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

TY - JOUR

T1 - The effect of age on the clinical presentation and treatment of women with psychosis

T2 - secondary analysis of the IMPaCT Randomised Clinical Trial

AU - Nettis, Maria Antonietta

AU - Ismail, Khalida

AU - Murray, Robin M

AU - Dima, Aikaterini

AU - Greenwood, Kathryn

AU - Atakan, Zerrin

AU - Smith, Shubulade

AU - Gaughran, Fiona

PY - 2025/12/2

Y1 - 2025/12/2

N2 - 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.

AB - 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.

U2 - 10.1192/bjo.2025.10860

DO - 10.1192/bjo.2025.10860

M3 - Article

C2 - 41327590

SN - 2056-4724

VL - 12

SP - e5

JO - BJPsych Open

JF - BJPsych Open

IS - 1

ER -