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70 - References

References

Drug treatment of psychiatric symptoms in the context of other conditions CHAPTER 10 Starting treatment Start HRT at 25–50mcg estradiol patch dose equivalents (1mg estradiol tablet/1–2 pumps estradiol 0.6mg/g gel). Increase after 6–8 weeks if symptomatic. Higher doses of estradiol may require additional progesterone for endometrial protection.24 HRT is not a contraceptive. Management of adverse effects Table 10.25 outlines the management of the possible adverse effects of HRT. References

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  9. Seeman MV. Men and women respond differently to antipsychotic drugs. Neuropharmacology 2020; 163:107631.
  10. Seeman MV. Treating schizophrenia at the time of menopause. Maturitas 2012; 72:117–120.
  11. Choi SY, et  al. Isoform-­specific regulation of cytochromes P450 expression by estradiol and progesterone. Drug Metab Dispos 2013; 41:263–269.
  12. Lange B, et al. How gender affects the pharmacotherapeutic approach to treating psychosis – a systematic review. Expert Opin Pharmacother 2017; 18:351–362.
  13. Brand BA, et al. Towards better care for women with schizophrenia-­spectrum disorders. Lancet Psychiatry 2022; 9:330–336.
  14. Li Z, et al. Estradiol and raloxifene as adjunctive treatment for women with schizophrenia: a meta-­analysis of randomized, double-­blind, placebo-­controlled trials. Acta Psychiatr Scand 2023; 147:360–372.
  15. Sommer IE, et al. Women with schizophrenia-­spectrum disorders after menopause: a vulnerable group for relapse. Schizophr Bull 2022; 49:136–143. Table 10.25  Management of adverse effects of hormone replacement therapy (HRT). Adverse effect Comments Breast tenderness Bloating Spotting Common within first 3–6 months, or on dose adjustment, normally transient. Headaches Nausea Common in first 3 months of starting or dose increase. May need slower titration. Mood swings Increase in PMS symptoms Increased anxiety/agitation Often common when starting for first month, then transient. Consider progesterone intolerance if beyond 1 month or severe. Irregular bleeding Common for the first 3 months. Refer for investigation if after 4–6 months it has not settled or patient has been on HRT for a while and it is a new presentation. PMS, premenstrual syndrome.

864 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 16. González-­Rodríguez A, et al. Women with schizophrenia over the life span: health promotion, treatment and outcomes. Int J Environ Res Public Health 2020; 17:5594. 17. Brand BA, et al. Evidence-­based recommendations for the pharmacological treatment of women with schizophrenia spectrum disorders. Curr Psychiatry Rep 2023; 25:723–733. 18. Culbert KM, et al. Risk for midlife psychosis in women: critical gaps and opportunities in exploring perimenopause and ovarian hormones as mechanisms of risk. Psychol Med 2022; 52:1612–1620. 19. Seeman MV. Selecting the right treatment plan for schizophrenia in postmenopausal women: an update of the literature. Expert Rev Neurother 2023; 23:515–523. 20. Hamoda H, et al. The British Menopause Society and Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reprod Health 2020; 26:181–209. 21. Chakrabarti R, et  al. Prescribing hormone replacement therapy: key considerations for primary care physicians. Br J Gen Pract 2023; 73:330–332. 22. Weiss SR, et al. A randomized controlled trial of four doses of transdermal estradiol for preventing postmenopausal bone loss. Transdermal Estradiol Investigator Group. Obstet Gynecol 1999; 94:330–336. 23. Boardman HM, et al. Hormone therapy for preventing cardiovascular disease in post-­menopausal women. Cochrane Database Syst Rev 2015; 2015:CD002229. 24. British Menopause Society (BMS). Progestogens and endometrial protection. BMS consensus statement. 2021; https://thebms.org.uk/wp-­ content/uploads/2021/10/14-­BMS-­TfC-­Progestogens-­and-­endometrial-­protection-­01H.pdf.

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