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Hormontherapie und schizophrene Psychosen

Hormone therapy and schizophrenic psychoses

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  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Der Einfluss von Östrogenen auf Genese und Verlauf psychischer Störungen wird seit längerer Zeit diskutiert. Studien untermauern die Hypothese, dass Östrogene über zerebrale Wirkungen vor Schizophrenie schützen und Einfluss auf Beginn und Verlauf der Erkrankung nehmen.

Diese Annahme bietet eine plausible Erklärung für Geschlechtsunterschiede im Ersterkrankungsalter und Krankheitsverlauf. Frauen genießen zwischen Menarche und Menopause einen relativen Schutz vor Schizophrenie. Postmenopausal kommt es bei Frauen zu einem zweiten Ersterkrankungsgipfel, nicht hingegen bei Männern.

Nicht nur postmenopausal, sondern auch während der perimenstruellen Zyklusphase und unter anderen Bedingungen, in denen niedrige Östrogenspiegel vorliegen, steigt das Risiko der Exazerbation einer Schizophrenie. Auch eine Verschlechterung der Psychopathologie in der perimenstruellen Zyklusphase konnte gezeigt werden.

Das Vorliegen einer primären Hypoöstrogenämie bei schizophrenen Frauen ist evident und unabhängig von einer durch klassische Antipsychotika verursachten Hyperprolaktinämie.

Die Studienlage erlaubt noch nicht die Ableitung von Therapieempfehlungen, da der therapeutische Stellenwert von Östrogenen in der Behandlung schizophrener Frauen noch zu bestimmen ist.

Abstract

The influence of estrogens on the genesis and course of psychological disorders has been discussed for a long time. Studies support the hypothesis that estrogens offer protection from schizophrenia by cerebral effects and have an influence on the beginning and course of the disease. This hypothesis offers a plausible explanation for gender differences in the age when first signs of the disease appear and the course of the disease. Women are relatively protected from schizophrenia between the menarche and menopause. In the postmenopausal period a second peak in first-time diseases occurs in women but not in men.

The risk of exacerbation of schizophrenia increases not only in the postmenopausal period but also during the perimenstrual cycle phase and under other conditions where low estrogen levels are present. A deterioration of the psychopathology has been demonstrated even in the perimenstrual cycle phase.

The presence of primary hypoestrogenemia in schizophrenic women is evident and independent of hyperprolactinemia caused by classical antipsychotic drugs.

The results of studies do not yet allow therapy recommendations to be derived because the therapeutic value of estrogens in the treatment of schizophrenic women still has to be determined.

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Anmerkung

Die hier zitierten Studien des Autors wurden im Rahmen des Sonderforschungsbereichs 258 „Indikatoren und Risikomodelle für Entstehung und Verlauf psychischer Störungen“ von der Deutschen Forschungsgemeinschaft (DFG) gefördert und als Kooperationsprojekt der Klinik für Allgemeine Psychiatrie, der Klinik für Kinder- und Jugendpsychiatrie und der Universitätsfrauenklinik des Heidelberger Universitätsklinikums durchgeführt. Der Beitrag erscheint in Kooperation mit dem Referat „Geschlechtsspezifische Fragen in der Psychiatrie“ der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN).

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  1. Schön Klinik Bad Arolsen, Hofgarten 10, 34454, Bad Arolsen, Deutschland

    N. Bergemann Dipl.-Psych.

  2. Universität Heidelberg, Heidelberg, Deutschland

    N. Bergemann Dipl.-Psych.

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Bergemann, N. Hormontherapie und schizophrene Psychosen. Gynäkologische Endokrinologie 9, 24–30 (2011). https://doi.org/10.1007/s10304-010-0387-5

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