女性賀爾蒙加強治療能改善停經後精神病

Female Sex Hormone Augmentation Is Effective for Menopausal Psychosis

背景：更年期婦女友較高出現精神病症狀的機會。更年期或是停經後精神病用抗精神病藥物治療無效時，加上女性荷爾蒙可能可改善療效。病例報告：我們提出一例50歲首次出現精神病症狀的晚發型精神分裂女性個案，其精神病症狀使用3種抗精神病藥物治療反應並不佳，且在抗精神病藥物劑量增加之後出現明顯錐體外症候群副作用。於是我們併用Premelle2.5(conjugatedestrogen0.625+medroxyprogesterone2.5mg)每日一顆，其精神病症狀獲得相當程度的控制與改善，並以隔日一顆與抗精神病藥合用治療兩年。在停止使用Premelle成單線使用抗精神病藥物後，其精神病症狀再度復發：再次投與Premelle即再次獲得改善，於一年後停止使用Premelle，個案繼續以抗精神病藥維持治療，病況穩定。結論：雌激素能調節多巴胺，有類似抗精神病劑之作用，故於停經後精神病婦女為一有效之加強治療。

Background: Perimenopausal women may have an increased vulnerability to psychosis. Antipsychotic drugs are considered effective for acute and maintenance treatment of menopausal psychosis. In those patients who respond poorly to antipsychotic agents, estrogen augmentation may be also benefi cial. Case report: We present a 50-year-old woman experiencing psychotic symptoms with onset one year after the menopause. The patient with positive psychotic symptoms did not respond well to three different antipsychotic drugs at adequate dosage and duration. But she responded with a combination of antipsychotic drug and Premelle 2.5 (conjugated estrogen 0.625 + medroxyprogesterone 2.5mg) daily, and achieved a satisfactory treatment response. The patient’s psychotic symptoms were re-emerged after discontinuation of Premelle and were resolved after resuming Premelle treatment. Conclusion: Estrogen modulates the dopamine system in a mechanism similar to neuroleptic drugs and is an effective augmentation treatment for menopausal psychosis.