Article

Sex differences in schizophrenia

Centre for Women's Mental Health, School of Community Based Medicine, University of Manchester, Oxford Road, Manchester, UK.
International Review of Psychiatry (Impact Factor: 1.8). 10/2010; 22(5):417-28. DOI: 10.3109/09540261.2010.515205
Source: PubMed

ABSTRACT Evidence suggests sex differences in schizophrenia reflect differences in both neurodevelopmental processes and social effects on disease risk and course. Male:female incidence approximates 1.4:1 but at older onset women predominate. Prevalence differences appear smaller. Men have poorer premorbid adjustment and present with worse negative and less depressive symptoms than women, which may explain their worse medium term outcome according to a range of measures. Substance abuse is a predominantly male activity in this group, as elsewhere. Findings of sex differences in brain morphology are inconsistent but occur in areas that normally show sexual dimorphism, implying that the same factors are important drivers of sex differences in both normal neurodevelopmental processes and those associated with schizophrenia. There are sex differences in antipsychotic responses but sex-specific endocrine effects on illness and response to antipsychotics are potentially complex. Oestrogen's role as an adjunctive medication is not yet clear due to methodological differences between the few randomized controlled trials. Services that are sensitive to differences in gender can better meet their patients' specific needs and potentially improve outcome.

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    • "mania symptoms , more lifetime psychotic , hallucination , and delusional symptoms , reported more negative symptoms and had lower premorbid IQ and PSP scores . The finding of a younger age of SCZ onset for males compared to females is consistent with the extant literature reporting that women tend to be diagnosed with SCZ later in life than men ( Abel et al . , 2010 ) . This difference in age of illness onset may account for the present finding that females had fewer negative symptoms than males , given research suggests that earlier age of illness onset predicts worse negative symptoms in psychosis ( Morgan et al . , 2008 ) . The absence of gender differences for age of SAD and BDP onset is also c"
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    ABSTRACT: Introduction It remains uncertain whether schizoaffective disorder (SAD) is a discrete diagnostic entity, is a variant of either a psychotic mood disorder such as bipolar disorder (BDP) or schizophrenia (SCZ), or exists on a spectral continuum between these disorders. The present study examined whether SCZ, SAD, and BDP differed qualitatively on demographic and clinical variables based on a large Australian dataset. Methods This study examined data from the Australian Survey of High Impact Psychosis (SHIP), in which 1469 of the 1825 participants in who had an ICD-10 diagnosis of SCZ (n=857), SAD (n=293), and BDP (n=319) were assessed across a broad range of variables. Results When compared to patients with SCZ, those with SAD reported more current delusional and thought disorder symptoms, a greater number of lifetime depression, mania, and positive symptoms, and fewer negative symptoms. Relative to the BPD group, the SAD group were younger, endorsed more current positive, delusional, and thought disorder symptoms, fewer lifetime mania symptoms, more lifetime psychotic, hallucination, and delusional symptoms, and recorded lower premorbid IQ scores. Compared to patients with BPD, those with SCZ were significantly younger, endorsed more current psychotic and hallucination symptoms, fewer lifetime depression and mania symptoms, more lifetime psychotic, hallucination, and delusional symptoms, reported more negative symptoms and had lower premorbid IQ and psychosocial functioning scores. Limitations Validated psychometric measures of psychotic or mood symptoms were not used. Conclusion This pattern of results is consistent with the conceptualisation of a spectrum of disorders, ranging from BDP at one end, to SAD in the middle, and SCZ at the other end.
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    • "Together, these results suggest that future attempts to delimit homogenous subtypes of schizophrenia patients and associated intermediate phenotypes should consider the relevance of interactions with sex. Investigation of the factors underlying sexually dimorphic relationships in schizophrenia – such as the effects of genetic and sex hormone differences on foetal and early postnatal development – may provide insights into the neurodevelopmental origins of disease-associated brain abnormalities (Abbs et al., 2011; Abel et al., 2010; Giedd et al., 2012; Goldstein et al., 2013; Jazin and Cahill, 2010; Goldstein et al., 2002; Dean and McCarthy, 2008). "
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    • "Female SCZ shows a different profile from male SCZ [Abel et al., 2010]. Female SCZ occurs 40% less than in the males, and the onset age of female SCZ patients is much older than that of male ones [Abel et al., 2010]. Moreover, there is a second onset peak in the females older than 45 years that may be due to estrogen withdrawal [Lindamer et al., 1997; Mellios et al., 2012]. "
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