Hospitalization in women with psychosis: An age-based proxy analysis for menopause

There is a known association between estrogen levels and psychotic disease severity, with lower estrogen levels associated with a more severe disease course. Estrogens support cognition, increase neuroplasticity, facilitate neurotransmission, and affect the pharmacokinetics and pharmacodynamics of antipsychotic medication, with lower concentrations of these hormones potentially reducing antipsychotics' effectiveness. In this study, we aimed to analyze the different patterns of hospitalization of female patients with psychotic disorders using age as a proxy for menopausal status. Additionally, we investigated differences in antipsychotic use profile, namely clozapine and long-duration antipsychotic administration in these patients under 45 and over 55 years of age. We conducted a retrospective study that included inpatients in the Psychiatry Department of Hospital de Santa Maria, stratifying them by sex and age group (<45 years or >55 years). Direct information about menopausal status was not collected. Our data showed that females over 55 had higher admission rates than their male counterparts (54 % vs 46 % of our sample >55 years old). The chi-square analysis showed that the relation between gender and different age groups in the admission rate was statistically significant, χ² (2, N = 682) = 19.51, p < .001, effect size (Fi): 0.169. No significant differences were found in our four subgroups regarding the number of involuntary commitments or clozapine treatment. These data support the evidence on the deterioration of psychotic illness in women after menopause, demonstrating the importance of knowing our patients' hormonal status to offer a more comprehensive treatment plan.