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Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders

PURPOSE OF REVIEW: Despite clear evidence that sex differences largely impact the efficacy and tolerability of antipsychotic medication, current treatment guidelines for schizophrenia spectrum disorders (SSD) do not differentiate between men and women. This review summarizes the available evidence o...

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Autores principales: Brand, Bodyl A., Willemse, Elske J. M., Hamers, Iris M. H., Sommer, Iris E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654163/
https://www.ncbi.nlm.nih.gov/pubmed/37864676
http://dx.doi.org/10.1007/s11920-023-01460-6
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author Brand, Bodyl A.
Willemse, Elske J. M.
Hamers, Iris M. H.
Sommer, Iris E.
author_facet Brand, Bodyl A.
Willemse, Elske J. M.
Hamers, Iris M. H.
Sommer, Iris E.
author_sort Brand, Bodyl A.
collection PubMed
description PURPOSE OF REVIEW: Despite clear evidence that sex differences largely impact the efficacy and tolerability of antipsychotic medication, current treatment guidelines for schizophrenia spectrum disorders (SSD) do not differentiate between men and women. This review summarizes the available evidence on strategies that may improve pharmacotherapy for women and provides evidence-based recommendations to optimize treatment for women with schizophrenia. RECENT FINDINGS: We systematically searched PubMed and Embase for peer-reviewed studies on three topics: (1) sex differences in dose-adjusted antipsychotic serum concentrations, (2) hormonal augmentation therapy with estrogen and estrogen-like compounds to improve symptom severity, and (3) strategies to reduce antipsychotic-induced hyperprolactinemia. Based on three database studies and one RCT, we found higher dose-adjusted concentrations in women compared to men for most antipsychotics. For quetiapine, higher concentrations were specifically found in older women. Based on two recent meta-analyses, both estrogen and raloxifene improved overall symptomatology. Most consistent findings were found for raloxifene augmentation in postmenopausal women. No studies evaluated the effects of estrogenic contraceptives on symptoms. Based on two meta-analyses and one RCT, adjunctive aripiprazole was the best-studied and safest strategy for lowering antipsychotic-induced hyperprolactinemia. SUMMARY: Evidence-based recommendations for female-specific pharmacotherapy for SSD consist of (1) female-specific dosing for antipsychotics (guided by therapeutic drug monitoring), (2) hormonal replacement with raloxifene in postmenopausal women, and (3) aripiprazole addition as best evidenced option in case of antipsychotic-induced hyperprolactinemia. Combining these strategies could reduce side effects and improve outcome of women with SSD, which should be confirmed in future longitudinal RCTs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11920-023-01460-6.
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spelling pubmed-106541632023-10-21 Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders Brand, Bodyl A. Willemse, Elske J. M. Hamers, Iris M. H. Sommer, Iris E. Curr Psychiatry Rep Article PURPOSE OF REVIEW: Despite clear evidence that sex differences largely impact the efficacy and tolerability of antipsychotic medication, current treatment guidelines for schizophrenia spectrum disorders (SSD) do not differentiate between men and women. This review summarizes the available evidence on strategies that may improve pharmacotherapy for women and provides evidence-based recommendations to optimize treatment for women with schizophrenia. RECENT FINDINGS: We systematically searched PubMed and Embase for peer-reviewed studies on three topics: (1) sex differences in dose-adjusted antipsychotic serum concentrations, (2) hormonal augmentation therapy with estrogen and estrogen-like compounds to improve symptom severity, and (3) strategies to reduce antipsychotic-induced hyperprolactinemia. Based on three database studies and one RCT, we found higher dose-adjusted concentrations in women compared to men for most antipsychotics. For quetiapine, higher concentrations were specifically found in older women. Based on two recent meta-analyses, both estrogen and raloxifene improved overall symptomatology. Most consistent findings were found for raloxifene augmentation in postmenopausal women. No studies evaluated the effects of estrogenic contraceptives on symptoms. Based on two meta-analyses and one RCT, adjunctive aripiprazole was the best-studied and safest strategy for lowering antipsychotic-induced hyperprolactinemia. SUMMARY: Evidence-based recommendations for female-specific pharmacotherapy for SSD consist of (1) female-specific dosing for antipsychotics (guided by therapeutic drug monitoring), (2) hormonal replacement with raloxifene in postmenopausal women, and (3) aripiprazole addition as best evidenced option in case of antipsychotic-induced hyperprolactinemia. Combining these strategies could reduce side effects and improve outcome of women with SSD, which should be confirmed in future longitudinal RCTs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11920-023-01460-6. Springer US 2023-10-21 2023 /pmc/articles/PMC10654163/ /pubmed/37864676 http://dx.doi.org/10.1007/s11920-023-01460-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Brand, Bodyl A.
Willemse, Elske J. M.
Hamers, Iris M. H.
Sommer, Iris E.
Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders
title Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders
title_full Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders
title_fullStr Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders
title_full_unstemmed Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders
title_short Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders
title_sort evidence-based recommendations for the pharmacological treatment of women with schizophrenia spectrum disorders
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654163/
https://www.ncbi.nlm.nih.gov/pubmed/37864676
http://dx.doi.org/10.1007/s11920-023-01460-6
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