The effect of age on the clinical presentation and treatment of women with psychosis: secondary analysis of the IMPaCT Randomised Clinical Trial

Background According to existing evidence, during menopause transition, women with psychosis may present with exacerbated psychiatric symptoms, due to age-related hormonal changes. Aims We aimed to (a) replicate this evidence, using age as a proxy for peri/menopausal status; (b) investigate how clinical presentation is affected by concomitant factors, including hyperprolactinaemia, dose and metabolism of prescribed antipsychotics using cross-sectional and longitudinal analyses. Method Secondary analysis on 174 women aged 18–65, from the IMPaCT (Improving physical health and reducing substance use in psychosis) randomised controlled trial. We compared women aged below ( N = 65) and above 40 ( N = 109) for (a) mental health status with the Positive and Negative Syndrome Scale (PANSS) and Montgomery Asberg Depression Rating Scale; (b) current medications and (c) prolactin levels, at baseline and at follow-up (12/15 months later). Results Women aged above 40 showed higher baseline PANSS total score (mean ± s.d. = 53.4 ± 14.1 v . 48.0 ± 13.0, p = 0.01) and general symptoms scores (28.0 ± 7.4 v . 25.7 ± 7.8, p = 0.03) than their younger counterparts. Progressive sub-analysis revealed that this age-related difference was observed only in women with non-affective psychosis ( n = 93) (PANSS total score: 57.1 ± 13.6 v . 47.0 ± 14.4, p < 0.005) and in those prescribed antipsychotic monotherapy with olanzapine or clozapine ( n = 25) (PANSS total score: 63 ± 16.4 v . 42.8 ± 10.9, p < 0.05). Among all women with hyperprolactinaemia, those aged above 40 also had higher PANSS positive scores than their younger counterparts. No longitudinal differences were found between age groups. Conclusions Women aged above 40 showed worse psychotic symptoms than younger women. This difference seems diagnosis-specific and may be influenced by antipsychotics metabolism. Further longitudinal data are needed considering the menopause transition.