Symptoms of schizophrenic women change tones with menstrual cycle, study shows

Study was conducted at a tertiary care mental hospital in eastern India, where the moods of 40 schizophrenia patients were monitored for 15 months.

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Bengaluru: Schizophrenic women feel more aggressive during PMS, while their levels of tension, depression and anxiety fall as their period draws to a close, a limited study conducted at an Indian hospital has suggested.

PMS, or premenstrual syndrome, refers to the physical and emotional symptoms women experience in the days before their period — a time that has come to be associated with severe mood swings in women.

The study was conducted at an unidentified tertiary care mental hospital in eastern India, where the moods of 40 women diagnosed with schizophrenia were monitored for 15 months to analyse how symptoms varied during the menstrual cycle.

The initial findings, published in the journal Archives of Women’s Mental Health,
reveal that symptoms of schizophrenia change based on the day of the menstrual cycle, and are exacerbated by PMS and menstruation.

Troughs and crests

It is well-established that there exists a link between symptoms of psychosis and menstrual phases, and women who’re diagnosed with schizophrenia are believed to be at a higher risk of episodes of acute psychosis.

Researchers Paramita Ray, Nikhilesh Mandal, and V.K. Sinha set off on their study with an aim to determine how symptoms of schizophrenia change over the menstrual cycle, which is divided into three phases: Pre-menstrual (seven days before menstruation), when progesterone is high, menstrual, and post-menstrual (seven days after), when oestrogen is higher.

Progesterone and oestrogen are two hormones regulating the reproductive system.
The researchers measured fluctuations in symptoms by using a Positive and Negative Symptom Scale for Schizophrenia (PANSS).

PANSS was formulated to test patients for the two types of symptoms associated with schizophrenia: Positive symptoms, where normal functions are in “excess” and cause, for example, hallucinations and delusions, and negative symptoms, where normal functions under-perform, leading to apathy and loss of motivation.

The PANSS test is conducted in the form of an interview that lasts 45 minutes to an hour. For each type of symptom, the patient is rated on a 1-to-7 scale, with 1 being the weakest level of that symptom.

“All the patients recruited for the study were on tablet Olanzapine 5 to10 mg (an anti-psychotic drug) per day, once daily, after dinner,” the researchers wrote in their study.

According to the results, most of the symptoms that showed changes were found to be heightened during the pre-menstrual phase, with their levels falling slowly as a woman transitioned to menstrual and post-menstrual phases.

For example, researchers observed a fall in the score for ‘excitement’ and ‘hostility’, categorised under the positive scale, from the pre-menstrual to the menstrual stages, indicating that feelings of aggression are indeed heightened during PMS phase.

The study also found that the transition from the menstrual phase to the post-menstrual phase was marked by the fewest changes in symptoms. During this time, the women showed an improvement in rapport, abstract thinking and social interactions.

Meanwhile, positive-type symptoms such as grandiosity, suspicion, and disorganisation were measured lower during the pre-menstrual period than in the menstrual phase, improved with the presence of progesterone. In the post-menstrual oestrogen-rich phase, negative symptoms like poor rapport, difficulty in abstract thinking and more measured lower.

The study concluded that as a woman moved from the menstrual to post-menstrual phases, her levels of anxiety, tension, depression, pre-occupation, active social avoidance, poor impulse control, and lack of contentment registered a decline.

The key, the study suggests, is progesterone.

“The finding in our study is an indicator of the potential role of progesterone in neuro-protection and also its relation to change with positive symptomatology,” the researchers wrote in the study.

“It is known that the functions of oestrogen are intimately associated with that of progesterone, making it difficult to consider each independently with respect to neuroprotection. Progesterone facilitates cognitive recovery, reducing secondary neuronal loss,” they added.

The researchers, however, said a more comprehensive study was needed to delve into the effects of progesterone/oestrogen on Indian women and how the hormones can be used to treat schizophrenic symptoms.