Neuroesteroides e esquizofrenia: a função do estrogênio e da progesterona na modulação e proteção do cérebro

Autores

  • Bruno Nascimento Barbosa Departamento de Medicina, Universidade Federal de Sergipe (UFS), São Cristóvão, SE.
  • Amaury Cantilino Professor adjunto, Residência Médica em Psiquiatria do Hospital das Clínicas, Programa de Saúde Mental da Mulher, Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE.
  • Rejane Lúcia Veiga Oliveira Johann Professora adjunta, Departamento de Psicologia, UFS, São Cristóvão, SE.
  • Giuliano Di Pietro Professor associado, Residência Multiprofi ssional em Saúde Mental, Departamento de Farmácia, UFS, São Cristóvão, SE.

DOI:

https://doi.org/10.25118/2763-9037.2019.v9.64

Palavras-chave:

Mulheres, esquizofrenia, neuroesteroides, estrogênio e progesterona

Resumo

A esquizofrenia é uma psicose crônica, debilitante, de origem multifatorial, que apresenta em sua fisiopatologia pelo menos três mecanismos conhecidos: a desregulação dopaminérgica, a perturbação da neurotransmissão glutamatérgica e GABAérgica e o estado pró-inflamatório do cérebro. Existem diferenças marcantes entre os gêneros na esquizofrenia, e muitos autores afirmam que os hormônios sexuais podem influenciar o curso e os sintomas da doença, modulando a sua gravidade. Os neuroesteroides são neuro-hormônios que têm a capacidade de modular a expressão de subunidades de receptores GABAérgicos subtipo A e N-metil D-aspartato, desempenhando um papel crucial na fisiopatologia de vários transtornos psiquiátricos. O objetivo deste artigo é investigar o quanto os neuroesteroides podem influenciar na fisiopatologia da esquizofrenia em mulheres, através de uma revisão de literatura onde foram incluídos estudos pré-clínicos, clínicos e moleculares que investigaram os efeitos do estrogênio e da progesterona na modulação e proteção do sistema nervoso central (SNC), discutindo a sua função como possíveis adjuvantes terapêuticos no tratamento da esquizofrenia.

Downloads

Não há dados estatísticos.

Métricas

Carregando Métricas ...

Referências

Searles S, Makarewicz JA, Dumas JA. The role of estradiol in schizophrenia diagnosis and symptoms in postmenopausal women. Schizophr Res. 2018;196:35-8.

Londero MDB, Massuda R, Gama CS. Neurobiologia da esquizofrenia. In: Antônio Egídio Narde, João Quevedo, Antônio Geraldo da Silva. Esquizofrenia. Porto Alegre: Artmed; 2015. p. 45-51.

Sun J, Walker AJ, Dean B, van den Buuse M, Gogos A. Progesterone: the neglected hormone in schizophrenia? A focus on progesterone-dopamine interacti ons. Psychoneuroendocrinology. 2016;74:126-40.

Kahn RS, Sommer IE. The neurobiology and treatment of fi rst episode schizophrenia. Mol Psychiatry. 2015;20:84-97.

Castle DJ. Diferenças Sexuais do cérebro e esquizofrenia. In: Castle DJ, Mcgrath J, Kulkarni J. As mulheres e a esquizofrenia. Lisboa: CLIMEPSI; 2003. p. 21-32.

Hafner H. Gender diff erences in schizophrenia. Psychoneuroendocrinology. 2003;28:17-54.

McGregor C, Riordan A, Thornton J. Estrogens and the cogniti ve symptoms of schizophrenia: possible neuroprotecti ve mechanisms. Front Neuroendocrinol. 2017;47:19-33.

Gogos A, Sbisa AM, Sun J, Gibbons A, Udawela M, Dean B. A role for estrogen in schizophrenia: clinical and preclinical fi ndings. Int J Endocrinol. 2015;2015:615356.

Ji E, Weickert CS, Lenroot R, Kindler J, Skilleter AJ, Vercammen A, et al. Adjuncti ve selecti ve estrogen receptor modulator increases neural acti vity in the hippocampus and inferior frontal gyrus during emoti onal face recogniti on in schizophrenia. Transl Psychiatry. 2016;6:e795.

Compagnone NA, Mellon SH. Neurosteroids: biosynthesis and functi on of these novel neuromodulators. Front Neuroendocrinol. 2000;21:1-56.

Strous RD, Spivak B, Yoran-Hegesh R, Maayan R, Averbuch E, Kotler M, et al. Analysis of neurosteroid levels in att enti on defi cit hyperacti vity disorder. Int J Neuropsychopharmacol. 2001;4:259-64.

Behl C. Estrogen can protect neurons: modes of acti on. J Steroid Biochem Mol Biol. 2003;83:95-97.

Woolley CS. Acute eff ects of estrogen on neuronal physiology. Annu Rev Pharmacol Toxicol. 2007;47:657-80.

MacKenzie EM, Odontiadis J, Le Mellédo JM, Prior TI, Baker GB. The relevance of neuroactive steroids in schizophrenia, depression, and anxiety disorders. Cell Mol Neurobiol. 2007;27:541-74.

Longone P, Rupprecht R, Manieri GA, Bernardi G, Romeo E, Pasini A. The complex roles of neurosteroids in depression and anxiety disorders. Neurochem Int. 2008;52:596-601.

Do Rego JL, Seong JY, Burel D, Leprince J, Luu- The V, Tsutsui K, et al. Neurosteroid biosynthesis: enzymatic pathways and neuroendocrine regulation by neurotransmitters and neuropeptides. Front Neuroendocrinol. 2009;30:259-301.

Luchetti S, Huitinga I, Swaab DF. Neurosteroid and GABA-A receptor alterations in Alzheimer’s disease, Parkinson’s disease and multiple sclerosis. Neuroscience. 2011;191:6-21.

Oberlander JG, Woolley CS. 17β-estradiol acutely potentiates glutamatergic synaptic transmission in the hippocampus through distinct mechanisms in males and females. J Neurosci. 2016;36:2677-90.

Cai H, Cao T, Zhou X, Yao JK. Neurosteroids in schizophrenia: pathogenic and therapeutic implications. Front Psychiatry. 2018;9:73.

Miller KK. Neuroactive steroids and depression. In: Shapero B, Mischoulon D, Cusin C. The Massachusetts general hospital guide to depression. Basileia: Springer Nature Switzerland; 2019. p. 147-51.

Robel P, Baulieu EE. Neurosteroids: biosynthesis and function. Trends Endocrinol Metab. 1994;5:1-8.

Sthal SM. Psicose e esquizofrenia. In: Sthal SM. Psicofarmacologia: bases neurocientíficas e aplicações práticas. 4ª ed. Rio de Janeiro: Guanabara Koogan; 2016. p. 130-199.

da Silva RCB. Esquizofrenia: uma revisão. Psicol USP. 2006;17:263-85.

Remington G, Foussias G, Agid O, Fervaha G, Takeuchi H, Hahn M. The neurobiology of relapse in schizophrenia. Schizophr Res. 2014;152:381-90.

Chávez-Castillo M, Núñez V, Nava M, Ortega A, Rojas M, Bermúdez V, et al. Depression as a neuroendocrine disorder: emerging neuropsychopharmacological approaches beyond monoamines. Adv Pharmacol Sci. 2019;2019;7943481.

Krystal JH, Anand A, Moghaddam B. Effects of NMDA receptor antagonists: implications for the pathophysiology of schizophrenia. Arch Gen Psychiatry. 2002;59:663-4.

Schwartz TL, Sachdeva S, Stahl SM. Genetic data supporting the NMDA glutamate receptor hypothesis for schizophrenia. Curr Pharm Des. 2012;18;1580-92.

Wang M, Yang Y, Wang CJ, Gamo NJ, Jin LE, Mazer JA, et al. NMDA receptors subserve persistent neuronal firing during working memory in dorsolateral prefrontal cortex. Neuron. 2013;77:736-49.

El-Khodor BF, Flores G, Srivastava LK, Boksa P. Effects of birth insult and stress at adulthood on excitatory amino acid receptors in adult rat brain. Synapse. 2004;54:138-46.

Kaur C, Sivakumar V, Ang LS, Sundaresan A. Hypoxic damage to the periventricular white matter in neonatal brain: role of vascular endothelial growth factor, nitric oxide and excitotoxicity. J Neurochem. 2006:98:1200-16.

Samuelsson AM, Jennische E, Hansson HA, Holmäng A. Prenatal exposure to interleukin-6 results in inflammatory neurodegeneration in hippocampus with NMDA/GABA(A) dysregulation and impaired spatial learning. Am J Physiol Regul Integr Comp Physiol. 2006;290:R1345-56.

Canetta SE, Brown AS. Prenatal infection, maternal immune activation, and risk for schizophrenia. Transl Neurosci. 2012;3:320-7.

Hagberg H, Gressens P, Mallard C. Inflammation during fetal and neonatal life: implications for neurologic and neuropsychiatric disease in children and adults. Ann Neurol. 2012;71:444-57.

Monji A, Kato T, Kanba S. Cytokines and schizophrenia: microglia hypothesis of schizophrenia. Psychiatry Clin Neurosci. 2009;63:257-65.

Papadia S, Soriano FX, Leveille F, Martel MA, Dakin KA, Hansen HH, et al. Synaptic NMDA receptor activity boosts intrinsic antioxidant defenses. Nat Neurosci. 2008;11:476-87.

King SR. Neurosteroids and the nervous system. Basileia: SpringerBriefs in Neuroscience; 2013.

Cai H, Zhou X, Dougherty GG, Reddy RD, Haas GL, Montrose DM, et al. Pregnenoloneprogesterone allopregnanolone pathway as a potenti al therapeuti c target in fi rst-episode anti psychoti c-naïve pati ents with schizophrenia. Psychoneuroendocrinology. 2018;90:43-51.

McEwen BS. Non-genomic and genomic eff ects of steroids on neural acti vity. Trends Pharmacol Sci. 1991;12:141-7.

Baulieu EE. Neurosteroids: of the nervous system, by the nervous system, for the nervous system. Recent Prog Horm Res. 1997;52:1-32.

Wang M. Neurosteroids and GABA-A receptor functi on. Front Endocrinol (Lausanne). 2011;2:44.

Carver CM, Reddy DS. Neurosteroid interacti ons with synapti c and extrasynapti c GABA (A) receptors: regulati on of subunit plasti city, phasic and tonic inhibiti on, and neuronal network excitability. Psychopharmacology (Berl). 013;230:151-88.

Reddy DS, Estes WA. Clinical potenti al of neurosteroids for CNS disorders. Trends Pharmacol Sci. 2016;7:543-61.

Uusi-Oukari M, Korpi ER. Regulati on of GABA-A receptor subunit expression by pharmacological agents. Pharmacol Rev. 2010;62:97-135.

Hosie AM, Clarke L, da Silva H, Smart TG. Conserved site for neurosteroid modulati on of GABA A receptors. Neuropharmacology. 2009;56:149-54.

Reddy DS. Neurosteroids: endogenous role in the human brain and therapeuti c potenti als. Prog Brain Res. 2010;186:113-37.

Shen W, Mennerick S, Covey DF, Zorumski CF. Pregnenolone sulfate modulates inhibitory synapti c transmission by enhancing GABA (A) receptor desensiti zati on. J Neurosci. 2000;20:3571-9.

Lambert JJ, Belelli D, Peden DR, Vardy AW, Peters JA. Neurosteroid modulati on of GABAA receptors. Prog Neurobiol. 2003;71:67-80.

Castle D, Sham P, Murray R. Diff erences in distributi on of ages of onset in males and females with schizophrenia. Schizophr Res. 1998;33:179-83.

Seeman MV. Menstrual exacerbati on of schizophrenia symptoms. Acta Psychiatr Scand. 2012;125:363-71.

Seeman MV. Gender diff erences in the prescribing of anti psychoti c drugs. Am J Psychiatry. 2004;161:1324-33.

Usall J, Suarez D, Haro JM; SOHO Study Group. Gender diff erences in response to anti psychoti c treatment in outpati ents with schizophrenia. Psychiatry Res. 2007;153:225-31.

Gogos A, Ney, LJ, Seymour N, Van Rheenen TE, Felmingham KL. Sex diff erences in schizophrenia, bipolar disorder, and postt raumati c stress disorder: are gonadal hormones the link? Br J Pharmacol. 2019 Jan 18. doi: 10.1111/bph.14584. [Epub ahead of print]

Bassit DP, Neto MRL. Relação entre data de admissão hospitalar e período do ciclo menstrual de mulheres com diagnósti co de esquizofrenia. Rev Bras Psiquiatr. 2000;22:57-61.

Andrade LHSG, Viana MC, Silveira CM. Epidemiologia dos transtornos psiquiátricos na mulher. Rev Psiquiatr Clin. 2006;33:43-54.

Riecher-Rössler A. Oestrogens, prolacti n, hypothalamic-pituitary-gonadal axis, and schizophrenic psychoses. Lancet Psychiatry. 2017;4:63-72.

Locci A, Pinna G. Neurosteroid biosynthesis down-regulati on and changes in GABAA receptor subunit compositi on: a biomarker axis in stressinduced cogniti ve and emoti onal impairment. Br J Pharmacol. 2017;174:3226-41.

Riecher-Rössler A, Butler S, Kulkarni J. Sex and gender diff erences in schizophrenic psychoses-a criti cal review. Arch Womens Ment Health. 2018;21:627-48.

Di Paolo T, Lévesque D, Daigle M. A physiological dose of progesterone aff ects rat striatum biogenic amine metabolism. Eur J Pharmacol. 1986;125:11-6.

Laconi MR, Cabrera RJ. Eff ect of centrally injected allopregnanolone on sexual recepti vity, luteinizing hormone release, hypothalamic dopamineturnover, and release in female rats. Endocrine. 2002;17:77-83.

Motzo C, Porceddu ML, Maira G, Flore G, Concas A, Dazzi L. Inhibition of basal and stress-induced dopamine release in the cerebral cortex and nucleus accumbens of freely moving rats by the neurosteroid allopregnanolone. J Psychopharmacol. 1996;10:266-72.

Adams JM, Thomas P, Smart TG. Modulation of neurosteroid potentiation by protein kinases at synaptic-and extrasynaptic-type GABAA receptors. Neuropharmacology. 2015;88:63-73.

Tenn CC, Niles LP. Sensitization of G proteincoupled benzodiazepine receptors in the striatum of 6-hydroxydopamine-lesioned rats. J Neurochem. 1997;69:1920-6.

Rougé-Pont F, Mayo W, Marinelli M, Gingras M, Le Moal M, Piazza PV. The neurosteroid allopregnanolone increases dopamine release and dopaminergic response to morphine in the rat nucleus accumbens. Eur J Neurosci. 2002;16:169-73.

Brandon N, Jovanovic J, Moss S. Multiple roles of protein kinases in the modulation of γ-aminobutyric acid(A) receptor function and cell surface expression. Pharmacol Ther. 2002;94:113-22.

Singer CA, Rogers KL, Strickland TM, Dorsa DM. Estrogen protects primary cortical neurons from glutamate toxicity. Neurosci Lett. 1996;212:13-6.

Sribnick EA, Ray SK, Nowak MW, Li L, Banik NL. 17beta-estradiol attenuates glutamate-induced apoptosis and preserves electrophysiologic function in primary cortical neurons. J Neurosci Res. 2004;76:688-96.

Spampinato SF, Merlo S, Molinaro G, Battaglia G, Bruno V, Nicoletti F, et al. Dual effect of 17beta estradiol on NMDA-induced neuronal death: involvement of metabotropic glutamate receptor 1. Endocrinology. 2012;153:5940-8.

Velíšková J, De Jesus G, Kaur R, Velíšek L. Females, their estrogens and seizures. Epilepsia. 2010;51:141-4.

Wang LJ, Lee SY, Choua MC, Lee MJ, Chou WJ. Dehydroepiandrosterone sulfate, free testosterone, and sex hormone-binding globulin on susceptibility to attention-deficit/hyperactivity disorder. Psychoneuroendocrinology. 2019;103:212-8.

Seeman MV. Treating schizophrenia at the time of menopause. Maturitas. 2012;72:117-20.

Culmsee C, Vedder H, Ravati A, Junker V, Otto D, Ahlemeyer B, et al. Neuroprotection by estrogens in a mouse model of focal cerebral ischemia and in cultured neurons: evidence for a receptorindependent antioxidative mechanism. J Cereb Blood Flow Metab. 1999;19:263-9.

Moosmann B, Behl C. The antioxidant neuroprotective effects of estrogens and phenolic compounds are independent from their estrogenic properties. Proc Natl Acad Sci U S A. 1999;96:8867-72.

Kirkpatrick B, Miller BJ. Inflammation and schizophrenia. Schizophr Bull. 2013;39:1174-9.

Feigenson KA, Kusnecov AW, Silverstein SM. Inflammation and the two-hit hypothesis of schizophrenia. Neurosci Biobehav Rev. 2014;38:72-93.

Adamski J, Ma Z, Nozell S, Benveniste EN. 17betaestradiol inhibits class II major histocompatibility complex (MHC) expression: influence on histone modifications and CBP recruitment to the class II MHC promoter. Mol Endocrinol. 2004;18:1963-74.

Xing D, Oparil S, Yu H, Gong K, Feng W, Black J, et al. Estrogen modulates NFκB signaling by enhancing IκBα levels and blocking p65 binding at the promoters of inflammatory genes via estrogen receptor-β. PLoS One. 2012;7:e36890.

Paimela T, Ryhänen T, Mannermaa E, Ojala J, Kalesnykas G, Salminen A, et al. The effect of 17β-estradiol on IL-6 secretion and NF-κB DNAbinding activity in human retinal pigment epithelial cells. Immunol Lett. 2007;110:139-44.

Ospina JA, Brevig HN, Krause DN, Duckles SP. Estrogen suppresses IL-1beta-mediated induction of COX-2 pathway in rat cerebral blood vessels. Am J Physiol Heart Circ Physiol. 2004;286:H2010-9.

Sarvari M, Kallo I, Hrabovszky E, Solymosi N, Liposits Z. Ovariectomy and subsequent treatment with estrogen receptor agonists tune the innateimmune system of the hippocampus in middle aged female rats. PLoS One. 2014;9:e88540.

Lopez Rodriguez AB, Mateos Vicente B, Romero-Zerbo SY, Rodriguez-Rodriguez N, Bellini MJ, Rodriguez de Fonseca F, et al. Estradiol decreases corti cal reacti ve astrogliosis aft er brain injury by a mechanism involving cannabinoid receptors. Cereb Cortex. 2011;21:2046-55.

Akabori H, Moeinpour F, Bland KI, Chaudry IH. Mechanism of the anti -infl ammatory eff ect of 17beta-estradiol on brain following traumahemorrhage. Shock. 2010;33:43-8.

Kulkarni J, de Castella A, Smith D, Taff e J, Keks N, Copolov D. A clinical trial of the eff ects of estrogen in acutely psychoti c women. Schizophr Res. 1996;20:247-52.

Ahokas A, Aito M, Turiainen S. Associati on between oestradiol and puerperal psychosis. Acta Psychiatr Scand. 2000;101:167-9; discussion 169-70.

Kulkarni J, Riedel A, de Castella AR, Fitzgerald PB, Rolfe TJ, Taff e J, et al. A clinical trial of adjuncti ve oestrogen treatment in women with schizophrenia. Arch Womens Ment Health. 2002;5:99-104.

Akhondzadeh S, Nejati safa AA, Amini H, Mohammadi MR, Larijani B, Kashani L, et al. Adjuncti ve estrogen treatment in women with chronic schizophrenia: a double-blind, randomized, and placebo-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:1007-12.

Kulkarni J, Fink G. Hormonas e psicose. In: Castle DJ, Mcgrath J, Kulkarni J. As mulheres e a esquizofrenia. Lisboa: CLIMEPSI; 2003. p. 57-68.

Kulkarni J, de Castella A, Fitzgerald PB, Gurvich CT, Bailey M, Bartholomeusz C, et al. Estrogen in severe mental illness: a potenti al new treatment approach. Arch Gen Psychiatry. 2008;65:955-60.

Kulkarni J, Gavrilidis E, Wang W, Worsley R, Fitzgerald PB, Gurvich C, et al. Estradiol for treatment-resistant schizophrenia: a large-scale randomized-controlled trial in women of childbearing age. Mol Psychiatry. 2014;20:695-702.

Lindamer LA, Buse DC, Lohr JB, Jeste DV. Hormone replacement therapy in postmenopausal women with schizophrenia: positi ve eff ect on negati ve symptoms? Biol Psychiatry. 2001;49:47-51.

Ritsner MS. Pregnenolone, dehydroepiandrosterone, and schizophrenia: alterati ons and clinical trials. CNS Neurosci Ther. 2010;16:32-44.

Louza MR, Marques AP, Elkis H, Bassitt D, Diegoli M, Gatt az WF. Conjugated estrogens as adjuvant therapy in the treatment of acute schizophrenia: a double-blind study. Schizophr Res. 2004;66:97-100.

Ghafari E, Fararouie M, Shirazi H, Farhangfar A, Ghaderi F, Mohammadi A. Combinati on of estrogen and anti psychoti cs in the treatment of women with chronic schizophrenia: a doubleblind, randomized, placebo-controlled clinical trial. Clin Schizophr Relat Psychoses. 2013;6:172-6.

Ko YH, Joe SH, Cho W, Park JH, Lee JJ, Jung IK, et al. Eff ect of hormone replacement therapy on cogniti ve functi on in women with chronic schizophrenia. Int J Psychiatry Clin Pract. 2006;10:97-104.

Bergemann N, Mundt C, Parzer P, Jannakos I, Nagl I, Salbach B, et al. Plasma concentrati ons of estradiol in women suff ering from schizophrenia treated with conventi onal versus atypical anti psychoti cs. Schizophr Res. 2005;73:357-66.

Baxter MG, Roberts MT, Gee NA, Lasley BL, Morrison JH, Rapp PR. Multi ple clinically relevant hormone therapy regimens fail to improve cogniti ve functi on in aged ovariectomized rhesus monkeys. Neurobiol Aging. 2013;34:1882-90.

Nilsen J, Brinton RD. Impact of progesti ns on estrogen-induced neuroprotecti on: synergy by progesterone and 19 morprogesterone and antagonism by medroxyprogesterone acetate. Endocrinology. 2002;143:205-12.

Fitzgerald P, Seeman MV. Implicações terapêuti cas. In: Castle DJ, Mcgrath J. Kulkarni J. As Mulheres e a esquizofrenia. Lisboa: CLIMEPSI; 2003. p. 93-104.

Chlebowski RT, Kuller LH, Prenti ce RL, Stefanick ML, Manson JE, Gass M, et al. Breast cancer aft eruse of estrogen plus progesti n in postmenopausal women. N Engl J Med. 2009;360:573-87.

Cyr M, Calon F, Morissett e M, Grandbois M, Di Paolo T, Callier S. Drugs with estrogen-like potency and brain acti vity: potenti al therapeuti c applicati on for the CNS. Curr Pharm Des. 2000;6:1287-312.

Kulkarni J, Gurvich C, Lee SJ, Gilbert H, Gavrilidis E, de Castella A, et al. Piloti ng the eff ecti ve therapeuti c dose of adjuncti ve selecti ve estrogen receptor modulator treatment in postmenopausal women with schizophrenia. Psychoneuroendocrinology. 2010;35:1142-7.

Usall J, Huerta-Ramos E, Iniesta R, Cobo J, Araya S, Roca M, et al. Raloxifene as an adjuncti ve treatment for postmenopausal women with schizophrenia: a double-blind, randomized, placebo-controlled trial. J Clin Psychiatry. 2011;72:1552-7.

Khodaie-Ardakani MR, Khosravi M, Zarinfard R, Nejati S, Mohsenian A, Tabrizi M, et al. A placebocontrolled study of raloxifene added to risperidone in men with chronic schizophrenia. Acta Med Iran. 2015;53:337-45.

Kulkarni J, Gavrilidis E, Gwini SM Worsley R, Grigg J, Warren A, et al. Eff ect of adjuncti ve raloxifene therapy on severity of refractory schizophrenia in women: a randomized clinical trial. JAMA Psychiatry. 2016;73:947-54.

Usall J, Huerta-Ramos E, Labad J, Cobo J, Nunez C, Creus M, et al. Raloxifene as an adjuncti ve treatment for postmenopausal women with schizophrenia: a 24-week double-blind, randomized, parallel, placebo-controlled trial. Schizophr Bull. 2016;42:309-17.

Weiser M, Levi L, Burshtein S, Hagin M, Matei VP, Podea D, et al. Raloxifene plus anti psychoti cs versus placebo plus anti psychoti cs in severely Ill decompensated postmenopausal women with schizophrenia or schizoaff ecti ve disorder: a randomized controlled trial. J Clin Psychiatry. 2017;78:e758-e65.

Huerta-Ramos E, Iniesta R, Ochoa S, Cobo J, Miquel E, Roca M, et al. Eff ects of raloxifene on cogniti on in postmenopausal women with schizophrenia: a double-blind, randomized, placebo-controlled trial. Eur Neuropsychopharmacol. 2014;24:223-31.

Berent-Spillson A, Briceno E, Pinsky A, Simmen A, Persad CC, Zubieta JK, et al. Disti nct cogniti ve eff ects of estrogen and progesterone in menopausal women. Psychoneuroendocrinology. 2015;59:25-36.

Downloads

Publicado

2019-03-29

Como Citar

1.
Barbosa BN, Cantilino A, Johann RLVO, Pietro GD. Neuroesteroides e esquizofrenia: a função do estrogênio e da progesterona na modulação e proteção do cérebro. Debates em Psiquiatria [Internet]. 29º de março de 2019 [citado 2º de outubro de 2025];9(1):32-44. Disponível em: https://revistardp.org.br/revista/article/view/64

Edição

Seção

Artigos de Revisão

Plaudit