Schizophrenia Bulletin Advance Access originally published online on December 21, 2007
Schizophrenia Bulletin 2008 34(6):1172-1181; doi:10.1093/schbul/sbm138
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Estrogen and Comprehension of Metaphoric Speech in Women Suffering From Schizophrenia: Results of a Double-Blind, Placebo-Controlled Trial
2 Department of General Psychiatry
3 Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany
4 Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany
1 To whom correspondence should be addressed; Department of General Psychiatry, Ruprecht-Karls-University of Heidelberg, Voss-Str. 4, D-69115 Heidelberg, Germany; tel: +49-6221-56-5411, fax: +49 6221-56-5477, e-mail: niels.bergemann{at}med.uni-heidelberg.de.
Objective: The effects of estrogen on comprehension of metaphoric speech, word fluency, and verbal ability were investigated in women suffering from schizophrenia. The issue of estrogen-dependent neuropsychological performance could be highly relevant because women with schizophrenia frequently suffer from hypoestrogenism. Method: A placebo-controlled, double-blind, crossover study using 17β-estradiol for replacement therapy and as an adjunct to a naturalistic maintenance antipsychotic treatment was carried out over a period of 8 months. Nineteen women (mean age = 38.0 years, SD = 9.9 years) with schizophrenia were included in the study. Comprehension of metaphoric speech was measured by a lexical decision paradigm, word fluency, and verbal ability by a paper-and-pencil test. Results: Significant improvement was seen for the activation of metaphoric meaning during estrogen treatment (P = .013); in contrast, no difference was found for the activation of concrete meaning under this condition. Verbal ability and word fluency did not improve under estrogen replacement therapy either. Conclusions: This is the very first study based on estrogen intervention instead of the physiological hormone changes to examine the estrogen effects on neuropsychological performance in women with schizophrenia. In addition, it is the first time that the effect of estrogen on metaphoric speech comprehension was investigated in this context. While in a previous study estrogen therapy as adjunct to a naturalistic maintenance treatment with antipsychotics did not show an effect on psychopathology measured by a rating scale, a significant effect of estrogen on the comprehension of metaphoric speech and/or concretism, a main feature of schizophrenic thought and language disturbance, was found in the present study. Because the improvement of formal thought disorders and language disturbances is crucial for social integration of patients with schizophrenia, the results may have implications for the treatment of these individuals.
Keywords: schizophrenia / estrogen / women / metaphoric speech / concrete thinking / concretism / verbal ability / word fluency / formal thought disorder / language disturbances