as we work toward our next milestones—the 200th and 225th anniversaries,” he said.
Read More >

MindGames Playoffs Offer Double Treat to Meeting Attendees

MindGames has become one of the most popular Annual Meeting attractions, and this year, attendees got two versions—the traditional resident competition and a special history version in honor of APA's 175th Anniversary.
Read More >

The Lincolns: Retrospective Diagnosing Raises Questions Worth Pondering

Studying the putative psychiatric symptoms of historical figures raises important questions about the nature of psychiatric diagnosis, how those diagnoses are viewed through various cultural lenses, and how they may change over time. Read More >

Medications for Cannabis Use Disorder May Ease Withdrawal But Fail to Achieve Abstinence

Treatments to manage withdrawal or block the positive effects of cannabis offer limited benefit, but an over-the-counter supplement may reduce drug-seeking behavior in youth. Experts question whether treatment goals should focus on curbing consumption versus total cessation. Read More >

APA Raises $15,000 for Center Serving Disadvantaged Women

As part of the APA’s annual “APA Gives Back” program, APA President Altha Stewart, M.D., presented a donation today of $15,000 to this year’s recipient, the Young Women’s Freedom Center. For 25 years, this center has been providing support, advocacy, and opportunities for healing for women and girls of color who are impacted by poverty or who were formerly incarcerated. Read More >

Friday, May 17, 2019

Obstructive Sleep Apnea May Raise Post-Op Heart Risk

Obstructive sleep apnea (OSA), a condition in which the soft tissues of the throat relax and narrow the airways during sleep, may raise the risk of developing heart problems after surgery, according to research published this week in JAMA. In OSA, breathing stops and starts multiple times during sleep, resulting in snoring, gasping for air, poor sleep quality, morning headaches, daytime fatigue, irritability, and difficulty concentrating.

The study, led by Matthew T. V. Chan, Ph.D., M.B.B.S., of the Chinese University of Hong Kong included 1,218 patients aged 45 years or older who had abdominal, vascular, or major orthopedic surgeries and were at risk for post-surgery heart-related complications. The patients underwent sleep studies at home or in the hospital the night before their procedures.

Although none of the patients had been diagnosed with OSA previously, the sleep studies revealed that 67.6% of them had the condition. Among all patients, 11.2% had a severe form of OSA in which their breathing stopped and started at least 30 times during the night.

In the 30 days after their surgeries, 21.7% of the participants with OSA developed heart and blood vessel complications, such as injury to their heart muscles, congestive heart failure, atrial fibrillation (an irregular, fluttering heartbeat), and thromboembolism (clots that block blood vessels). Only 14.2% of those without OSA developed these complications. This represents a 50% greater risk in people with OSA, regardless of the condition’s severity. However, after the researchers accounted for other factors, they determined the increased risk to be statistically significant only in patients with severe OSA, not mild or moderate OSA. Those with severe OSA had more than double the risk of those without OSA. Severe OSA was also associated with a nearly 14-fold increase in cardiac death, a nearly 7-fold higher risk of heart failure, and an 80% higher risk of heart injury.

The researchers noted that episodes of apnea and higher sedation either during or after the surgeries may have prompted health care professionals to make adjustments to the patients’ care such as lowering doses of opioids or keeping the patients on supplemental oxygen longer than usual.

“It is unclear how these interventions may affect perioperative outcomes. Nevertheless, the event rates reported in this study would represent the expected perioperative outcomes associated with untreated OSA in contemporary anesthetic practice for major noncardiac surgery,” the researchers wrote.

For more information, see the Psychiatric News article “Sleep Apnea Linked With Hard-to-Treat High Blood Pressure in Blacks.”

(Image: iStock/Squaredpixels)

Thursday, May 16, 2019

Hospitalization for Psychosis Tied to Substance Misuse, Treatment Delays, Medication Nonadherence

The hospitalization rate for patients with first-episode psychosis (FEP) may be reduced by avoiding delays in initial treatment, preventing substance misuse, and enhancing medication adherence, according to a study published Tuesday in Psychiatric Services in Advance.

Even with current, evidence-based treatment, at least one-third of individuals with FEP will be hospitalized within two years of diagnosis, increasing treatment costs, disrupting schooling, and often, resulting in stress and trauma, wrote Delbert G. Robinson, M.D., of the Center for Psychiatric Neuroscience at the Feinstein Institutes for Medical Research and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and colleagues.

To identify risk factors for hospitalization, researchers evaluated data from the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, which compared outcomes in patients experiencing a first episode of psychosis who received early intervention services versus usual care. (Patients in the early intervention group received personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported education and employment. Those in the usual-care group received psychosis treatment determined by individual and clinician choice and service availability. The study found that those in the early intervention program remained in treatment longer, experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school, compared with those in the usual-care group.)

As part of the original study, researchers conducted a Structured Clinical Interview for DSM-IV at baseline and assessed various other clinical measures every six months thereafter. Every month during the trial, researchers asked participants about their use of inpatient and emergency mental health services and assessed drug and alcohol use. At multiple times throughout the trial, the participants also rated their mental and emotional health and took various other evaluations.

Based on these data, Robinson and colleagues found that patients with longer duration of untreated psychosis, more hospitalizations before study entry, positive psychosis symptoms such as hallucinations and delusions, illegal drug use, and doubts about the value of medication were more likely to be hospitalized during the two-year treatment period.

The study findings could assist clinicians in developing more effective early intervention services. “Individuals enter outpatient treatment with an already fixed number of prior hospitalizations and [duration of untreated psychosis]. Changing these factors will require public health initiatives and innovative outreach strategies to facilitate earlier entry into treatment,” the researchers wrote. “Current [early intervention services] models include interventions to help individuals decrease substance misuse, achieve symptom reduction, and understand medications and adherence. Some of these interventions have low participation … suggesting that more effort may be needed to motivate individuals to use available services.”

For more information, see the Psychiatric News article “Psychosocial Treatments Found Effective for Early Psychosis” and the American Journal of Psychiatry article “Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program.”

(Image: iStock/whyframestudio)

Wednesday, May 15, 2019

Benzodiazepine Use in Early Pregnancy Increases Risk of Miscarriage, Study Suggests

The use of any benzodiazepines during early pregnancy may increase the risk of miscarriage, according to a study published today in JAMA Psychiatry.

“The findings suggest that health care clinicians should carefully evaluate the risk-benefit ratio of benzodiazepines for the treatment of insomnia and mood or anxiety disorders in early pregnancy,” wrote Odile Sheehy, M.Sc., of the Centre Hospitalier Universitaire Sainte-Justine in Montreal and colleagues. “[I]f benzodiazepines are needed, they should be prescribed for short durations.”

Sheehy and colleagues analyzed data from the Quebec Pregnancy Cohort, which included all pregnancies of women aged 15 to 45 who were covered by the Quebec Public Prescription Drug Insurance Plan from January 1, 1998, to December 31, 2015. The researchers excluded data on pregnancies among several groups of women from the analysis, including women exposed to known teratogens during the first trimester, as well as those with a history of epilepsy, previous use of benzodiazepines, and/or planned abortions.

Of the 442,066 pregnancies included in the cohort, 27,149 (6.1%) ended with miscarriage. A pregnant woman was considered to have been exposed to a benzodiazepine if she had filled at least one prescription for any type of benzodiazepine between the first day of the last menstrual period and the date of miscarriage.

Among pregnancies ending with miscarriage, 375 (1.4%) were among women exposed to benzodiazepines in early pregnancy compared with 788 (0.6%) of the 134,305 matched-control pregnancies. After adjusting for potential confounders, including diagnoses of mood and anxiety disorders and insomnia before pregnancy, the researchers found benzodiazepine exposure in early pregnancy was independently associated with an increased risk of miscarriage (adjusted odds ratio, 1.85).

“The risk of [miscarriage] increased with increasing daily dose of benzodiazepines, which may suggest a dose-response effect,” the authors wrote.

Additional analysis revealed that the risk of miscarriage was similar among pregnant women exposed to short-acting benzodiazepines (defined as a half-life less than or equal to 24 hours), such as lorazepam, and long-acting benzodiazepines (defined as a half-life greater than 24 hours), such as diazepam.

The authors noted several limitations of the study, including smaller sample sizes in subgroup analyses on specific benzodiazepine agents, which resulted in lower statistical power, and missing information about smoking and/or alcohol intake behaviors during pregnancy.

For related information, see the Psychiatric News article “Benzodiazepine Use and Misuse Among Adults in the United States.”

(Image: iStock/serezniy)

Tuesday, May 14, 2019

Low Social Engagement May Point to Older Adults at Risk of Alzheimer’s Disease

Spending little time engaging with friends and family or participating in activities outside the home may be a marker for possible cognitive decline in older adults who are still cognitively normal but show evidence of brain changes indicative of possible Alzheimer’s disease (AD), according to a report in the American Journal of Geriatric Psychiatry.

“Understanding changes in social engagement in older adults may lead to earlier diagnosis of AD and advances in evidence-based prevention and treatment,” wrote senior author Nancy Donovan, M.D., chief of the Division of Geriatric Psychiatry at Brigham and Women’s Hospital, and colleagues.

A total of 217 men and women aged 63 to 89 underwent assessments for social engagement and cognitive performance at baseline and three years later. The participants were evaluated using the Community Healthy Activities Model Program for Seniors questionnaire, including questions about the amount of time participants spent with friends and family outside the home, involvement with church and clubs, and more; the less total time participants reported engaging in such activities, the lower their total social engagement score. The Preclinical Alzheimer Cognitive Composite (PACC) assessed the episodic memory, executive function, and global cognition of the participants. Amyloid-β (a protein associated with AD) was measured using Pittsburgh Compound B-PET.

The researchers found that cognitively normal older adults with low levels of social engagement and evidence of accumulation of amyloid-β in the brain at baseline had greater cognitive decline at three years than those with high levels of social engagement at baseline. In contrast, higher baseline social engagement was associated with relative preservation of PACC, the authors reported.

“These findings emphasize the importance of social engagement as a resilience or vulnerability marker in older adults at risk of cognitive impairment due to AD and support recommendations promoting social engagement in older adults,” they wrote.

For related information, see the Psychiatric News article “Purpose in Life Linked to Physical Function in Older Adults.”

(Image: iStock/asiseeit)

Monday, May 13, 2019

Psychotic Symptoms May Worsen During Perimenstrual Phase, Meta-Analysis Suggests

Women with psychotic disorders may be more likely to be admitted into the hospital in the days immediately before or during menstruation than at other points during their menstrual cycle, according to a meta-analysis in Schizophrenia Bulletin. The findings suggest that these women may experience worsening symptoms of psychosis at times when their estrogen levels are low.

“[I]dentifying whether women whose psychotic illness is vulnerable to menstrual fluctuations are subsequently at increased risk of relapse postpartum and postmenopausal (times of declining estrogen levels) could provide impetus for novel preventative treatments,” wrote Thomas J. Reilly, M.D., of the Department of Psychosis Studies at King’s College London and colleagues.

Reilly and colleagues conducted a review and meta-analysis of studies that examined changes in psychiatric symptoms in relation to the menstrual cycle. Nineteen studies, comprising 1,193 women diagnosed with a psychotic disorder (schizophrenia, schizoaffective disorder, schizophreniform disorder, psychotic disorder not otherwise specified, bipolar disorder with psychotic symptoms, and depressive disorder with psychotic symptoms) were included in the analysis. Eleven studies examined psychiatric admission rates, five examined symptom scores, two examined self-reported exacerbation, and one examined both admission rates and symptom scores. To compare findings across studies, the authors standardized the results to a 28-day cycle, with day 1 marking the first day of menstruation and day 24 to day 5, the perimenstrual phase.

They found that psychiatric admission rates were significantly higher during the perimenstrual phase than during the non-perimenstrual phase (standardized incidence ratio = 1.48). Although four of the six studies that examined symptom scores also suggested that the participants’ symptoms worsened during the perimenstrual phase, the authors noted that the time points when symptoms were assessed varied considerably between the studies, precluding meta-analysis of the data.

“Further research is needed to characterize the effect of the menstrual cycle on the symptomatology of psychosis, whether there is a subgroup of women who individually have a strong correlation between psychotic symptoms and menstrual cycles, and whether this subgroup is amenable to intervention in the form of hormonal therapy,” the authors concluded.

For related information, see the Psychiatric News article “Raloxifene May Improve Symptoms in Older Women With Refractory Schizophrenia.”

(Image: iStock/FilippoBacci)


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