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


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.

Download full-text


Available from: Km Abel,
  • Source
    • "For example, women with schizophrenia present with less severe negative symptoms but exhibit more positive and affective symptoms [32]. In women, a later age-at-onset and presentation of affective symptoms have predicted a better prognosis, whereas in men an earlier onset and presentation of primarily negative symptoms predict a worse course of illness and outcome [22]. Females show a more favourable antipsychotic treatment response than males [33] [34], have fewer hospitalisations, better adapt to the illness, and present less disability (particularly with selfcare ). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Gender differences in schizophrenia have been extensively researched and it is being increasingly accepted that gonadal steroids are strongly attributed to this phenomenon. Of the various hormones implicated, the estrogen hypothesis has been the most widely researched one and it postulates that estrogen exerts a protective effect by buffering females against the development and severity of the illness. In this review, we comprehensively analyse studies that have investigated the effects of estrogen, in particular 17 β -estradiol, in clinical, animal, and molecular research with relevance to schizophrenia. Specifically, we discuss the current evidence on estrogen dysfunction in schizophrenia patients and review the clinical findings on the use of estradiol as an adjunctive treatment in schizophrenia patients. Preclinical research that has used animal models and molecular probes to investigate estradiol’s underlying protective mechanisms is also substantially discussed, with particular focus on estradiol’s impact on the major neurotransmitter systems implicated in schizophrenia, namely, the dopamine, serotonin, and glutamate systems.
    International Journal of Endocrinology 08/2015; 2015(4, article 39). DOI:10.1155/2015/615356 · 1.95 Impact Factor
  • Source
    • "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"
    [Show abstract] [Hide abstract]
    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.
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Heterogeneity in the structural brain abnormalities associated with schizophrenia has made identification of reliable neuroanatomical markers of the disease difficult. The use of more homogenous clinical phenotypes may improve the accuracy of predicting psychotic disorder/s on the basis of observable brain disturbances. Here we investigate the utility of cognitive subtypes of schizophrenia – ‘cognitive deficit’ and ‘cognitively spared’ – in determining whether multivariate patterns of volumetric brain differences can accurately discriminate these clinical subtypes from healthy controls, and from each other. We applied support vector machine classification to grey- and white-matter volume data from 126 schizophrenia patients previously allocated to the cognitive spared subtype, 74 cognitive deficit schizophrenia patients, and 134 healthy controls. Using this method, cognitive subtypes were distinguished from healthy controls with up to 72% accuracy. Cross-validation analyses between subtypes achieved an accuracy of 71%, suggesting that some common neuroanatomical patterns distinguish both subtypes from healthy controls. Notably, cognitive subtypes were best distinguished from one another when the sample was stratified by sex prior to classification analysis: cognitive subtype classification accuracy was relatively low (<60%) without stratification, and increased to 83% for females with sex stratification. Distinct neuroanatomical patterns predicted cognitive subtype status in each sex: sex-specific multivariate patterns did not predict cognitive subtype status in the other sex above chance, and weight map analyses demonstrated negative correlations between the spatial patterns of weights underlying classification for each sex. These results suggest that in typical mixed-sex samples of schizophrenia patients, the volumetric brain differences between cognitive subtypes are relatively minor in contrast to the large common disease-associated changes. Volumetric differences that distinguish between cognitive subtypes on a case-by-case basis appear to occur in a sex-specific manner that is consistent with previous evidence of disrupted relationships between brain structure and cognition in male, but not female, schizophrenia patients. Consideration of sex-specific differences in brain organization is thus likely to assist future attempts to distinguish subgroups of schizophrenia patients on the basis of neuroanatomical features.
    Clinical neuroimaging 12/2014; 6. DOI:10.1016/j.nicl.2014.09.009 · 2.53 Impact Factor
Show more