title: Estrogen and comprehension of metaphoric speech in women suffering from schizophrenia: results of a double-blind, placebo-controlled trial.
abstract: 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.
  
  
  METHODS
  A placebo-controlled, double-blind, crossover study using 17beta-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.
authors.affiliation: Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany. niels.bergemann@med.uni-heidelberg.de
authors.forename: Niels
authors.initials: N
authors.lastname: Bergemann
authors.forename: Peter
authors.initials: P
authors.lastname: Parzer
authors.forename: Susanne
authors.initials: S
authors.lastname: Jaggy
authors.forename: Beatrice
authors.initials: B
authors.lastname: Auler
authors.forename: Christoph
authors.initials: C
authors.lastname: Mundt
authors.forename: Sabine
authors.initials: S
authors.lastname: Maier-Braunleder
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001288:Attention / Q000187:drug effects; D010054:Brief Psychiatric Rating Scale; D032882:Comprehension / Q000187:drug effects*; D018592:Cross-Over Studies; D003657:Decision Making / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000172:deficiency / Q000627:therapeutic use*; D004964:Estriol / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D019365:Metaphor; D008875:Middle Aged; D009483:Neuropsychological Tests; D009640:Norethindrone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D013067:Speech Perception / Q000187:drug effects*; D013850:Thinking / Q000187:drug effects; D014705:Verbal Behavior / Q000187:drug effects
chemical_list: D014150:Antipsychotic Agents; D004338:Drug Combinations; D004958:Estradiol; C032040:Trisequens; D004964:Estriol; D009640:Norethindrone