590459 research-article2015
ANP0010.1177/0004867415590459ANZJP ArticlesGleeson et al.
Research
Menstrual cycle characteristics in women with persistent schizophrenia
Australian & New Zealand Journal of Psychiatry 1–7 DOI: 10.1177/0004867415590459 © The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com
Pia C Gleeson1, Roisin Worsley2, Emorfia Gavrilidis2, Shainal Nathoo2, Elisabeth Ng2, Stuart Lee2 and Jayashri Kulkarni2
Abstract Objective: Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms. Method: Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery–Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays. Results: Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery–Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%). Conclusion: Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia. Keywords menstrual cycle, schizophrenia, oestradiol, psychosis
1School
Introduction
of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
2Alfred
Schizophrenia is a severe mental illness that affects approximately 1% of the population worldwide and causes considerable morbidity (Prince et al., 2007). Gender differences in the presentation of schizophrenia have been recognised for over a century (Kraepelin, 1909-15). Women with schizophrenia are
Corresponding author: Jayashri Kulkarni, Monash Alfred Psychiatry Research Centre (MAPrc), Level 4, 607 St Kilda Rd, Melbourne, VIC 3004, Australia. Email: [email protected]
Australian & New Zealand Journal of Psychiatry
Downloaded from anp.sagepub.com at UNIVERSITE LAVAL on November 14, 2015
2 at higher risk of acute psychotic symptoms at times of physiologically low or decreasing serum oestradiol levels, such as postpartum (Matevosyan, 2011) and the menopause transition (Seeman, 2012b). The fluctuations in serum levels of oestradiol in the menstrual cycle also have a significant effect on psychopathology in some women (Seeman, 2012a). Admissions to psychiatric units are reported to be more common in the late luteal and early follicular menstrual phase, and lowest in the high oestradiol ovulatory phase (Lande and Karamchandani, 2002). We recently reported that adjunctive treatment with high-dose oestradiol patches has an antipsychotic effect in women with treatment-resistant schizophrenia (Kulkarni et al., 2014), further adding to the weight of evidence that hormones related to the menstrual cycle play an important role in modulating the symptoms of schizophrenia. Menstrual dysfunction is common in women with schizophrenia and is at least partially accounted for by antipsychotic induced hyperprolactinaemia (Chiang et al., 2011; Magharious et al., 1998; Prentice and Deakin, 1992; Smith et al., 2002; Wieck and Haddad, 2003). Irregular menses are usually associated with anovulation (Munro et al., 2011) and therefore lack of rise in oestradiol levels in the luteal phase of the menstrual cycle. There has also been a suggestion that poorer cognition may be associated with menstrual dysfunction in women with schizophrenia (Prentice and Deakin, 1992). Although several studies have documented the changes in symptoms of psychosis across the menstrual cycle (Bergemann et al., 2007; Hallonquist et al., 1993; Seeman, 2012a), there is a dearth of information on menstrual symptoms in women with schizophrenia. Therefore, in this study, we have documented the menstrual cycle characteristics of a group of women with treatment-resistant schizophrenia, with a particular focus upon menstrual regularity, menstrual cycle length and symptoms associated with menstruation. Our aims were to determine (1) which patient characteristics are associated with irregular menses and (2) whether irregular menses are associated with psychotic symptoms, menstrual symptoms or depressive symptoms.
Methods Participants Cross-sectional analyses were performed using data taken from baseline characteristics of women enrolled in a clinical trial of adjunctive oestradiol for treatment-resistant schizophrenia. The inclusion criteria for this study were Diagnostic and Statistical Manual of Mental Disorders– Fourth Edition, Text Revision (DSM-IV-TR) (Michael and First, 2000) diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; age between 18 and 51 years; and residual symptoms of psychosis despite treatment with
ANZJP Articles a stable dose of antipsychotic medication for at least 4 weeks. Women were excluded if they were pregnant or lactating, postmenopausal and had a history of thromboembolic disorders, breast cancer or an unstable medical condition. The study had approval from the Human Ethics Committee of the Alfred Hospital (202/04) and was registered at ClinicalTrials.gov (NCT00357006).
Characterising the menstrual cycle Women were asked questions on menstrual cycle regularity, the date of the last menstrual cycle and usual menstrual cycle length. Menses were classified as regular if they occurred once every 3–5 weeks. Cycle lengths outside this time frame were considered irregular and included women with amenorrhoea. Menstrual cycle length was assessed in women who had menstruated within the last 6 months. Women were also asked whether they experienced a series of physical symptoms in relation to their menses, or whether their psychotic symptoms or mood worsened before, during or after their period.
Hormone assays Hormone assays were performed by the Department of Biochemistry, Alfred Hospital. A single 10 mL blood sample was collected at baseline for serum oestradiol, prolactin and testosterone.
Psychopathology Symptoms of schizophrenia were measured using the Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1987). The PANSS is a semi-structured interview that consists of 30 items across three subscales – positive, negative and general psychopathology. The subscales are added to create a total PANSS score, with a range of 30–210. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (Randolph, 1999). Depression was assessed using the Montgomery–Asberg Depression Rating Scale (MADRS), a 10-item researcher rated scale of depression (Montgomery and Asberg, 1979).
Antipsychotic medications Antipsychotic medications act as dopamine antagonists and can be classified as either ‘typical’ or ‘atypical’. Atypical antipsychotics differ from the older generation typical antipsychotics in their greater specificity for the dopamine D2 receptor. Dopamine inhibits the secretion of prolactin from the pituitary gland, with greater affinity for the D2 receptor associated with hyperprolactinaemia.16 In particular, risperidone, amisulpride and paliperidone are well
Australian & New Zealand Journal of Psychiatry Downloaded from anp.sagepub.com at UNIVERSITE LAVAL on November 14, 2015
3
Gleeson et al. Table 1. Categories of antipsychotics. Typical antipsychotics (TA)
Non-hyperprolactinaemic antipsychotics (AA)
Hyperprolactinaemic antipsychotics (PAA)
Fluphenazine decoante
Aripiprazole
Risperidone
Tricluperazine hydrochloride
Ziprasidone hydrochloride
Amisulpride
Chlorpromazine hydrochloride
Olanzapine
Paliperidone
Zuclopenthixol
Clozapine
Flupenthixol
Quetiapine fumurate
Haloperidol
known to cause hyperprolactinaemia.(Haddad and Wieck, 2004; Peuskens et al., 2014). For the purposes of these analyses, antipsychotic medications were clustered into three categories: typical antipsychotics (TA), atypical antipsychotics that are not likely to cause hyperprolactinaemia (AA) and atypical antipsychotics that are likely to cause hyperprolactinaemia (PAA) (Table 1).
Statistical analysis For the purposes of these analyses, women using a hormonal contraceptive (the combined oral contraceptive pill, depot progestin or progestin implant) were excluded. Descriptive statistics are presented as number (percent) for categorical data and mean (standard deviation) for descriptive data. T-tests were used to compare means in menstrual cycle length and psychopathology between those with regular and irregular cycles. One-way analysis of variance (ANOVA) was used to test differences in menstrual cycle length and hormone levels between antipsychotic groups. Chi-square tests were used to examine differences in menstrual cycle symptoms between those with regular and irregular cycles. Bivariate regression was used to determine factors associated with irregular cycles. A multiple logistic regression model was constructed with the outcome defined as ‘irregular cycles’ versus ‘regular cycles’. Factors significantly associated with irregular cycles in bivariate analysis were used to construct a multiple logistic regression model with the outcome defined as ‘irregular cycles’ versus ‘regular cycles’. All analyses were undertaken using STATA version 12.0 (StataCorp). An alpha of 0.05 was used to determine a significant effect.
Table 2. Characteristics of entire sample. Characteristic (n = 139)
n (%)
Age (years), mean ± SD
35.0 ± 8.2
Age at diagnosis (years), mean ± SD
24.1 ± 8.2
Duration of illness (years)
9.6 ± 7.5
Diagnosis Schizophrenia Schizoaffective disorder
89 (64) 50 (36)
Antipsychotic type TA AA PAA
23 (16.6) 81 (58.3) 35 (25.2)
Total antipsychotic dose in risperidone equivalents
7.7 ± 4.9
Married/defacto
23 (16.5)
Has children
56 (40.3)
Current smoker
79 (56.8)
Number of psychiatric hospitalisations
2.6 ± 1.6
PANSS total
73.7 ± 17.5
MADRS
16.7 ± 10.5
RBANS total
78.9 ± 15.5
Menses Regular Irregular Missing
77 (55.4) 57 (41.0) 5 (3.6)
Menstrual cycle length (days), mean (SD)
30.3 (10.3)
Results
Amenorrhoea ⩾ 6 months
10 (7.2)
Overall, between 2006 and 2011, 180 women were recruited to the study. Of these, 41 (22.7%) were excluded as they were using hormonal contraception. The remaining 139 women comprise the study sample. The mean age of the group was 35.0 ± 8.2 years, with a mean duration of illness of 9.6 ± 7.5 years (Table 2). TA were used by 23 (16.6%) women, AA by 81 (58.3%) and
White
124 (89.2)
Number of pregnancies, mean (SD)
1.6 (2)
SD: standard deviation; TA: typical antipsychotics; AA: atypical antipsychotics not likely to cause hyperprolactinaemia; PAA: atypical antipsychotics likely to cause hyperprolactinaemia; PANSS: Positive and Negative Syndrome Scale; MADRS: Montgomery–Asberg Depression Rating Scale; RBANS: Repeatable Battery for the Assessment of Neuropsychological Status.
Australian & New Zealand Journal of Psychiatry
Downloaded from anp.sagepub.com at UNIVERSITE LAVAL on November 14, 2015
4
ANZJP Articles
Table 3. Menstrual cycle associated symptoms. Symptom
Total group, N = 139
Regular menses, n = 77
Irregular menses, n = 57
χ2
Cyclical decrease in mood
90 (64.8)
63 (81.82)
27 (47.37)
χ2 = 17.63, p
ANP0010.1177/0004867415590459ANZJP ArticlesGleeson et al.
Research
Menstrual cycle characteristics in women with persistent schizophrenia
Australian & New Zealand Journal of Psychiatry 1–7 DOI: 10.1177/0004867415590459 © The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com
Pia C Gleeson1, Roisin Worsley2, Emorfia Gavrilidis2, Shainal Nathoo2, Elisabeth Ng2, Stuart Lee2 and Jayashri Kulkarni2
Abstract Objective: Oestradiol has been implicated in the pathogenesis of schizophrenia. Women with schizophrenia often suffer with menstrual dysfunction, usually associated with low oestradiol levels, but whether menstrual dysfunction has an effect on their psychiatric symptoms is not well researched. The aim of this study is to document the menstrual characteristics of women with chronic schizophrenia with focus upon menstrual regularity, menstrual cycle length and menstrual symptoms. To determine which patient characteristics are associated with irregular menses and whether irregular menses are associated with the severity of psychotic symptoms, menstrual symptoms or depressive symptoms. Method: Cross-sectional analyses using baseline data of women enrolled in a clinical trial. Inclusion criteria include Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, Text Revision diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; aged between 18 and 51 years; residual symptoms of psychosis despite treatment with a stable dose of antipsychotic medication for at least 4 weeks. Menstrual cycle characteristics including regularity, cycle length and menstrual associated symptoms were documented. Symptoms of schizophrenia were measured using Positive and Negative Syndrome Scale, cognition was measured using Repeatable Battery for the Assessment of Neuropsychological Status and depression was assessed using the Montgomery–Asberg Depression Rating Scale. Blood samples were collected at baseline for hormone assays. Results: Of the 139 women, 77 (55.4%) had regular menses, 57 (41%) had irregular menses and 5 (3.6%) women had missing data on their menstrual cycle. Use of atypical antipsychotics associated with hyperprolactinaemia was positively associated with irregular menses (odds ratio = 4.4, 95% confidence interval = [1.8, 10.9], p = 0.001), while age more than 30 years was negatively associated (odds ratio = 0.3, 95% confidence interval = [0.1, 0.6], p = 0.004). Women with irregular cycles had significantly lower oestradiol levels than women with regular cycles (213.2 ± 25.0 vs 299.0 ± 27.3, p = 0.03), but there was no difference in Positive and Negative Syndrome Scale, Montgomery–Asberg Depression Rating Scale or Repeatable Battery for the Assessment of Neuropsychological Status between those with regular and irregular cycles. The most common menstrual associated symptoms were decrease in mood with the menstrual cycle (64.8%), bloating (64.8%), cramps (59.7%), back pain (37.6%) and worsening of psychosis symptoms (32.4%). Conclusion: Regular menses are associated with higher oestradiol levels and higher rates of cyclical mood symptoms but are not associated with Positive and Negative Syndrome Scale scores. Understanding the effect the menstrual cycle can have on psychiatric illness, such as premenstrual exacerbations, is important for the holistic care of women with schizophrenia. Keywords menstrual cycle, schizophrenia, oestradiol, psychosis
1School
Introduction
of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Hospital Psychiatry Department and Monash University Central Clinical School, Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, VIC, Australia
2Alfred
Schizophrenia is a severe mental illness that affects approximately 1% of the population worldwide and causes considerable morbidity (Prince et al., 2007). Gender differences in the presentation of schizophrenia have been recognised for over a century (Kraepelin, 1909-15). Women with schizophrenia are
Corresponding author: Jayashri Kulkarni, Monash Alfred Psychiatry Research Centre (MAPrc), Level 4, 607 St Kilda Rd, Melbourne, VIC 3004, Australia. Email: [email protected]
Australian & New Zealand Journal of Psychiatry
Downloaded from anp.sagepub.com at UNIVERSITE LAVAL on November 14, 2015
2 at higher risk of acute psychotic symptoms at times of physiologically low or decreasing serum oestradiol levels, such as postpartum (Matevosyan, 2011) and the menopause transition (Seeman, 2012b). The fluctuations in serum levels of oestradiol in the menstrual cycle also have a significant effect on psychopathology in some women (Seeman, 2012a). Admissions to psychiatric units are reported to be more common in the late luteal and early follicular menstrual phase, and lowest in the high oestradiol ovulatory phase (Lande and Karamchandani, 2002). We recently reported that adjunctive treatment with high-dose oestradiol patches has an antipsychotic effect in women with treatment-resistant schizophrenia (Kulkarni et al., 2014), further adding to the weight of evidence that hormones related to the menstrual cycle play an important role in modulating the symptoms of schizophrenia. Menstrual dysfunction is common in women with schizophrenia and is at least partially accounted for by antipsychotic induced hyperprolactinaemia (Chiang et al., 2011; Magharious et al., 1998; Prentice and Deakin, 1992; Smith et al., 2002; Wieck and Haddad, 2003). Irregular menses are usually associated with anovulation (Munro et al., 2011) and therefore lack of rise in oestradiol levels in the luteal phase of the menstrual cycle. There has also been a suggestion that poorer cognition may be associated with menstrual dysfunction in women with schizophrenia (Prentice and Deakin, 1992). Although several studies have documented the changes in symptoms of psychosis across the menstrual cycle (Bergemann et al., 2007; Hallonquist et al., 1993; Seeman, 2012a), there is a dearth of information on menstrual symptoms in women with schizophrenia. Therefore, in this study, we have documented the menstrual cycle characteristics of a group of women with treatment-resistant schizophrenia, with a particular focus upon menstrual regularity, menstrual cycle length and symptoms associated with menstruation. Our aims were to determine (1) which patient characteristics are associated with irregular menses and (2) whether irregular menses are associated with psychotic symptoms, menstrual symptoms or depressive symptoms.
Methods Participants Cross-sectional analyses were performed using data taken from baseline characteristics of women enrolled in a clinical trial of adjunctive oestradiol for treatment-resistant schizophrenia. The inclusion criteria for this study were Diagnostic and Statistical Manual of Mental Disorders– Fourth Edition, Text Revision (DSM-IV-TR) (Michael and First, 2000) diagnosis of schizophrenia, schizoaffective or schizophreniform disorder; age between 18 and 51 years; and residual symptoms of psychosis despite treatment with
ANZJP Articles a stable dose of antipsychotic medication for at least 4 weeks. Women were excluded if they were pregnant or lactating, postmenopausal and had a history of thromboembolic disorders, breast cancer or an unstable medical condition. The study had approval from the Human Ethics Committee of the Alfred Hospital (202/04) and was registered at ClinicalTrials.gov (NCT00357006).
Characterising the menstrual cycle Women were asked questions on menstrual cycle regularity, the date of the last menstrual cycle and usual menstrual cycle length. Menses were classified as regular if they occurred once every 3–5 weeks. Cycle lengths outside this time frame were considered irregular and included women with amenorrhoea. Menstrual cycle length was assessed in women who had menstruated within the last 6 months. Women were also asked whether they experienced a series of physical symptoms in relation to their menses, or whether their psychotic symptoms or mood worsened before, during or after their period.
Hormone assays Hormone assays were performed by the Department of Biochemistry, Alfred Hospital. A single 10 mL blood sample was collected at baseline for serum oestradiol, prolactin and testosterone.
Psychopathology Symptoms of schizophrenia were measured using the Positive and Negative Syndrome Scale (PANSS) (Kay et al., 1987). The PANSS is a semi-structured interview that consists of 30 items across three subscales – positive, negative and general psychopathology. The subscales are added to create a total PANSS score, with a range of 30–210. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (Randolph, 1999). Depression was assessed using the Montgomery–Asberg Depression Rating Scale (MADRS), a 10-item researcher rated scale of depression (Montgomery and Asberg, 1979).
Antipsychotic medications Antipsychotic medications act as dopamine antagonists and can be classified as either ‘typical’ or ‘atypical’. Atypical antipsychotics differ from the older generation typical antipsychotics in their greater specificity for the dopamine D2 receptor. Dopamine inhibits the secretion of prolactin from the pituitary gland, with greater affinity for the D2 receptor associated with hyperprolactinaemia.16 In particular, risperidone, amisulpride and paliperidone are well
Australian & New Zealand Journal of Psychiatry Downloaded from anp.sagepub.com at UNIVERSITE LAVAL on November 14, 2015
3
Gleeson et al. Table 1. Categories of antipsychotics. Typical antipsychotics (TA)
Non-hyperprolactinaemic antipsychotics (AA)
Hyperprolactinaemic antipsychotics (PAA)
Fluphenazine decoante
Aripiprazole
Risperidone
Tricluperazine hydrochloride
Ziprasidone hydrochloride
Amisulpride
Chlorpromazine hydrochloride
Olanzapine
Paliperidone
Zuclopenthixol
Clozapine
Flupenthixol
Quetiapine fumurate
Haloperidol
known to cause hyperprolactinaemia.(Haddad and Wieck, 2004; Peuskens et al., 2014). For the purposes of these analyses, antipsychotic medications were clustered into three categories: typical antipsychotics (TA), atypical antipsychotics that are not likely to cause hyperprolactinaemia (AA) and atypical antipsychotics that are likely to cause hyperprolactinaemia (PAA) (Table 1).
Statistical analysis For the purposes of these analyses, women using a hormonal contraceptive (the combined oral contraceptive pill, depot progestin or progestin implant) were excluded. Descriptive statistics are presented as number (percent) for categorical data and mean (standard deviation) for descriptive data. T-tests were used to compare means in menstrual cycle length and psychopathology between those with regular and irregular cycles. One-way analysis of variance (ANOVA) was used to test differences in menstrual cycle length and hormone levels between antipsychotic groups. Chi-square tests were used to examine differences in menstrual cycle symptoms between those with regular and irregular cycles. Bivariate regression was used to determine factors associated with irregular cycles. A multiple logistic regression model was constructed with the outcome defined as ‘irregular cycles’ versus ‘regular cycles’. Factors significantly associated with irregular cycles in bivariate analysis were used to construct a multiple logistic regression model with the outcome defined as ‘irregular cycles’ versus ‘regular cycles’. All analyses were undertaken using STATA version 12.0 (StataCorp). An alpha of 0.05 was used to determine a significant effect.
Table 2. Characteristics of entire sample. Characteristic (n = 139)
n (%)
Age (years), mean ± SD
35.0 ± 8.2
Age at diagnosis (years), mean ± SD
24.1 ± 8.2
Duration of illness (years)
9.6 ± 7.5
Diagnosis Schizophrenia Schizoaffective disorder
89 (64) 50 (36)
Antipsychotic type TA AA PAA
23 (16.6) 81 (58.3) 35 (25.2)
Total antipsychotic dose in risperidone equivalents
7.7 ± 4.9
Married/defacto
23 (16.5)
Has children
56 (40.3)
Current smoker
79 (56.8)
Number of psychiatric hospitalisations
2.6 ± 1.6
PANSS total
73.7 ± 17.5
MADRS
16.7 ± 10.5
RBANS total
78.9 ± 15.5
Menses Regular Irregular Missing
77 (55.4) 57 (41.0) 5 (3.6)
Menstrual cycle length (days), mean (SD)
30.3 (10.3)
Results
Amenorrhoea ⩾ 6 months
10 (7.2)
Overall, between 2006 and 2011, 180 women were recruited to the study. Of these, 41 (22.7%) were excluded as they were using hormonal contraception. The remaining 139 women comprise the study sample. The mean age of the group was 35.0 ± 8.2 years, with a mean duration of illness of 9.6 ± 7.5 years (Table 2). TA were used by 23 (16.6%) women, AA by 81 (58.3%) and
White
124 (89.2)
Number of pregnancies, mean (SD)
1.6 (2)
SD: standard deviation; TA: typical antipsychotics; AA: atypical antipsychotics not likely to cause hyperprolactinaemia; PAA: atypical antipsychotics likely to cause hyperprolactinaemia; PANSS: Positive and Negative Syndrome Scale; MADRS: Montgomery–Asberg Depression Rating Scale; RBANS: Repeatable Battery for the Assessment of Neuropsychological Status.
Australian & New Zealand Journal of Psychiatry
Downloaded from anp.sagepub.com at UNIVERSITE LAVAL on November 14, 2015
4
ANZJP Articles
Table 3. Menstrual cycle associated symptoms. Symptom
Total group, N = 139
Regular menses, n = 77
Irregular menses, n = 57
χ2
Cyclical decrease in mood
90 (64.8)
63 (81.82)
27 (47.37)
χ2 = 17.63, p
