Hormones, gender, and the aging brain : the endocrine basis of geriatric psychiatry

The significance of hormone action in psychiatry has long been studied, but only recently has this study included the psychiatric effects of hormones on the aging process. Hormones influence a wide scope of states and conditions, ranging from pain tolerance and anorexia to attention, mood, immunity, cardiovascular and cognitive function, schizophrenia, and Alzheimer's disease. Written by an eminent team of psychiatrists, psychologists, geriatricians, and neuropharmacologists, this pioneering clinical reference addresses the hormonal basis of mental disorders in older people. This book brings together established information and recent findings in four sections: An overview of the basic science of neurosteroids Sex difference and the roles that cortisol, thyroid hormone, and the sex steroids estrogen, progesterone, dehydroepiandrosterone and testosterone play in common mental disorders and pain sensitivity Psychoneuroimmunology in relation to age Sex differences and hormones in psychotropic drug metabolism in the elderly. Cover......Page 1 Half-title......Page 3 Title......Page 5 Copyright......Page 6 Dedication......Page 7 Contents......Page 9 Contributors......Page 11 Preface......Page 15 Acknowledgments......Page 19 Part I Overview......Page 21 Introduction......Page 23 Endocrine disorders as a cause of mental illness......Page 24 Hormones and aging......Page 25 Estrogen and cognitive dysfunction......Page 27 Testosterone and behavior......Page 28 Depression and the hypothalamic–pituitary–adrenal axis......Page 29 Conclusions......Page 30 REFERENCES......Page 31 Endocrine steroid synthesis......Page 35 Neurosteroids......Page 38 General principles......Page 39 CNS Localization and subtypes......Page 41 Classical effects involve changes in neurotransmission......Page 43 Novel effects of steroids......Page 44 Interactions with other steroids......Page 45 Summary and conclusions......Page 46 REFERENCES......Page 47 Part II Hormones and mental health in the elderly......Page 55 The physiology of the HPA axis......Page 57 Animal studies......Page 59 Human studies......Page 61 The HPA axis in human disease states associated with aging......Page 63 Conclusions and future directions......Page 64 REFERENCES......Page 65 Introduction......Page 73 Physiology of the thyroid axis......Page 74 Regulation......Page 75 Effects of HPT-axis hormones on the brain: TRH and metabolites......Page 76 The HPT axis in the elderly......Page 77 Hypothyroidism......Page 78 Hyperthyroidism......Page 79 Geriatric depression......Page 80 Therapeutic effects of HPT axis-related hormones in affective disorders......Page 83 Relationship between treatment modalities for affective disorders and the thyroid axis......Page 84 Cognitive effects of HPT axis in aging......Page 86 Summary and conclusions......Page 87 REFERENCES......Page 88 Epidemiology of depressive disorders in aging......Page 104 The estrogen deficiency hypothesis of depression......Page 105 Epidemiologic evidence that estrogen use is protective against depression......Page 106 Estrogen therapy for mood disorders......Page 107 Recent clinical trials of estrogen replacement to improve mood......Page 109 Selective estrogen receptor modulators......Page 112 Tamoxifen......Page 113 Serotonin......Page 114 Estrogen and 5–HT2 receptors......Page 115 Estrogen and the serotonin transporter......Page 116 Estrogen and serotonergic antidepressant response......Page 117 Imaging data......Page 118 Estrogen and norepinephrine......Page 119 Progestin......Page 120 The role of the HPA and HPG axes in mood......Page 121 Estrogen metabolism......Page 122 Effects of estrogen on peripheral target tissues......Page 123 Estrogen replacement therapy regimens......Page 124 Compliance with ERT......Page 125 REFERENCES......Page 126 Overview......Page 134 Methodologic problems......Page 135 Testosterone secretion......Page 136 Testosterone levels through life......Page 138 Prenatal organizing effects......Page 139 Postpubertal behavioral effects......Page 140 Dominance and submission......Page 141 Aggression......Page 142 Cognition......Page 143 Testosterone in aging men......Page 144 Testosterone and male depressive illness......Page 145 Depression in hypogonadal men......Page 146 The HPG axis in depressed men......Page 147 Exogenous testosterone administration......Page 150 Androgen administration to non-depressed eugonadal men......Page 151 Androgen administration to depressed men......Page 153 Treatment with exogenous testosterone......Page 155 ACKNOWLEDGMENT......Page 156 REFERENCES......Page 157 DHEA(S) as a neurosteroid......Page 164 DHEA(S) levels decrease as a function of aging, chronic stress and illness......Page 165 DHEA(S) improves learning and memory in animals......Page 166 Antidepressant and anti-anxiety effects in animals......Page 167 Mood......Page 168 Response to antidepressant and antianxiety medication......Page 169 General functional abilities and sense of well-being......Page 170 Cognitive function......Page 171 Well-being and general functioning......Page 174 Mood......Page 175 Memory......Page 176 Summary......Page 178 REFERENCES......Page 179 Possible biological mechanisms of estrogen’s effect on cognition......Page 188 Estrogen and cognition in non-demented women......Page 189 Estrogen therapy and dementia risk......Page 192 Estrogen for treatment of Alzheimer’s disease......Page 193 Testosterone......Page 194 Conclusions......Page 196 REFERENCES......Page 197 Introduction......Page 203 Cholinergic neurons and cognition......Page 204 Estrogen and basal forebrain cholinergic neurons......Page 205 Estrogen replacement and acetylcholine release......Page 209 Estrogen replacement and learning and memory......Page 210 Effects on growth factors and growth factor receptors......Page 214 Changes in cholinergic parameters associated with long-term loss of ovarian function......Page 220 Other effects of estrogen......Page 223 Effects on other neurotransmitter systems......Page 224 Effects on hippocampal connectivity......Page 226 Effects on ß-amyloid processing......Page 227 Neuroprotective effects......Page 228 Summary and conclusions......Page 229 REFERENCES......Page 231 Age of onset of schizophrenia......Page 243 Symptom presentation......Page 244 Course of illness......Page 245 Cognitive performance......Page 246 Neuroradiological abnormalities......Page 247 Report of ongoing studies assessing gender differences in clinical and neuropsychological variables of schizophrenia......Page 248 Materials and methods......Page 249 Statistical methods......Page 250 Discussion and summary......Page 251 REFERENCES......Page 255 Anxiety disorder overview......Page 261 Generalized anxiety disorder (GAD)......Page 263 Panic disorder......Page 264 Simple phobia......Page 266 Social phobia......Page 267 OCD......Page 269 PTSD......Page 270 Estrogen......Page 272 Progesterone......Page 274 Female reproductive cycles impact on course of anxiety......Page 276 REFERENCES......Page 277 Introduction......Page 287 Sex differences in the response to noxious stimuli in the laboratory......Page 288 Sex differences in health care utilization and chronic pain conditions......Page 291 Sex differences in responses to analgesic drugs......Page 292 Hormonal factors in human pain sensitivity......Page 293 Sex differences and hormonal factors in pain sensitivity in animal subjects......Page 294 Animal sex differences and hormonal factors in the analgesic responses to environmental stress and pharmaceuticals......Page 296 Magnitudinal differences in analgesia between the sexes......Page 297 Qualitative differences in analgesia between the sexes......Page 298 Conclusions......Page 300 REFERENCES......Page 301 Part III Effects of hormones and behavior on immune function......Page 307 Estrogen and immune function......Page 309 Estrogen-related differences in physiological reactivity to brief stressors......Page 312 Estrogen-related differences in immune reactivity to stress: possible pathways......Page 314 REFERENCES......Page 316 Introduction......Page 322 Sex differences in the neuroendocrine stress response: the role of glucocorticoids and their receptors.......Page 323 Mechanism of glucocorticoid regulation of immune function......Page 324 Mechanism of sex steroid regulation of immune function......Page 326 Cellular events induced by sex steroids......Page 327 Direct effects of sex steroids on immune function......Page 328 Aging......Page 329 Areas for further study......Page 331 REFERENCES......Page 332 Part IV Hormones and gender differences in psychotropic drug metabolism......Page 339 Introduction......Page 341 Gastric effects......Page 342 Phase one and phase two metabolism......Page 343 Effects of exogenous estrogen......Page 345 Menstrual cycle effects......Page 346 Summary......Page 347 ACKNOWLEDGMENT......Page 348 REFERENCES......Page 349 Introduction......Page 354 Influence of aging on benzodiazepine pharmacokinetics and pharmacodynamics......Page 356 Influence of oral contraceptives on benzodiazepine pharmacokinetics and pharmacodynamics......Page 357 Neurosteroids......Page 359 Postmenopausal women and GABA-active drugs......Page 361 Influence of endogenous progesterone on GABA-active drugs......Page 363 Influence of aging on allopregnanolone concentrations......Page 365 Conclusions......Page 366 REFERENCES......Page 367 Index......Page 371

this Clinical Reference Addresses The Hormonal Basis Of Mental Disorders In Older People.

howard M. Kravitz

a Perspective On The Role Of Hormones In Mental Function With Special Reference To The Aging Process Is Presented In This Book. The Focus Is On The Extensive Literature, Both Established Information And Recent Findings, On The Hormonal Causes And Treatment Of Mental Disorders Associated With Aging And Gender Differences. According To The Editor, This Book Enhances Our Understanding Of The Role Hormones Play In The Geriatric Mental Disorders That Can Threaten Our Relationships And Self (p. Xvi). It Would Be An Understatement To Say That The Objective Of Focusing The Scientific Community On The Endocrine Aspects Of Mental Disorders (p. Xvii) Was Accomplished. The Intended Audience Is Psychiatric Clinicians And Researchers. Psychiatric Epidemiologists Will Find This Volume Useful For Conceptualizing Subtle And Not-so-subtle Ways That Age And Gender Confound Our Understanding Of Hormonal-related Risk Factors. Psychiatrists, Psychologists, Geriatricians, And Neuropharmacologists Who Are Authorities In Their Respective Areas Contributed To This Work. The Editor, A Junior Investigator In The Area Of Sex Steroids And Mood Disorders, Accomplished A Remarkable Task In Organizing This Volume; Little Overlap Among The Chapters Is Evident. The 16 Chapters Are Divided Into Four Main Parts: An Overview Of The Basic Science Of Neurosteroids; Sex Differences, Aging, And The Roles Of Various Hormones And Sex Steroids In Mental Disorders And Pain Sensitivity; Psychoneuroimmunology In Relation To Aging; And Influences Of Gender, Hormones, And Aging On Psychotropic Drug Metabolism. Basic Science And Clinical Research Data Are Integrated Nicely; Information Relevant To Clinical Therapeutics Issparse. Readers Will Gain An Appreciation For The Complexities Involved In Research In Psychoendocrinology, Particularly Age And Gender Variability. Particularly In Part Ii, Chapters Could Have Benefited From More Generous Use Of Tables And Figures To Highlight Textual Material And To Orient The Reader. Also, Some Figures Needed Clearer Labeling (e.g., Define Abbreviations In The Legends). The Index Was Only Moderately Helpful (e.g., Allopregnanolone Does Not Appear In The Index). This Scholarly Compilation Of Up-to-date Review Papers Has Been Well Integrated Into A Very Comprehensive And Informative Text On The Hormonal Basis Of Psychopathology In Adults. However, Readers Should Beware Of The Misleading Subtitle—this Book Is About Age-associated Changes But Is Not Specifically About Geriatric Psychiatry Or The Elderly. Data Are Presented That Characterize Changes And Differences Over The Adult Life Cycle, From Young Adult To Elderly. Gender-specific Findings Also Are Well Described, Particularly Pre- And Post-menopausal Variations In Women. Despite The Moderately High Price Tag, This Book Contains A Wealth Of Information; Readers Looking For A Single Reference On Psychoendocrinology Across The Adult Life Cycle Need Not Look Further.

The significance of hormone action in psychiatry has been long studied, now including the psychiatric effects of hormones on the aging process. This clinical reference addresses the hormonal basis of mental disorders in older people. Hormones influence a wide range of states and conditions, from pain tolerance and anorexia to attention, mood, immunity, cardiovascular and cognitive function, schizophrenia and Alzheimer's disease. Written by an eminent team of psychiatrists, psychologists, geriatricians and neuropharmacologists, this book brings together established information and findings in four sections: • An overview of the basic science of neurosteroids • Sex difference and the roles that cortisol, thyroid hormone, and the sex steroids estrogen, progesterone, dehydroepiandrosterone and testosterone play in common mental disorders and pain sensitivity • Psychoneuroimmunology in relation to age • Sex differences and hormones in psychotropic drug metabolism in the elderly. "This is the first clinical reference to address the hormonal basis of mental disorders in older people. Hormones influence a wide range of states and conditions, from pain tolerance and anorexia to attention, mood, immunity, cardiovascular and cognitive function, schizophrenia and Alzheimer's disease." "Clinicians and researchers alike will value this comprehensive review of a complex and sometimes controversial area of psychiatry."--Jacket This pioneering clinical reference addresses the hormonal basis of mental disorders in older people. Written by an eminent team of psychiatrists, psychologists, geriatricians and neuropharmacologists, it ranges from the impact of hormones on pain tolerance and anorexia to attention, depression, immunity, cardiovascular and cognitive function, and psychosis