Estrogen supplementation for female schizophrenics treated with atypical antipsychotics

It has been suggested that estrogen supplementation can augment the treatment effects of typical antipsychotic medication. We report the use of estrogen supplementation for four female chronic inpatients. These patients were diagnosed with schizophrenia or schizoaffective disorders and were treated with atypical antipsychotics. Premenstrual exacerbation of psychiatric symptoms had been noted for all patients. Daily oral conjugated estrogen (Premarin 0.625 mg) was administered for three months continuously, and patients were assessed using the Nurses' Observation Scale for Inpatient Evaluation. Attenuation of premenstrual aggravation of psychiatric symptoms during menstruation was noted for two of the four cases, with substantial improvement noted for one of these. After Premarin treatment was discontinued, three patients were assessed as worse than the pre-supplementation phase using the evaluation scale. This finding is suggestive of individual variability for response to estrogen supplementation, with a possible association for onset age. Caution is advised where estrogen is used to treat schizophrenic patients taking atypical antipsychotics.