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.

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    • "Most neuropsychiatric disorders are heavily genderbiased . Autism spectrum disorder is diagnosed in boys four to five times more often than girls [76,77], schizophrenia manifests differently in men and women across the lifespan [78], and affective disorders such as unipolar depression and PTSD are up to twice as frequent in women and girls [79,88]. The latter may be skewed by social factors such as willingness to seek treatment. "

    Preview · Article · Feb 2016 · Philosophical Transactions of The Royal Society B Biological Sciences
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    • "An association between earlier age at onset and a family history of psychosis has been reported (McInnis et al., 1999), and a higher familial vulnerability, i.e. having a higher distribution of relatives with psychosis, in substance using patients has been suggested (McGuire et al., 1995). Gender might also be a confounder, as males have both earlier age at onset and more substance use (Abel et al., 2010). "
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    ABSTRACT: Background: Patients with schizophrenia spectrum disorders and substance use may have an earlier onset of illness compared to those without substance use. Most previous studies have, however, too small samples to control for confounding variables and the effect of specific types of substances. The present study aimed to examine the relationship between substance use and age at onset, in addition to the influence of possible confounders and specific substances, in a large and heterogeneous multisite sample of patients with schizophrenia spectrum disorders. Methods: The patients (N=1119) were recruited from catchment areas in Oslo, Stavanger and Bergen, Norway, diagnosed according to DSM-IV and screened for substance use history. Linear regression analysis was used to examine the relationship between substance use and age at onset of illness. Results: Patients with substance use (n=627) had about 3years earlier age at onset (23.0years; SD 7.1) than the abstinent group (n=492; 25.9years; SD 9.7). Only cannabis use was statistically significantly related to earlier age at onset. Gender or family history of psychosis did not influence the results. Conclusion: Cannabis use is associated with 3years earlier onset of psychosis.
    Full-text · Article · Dec 2015 · Schizophrenia Research
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    • "It should be underlined that 74% of our sample were males contrary to the 1:1 sex ratio of schizophrenia in the general population (McGrath et al., 2004). This could be due to the fact that male SZ patients are more at risk of a relapse due to lower insight, substance abuses, and lower treatment adherence (Abel et al., 2010). Therefore, these patients were more often referred by psychiatrists to the Expert Centers for a clinical assessment and therapeutic advice. "

    Full-text · Article · Nov 2015
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