{"paper_id":"d61bf3dc-6974-41aa-9747-7c3efc1e679a","body_text":"127CORRESPONDENCE\nMenstrual changes with antipsychotic drugs\nSIR: Menstruation could be termed a life event for\nwomen. Although a minor irritant to some, it\nbecomes a major issue to others. It is surprising that\nthe issue of menstruation in chronic schizophrenic\nwomen has been little studied.\nIt is known that neuroleptics can cause amenorr\nhoea and this is now accepted as a side effect, yet\nmany clinicians choose not to enquire about it.\nIt may, however, be of vital importance to a young\nmarried schizophrenic woman expected to remain on\ndepot neuroleptic medication for an undefined\nnumber of years.\nIt is also known that psychotic patients may\nexperience amenorrhoea regardless of whether or\nnot they are on neuroleptic medication for their\npsychosis. The incidence is higher for those women\non neuroleptics but the physiological basis for this is\nas yet unknown. Ghadirian et a! (1982) demon\nstrated that 91% of their schizophrenic patients\nexperienced menstrual changes but the researchers\nwere unable to specify the nature and quality of the\nchanges. Meltzer & Fang (1976), in a cohort of\nwomen on neuroleptics, showed that nearly all\nhad a rise in prolactin as early as three days after\ncommencing neuroleptics, which is presumed to be\nthe cause of the amenorrhoea. In a different study,\nthe same authors found that up to 50% of women\non neuroleptics can be expected to become\namenorrhoeic.\nAs part of a larger project, we studied the preva\nlence of amenorrhoea in a group of 36 chronic\nschizophrenic women. All patients were already on\ndepot neuroleptics and all fulfilled DSM—III—R\ndiagnostic criteria. We found that over a third\nof women on depot neuroleptics had menstrual\nirregularities including amenorrhoea. Our sample\nranged in age from 21 to 44 years. Seven women\nwere receiving hormonal contraceptive treatment,\nand 29 women were not. Of this latter group of 29\nwomen, 4 (13%) were amenorrhoeic, 6 (21 %) had\nirregular menstrual periods and 19 (66%) had\nregular periods.\nOur findings add to the scant literature on the\nsubject. There appears to be a significant proportion\nof women who experience menstrual changes while\non depot neuroleptic medication. Further to the\neffect that this has on reproductive capacity, there\nmay also be implications with regard to the changing\nhormonal environment and the severity of psychotic\nsymptoms (Berlin eta!, 1982; Clare, 1983).\nBERLIN, F. S., BERGEY,G. K. & MoNEY, M. (1982) Periodic psy\nchosisofpuberty.Acasereport.American JournalofPsychiatry.\n139,119—120.\nCLARE, A. W. (1983) The relationship between psychopathology\nand the menstrual cycle. Womenand Health, 8, 125-136.\nGHADIRIAN, A. M., CHOVINARD, 0. & ANNABLE, L. (1982) Sexual\ndysfunctionand plasmaprolactinlevelsin neuroleptictreated\nschizophrenic outpatients. Journal of Nervous and Mental\nDisease, 170,463—467.\nMELTZER,H. Y. & FANG, V.5. (1976) The effect of neuroleptics on\nserum prolactin in schizophrenic patients. Archives of General\nPsychiatry. 33,279—286.\nNewtown Hospital\nNewtown Road\nWorcester\nKidderminster General Hospital\nWorcestershire\nAll Saints Hospital\nLodge Road\nWinson Green\nBirmingham B18\nTheUnconscious BeforeFreud\nK. H. GINGELL\nJ. S. DA.RLEY\nC. A. LENGUA\nP. BADDELA\nSIR:I was delighted to see Lancelot Law Whyte's The\nUnconscious Before Freud reviewed under “¿\u0003Books\nReconsidered” (Journal, September 1992, 161, 430—\n432). I have always been a fan of this book and often\nreferred to so I was surprised to see Tim Rogers say\nthat “¿\u0003it is not cited by many of the standard works\non dynamic psychotherapy”.Dennis Brown and I\n(1991) in our joint Introduction to Psychotherapy\nrefer to it several times. I also referred to it in a Freud\nMemorial Lecture (Pedder, 1989) for exactly the\nreasons that Rogers gives, to place psychoanalysis in\nthe proper context of the development of Western\nthought over several centuries, and to show that\npsychoanalytic ideas about conflict have a long pre\nhistory. Freud's contribution was to address these\nideas to a medical context in a way that stuck.\nBROWN,D. & PEDDER,J. (1991) Introduction to Psychotherapy, 2nd\nEdition. London: Routledge.\nPEDDER, J. R. (1989) The proper image of mankind. British Journal\nof Psychotherapy. 6,70—80.\nPsychotherapy Unit\nMaudsley Hospital\nDenmark Hill\nLondon SE5 8AZ\nJONAThAN PEDDER\nSelf-poisoning and general elections\nSIR: While auditing deliberate self-poisoning (DSP)\nin Nottingham, I was interested to find a significant\nfall in cases immediately following the result of the\nDownloaded from https://www.cambridge.org/core. 17 Sep 2026 at 07:33:19, subject to the Cambridge Core terms of use.","source_license":"CC0","license_restricted":false}