Really interesting post. Is there any chance that increased prescription of HRT led to a reduced incidence of schizophrenia in post-menopausal age groups? Is the second peak in women seen more often in the earlier studies?
I hadn’t thought of that! I’m not sure the proportion of women who are prescribed HRT, I’ve seen the figure of 10% in some media articles - which would surely be too low to have an effect. My guess is women with risk factors for schizophrenia would also be less likely to seek out HRT than the general population.
But I’m sure there a record-linkage study waiting to be done.
Re the lancet article - relative risks for HRT and breast cancer looks worrying but the absolute risk goes up from 6% to 8% which most individuals could probably accept.
It's is from the USA in the 1990s, so perhaps the peak of HRT anywhere. It's still a bit of a longshot, but perhaps there was enough HRT to have had an effect, especially if it was targeted to those who are most symptomatic?
Is oestrogen affecting learning (in the sense that in schizophrenia the brain might be said to be ‘over-learning’ or ‘over-weighting’ certain hypotheses and is unconstrained by (and resistant to updating by) the sensory evidence which would tell the brain that, perhaps whilst theoretically possible, the delusion being suffered is not probable and can be discounted?
Have you read this case study of a trans woman with psychosis who had severe symptoms when she couldn't get estrogen? Not high quality but definitely gives the impression this hypothesis should be researched further.
Moffitt, O., & Findley, J. C. (2016). A case of first-onset psychosis and repeated relapses secondary to discontinuation of non-prescription estrogen replacement therapy in a transgendered female. Gynecological Endocrinology, 32(10), 796–798. https://doi.org/10.1080/09513590.2016.1202230
Really interesting post. Is there any chance that increased prescription of HRT led to a reduced incidence of schizophrenia in post-menopausal age groups? Is the second peak in women seen more often in the earlier studies?
Some nice data on HRT prescriptions here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2819%2931709-X/fulltext
I hadn’t thought of that! I’m not sure the proportion of women who are prescribed HRT, I’ve seen the figure of 10% in some media articles - which would surely be too low to have an effect. My guess is women with risk factors for schizophrenia would also be less likely to seek out HRT than the general population.
But I’m sure there a record-linkage study waiting to be done.
Re the lancet article - relative risks for HRT and breast cancer looks worrying but the absolute risk goes up from 6% to 8% which most individuals could probably accept.
Good data are surprisingly hard to find, but I've done a little more digging...
This paper says: 'The percentage of women aged 50 to 74 years taking hormone therapy increased from 33% to 42% between 1995 and 2001.' https://jamanetwork.com/journals/jama/article-abstract/197940
It's is from the USA in the 1990s, so perhaps the peak of HRT anywhere. It's still a bit of a longshot, but perhaps there was enough HRT to have had an effect, especially if it was targeted to those who are most symptomatic?
Is oestrogen affecting learning (in the sense that in schizophrenia the brain might be said to be ‘over-learning’ or ‘over-weighting’ certain hypotheses and is unconstrained by (and resistant to updating by) the sensory evidence which would tell the brain that, perhaps whilst theoretically possible, the delusion being suffered is not probable and can be discounted?
https://www.sciencedirect.com/science/article/pii/S0920996421003054
Is there a connection between menstrual psychosis and PMDD?
Good question that I don’t think has been properly answered by research
Have you read this case study of a trans woman with psychosis who had severe symptoms when she couldn't get estrogen? Not high quality but definitely gives the impression this hypothesis should be researched further.
Moffitt, O., & Findley, J. C. (2016). A case of first-onset psychosis and repeated relapses secondary to discontinuation of non-prescription estrogen replacement therapy in a transgendered female. Gynecological Endocrinology, 32(10), 796–798. https://doi.org/10.1080/09513590.2016.1202230
https://www.tandfonline.com/doi/full/10.1080/09513590.2016.1202230#d1e143
Thanks, I hadn’t come across that before!