Selective Estrogen Receptor Modulators for Women of Child-bearing Age With Schizophrenia

Inclusion Criteria: * Physically well * A current DSM-IV diagnosis of schizophrenia or related disorder. * 18- 45 years * Premenopausal (regular menstrual cycles and follicle stimulating hormone \< 40 mIU/ml; for hysterectomised women, FSH\< 40mIU/ml and estradiol\> 120pmol/L) * Able to give informed consent. * PANSS total score \> 60 (1 - 7 scale) and a score of 4 (moderate) or more on two or more of the following PANSS items: delusions, hallucinatory behaviour, conceptual disorganization or suspiciousness. * No abnormality observed during physical breast examination. * Documented normal PAP smear and pelvic examination in the preceding two years. Exclusion Criteria: * Patients with known abnormalities in the hypothalamo-pituitary gonadal axis, thyroid dysfunction, central nervous system tumours, active or past history of a venous thromboembolic event, or undiagnosed vaginal bleeding. * Patients with any significant unstable medical illness such as epilepsy and diabetes or known active cardiac, renal or liver disease; presence of illness causing immobilisation. * Patients whose psychotic illness is directly related to illicit substance use or who have a history of substance abuse or dependence during the last six months, or consumption of more than 30gm of alcohol (three standard drinks) per day. * Smoking more than 20 cigarettes per day. * Use of any form of estrogen, progestin or androgen as hormonal therapy, or antiandrogen including tibolone or use of phytoestrogen su…