Gender difference in affective and nonaffective psychosis

Abstract

Introduction Recent studies have begun to examine sex differences in first-episode psychosis in an attempt to explain the heterogeneity of the illness. The aim of the current study was to examine sex differences with respect to sociodemographics and clinical presentations, including cognitive, affective, and psychotic aspects, in both nonaffective and affective groups at their first episode of psychosis. Materials and methods Sixty-one men and 29 women, 18 years of age or older, were recruited, admitted in the psychological medicine hospital, state of Kuwait, from January 2007 up to December 2009 for treatment of first-episode psychosis. All patients were divided according to the consensus clinical diagnoses on the basis of a structured clinical interview of DSM-IV into two groups: patients with nonaffective psychosis (n = 49, 39 men and 10 women) and patients with affective psychosis (n = 41, 22 men and 19 women). Psychometric assessment was carried out using Hamilton Depression Rating Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scales, Wechsler Adult Intelligence Scale, and (Wechsler Memory Scale - 3rd ed.) subtests including measures for verbal, visual and working memory, attention, and executive functions as well as the trail-making test. Assessment of neurological side effects was carried out using the Simpson-Angus Scale. The assessment was carried out at baseline and after 2 years of follow-up. Results Men in the nonaffective psychosis group (schizophrenia, schizoaffective, and delusional disorder) were significantly younger, had an early age at onset (3-5 years), higher level of education, and intact occupational function compared with women who had a more stable marital life. Men required a longer period for improvement in symptoms and were more sensitive to neurological side effects than women. Sociodemographics were comparable in both sexes in the affective psychosis group (bipolar psychosis and depressive psychosis). In terms of symptom presentation, there was no statistically significant impact of sex on different cognitive, affective, and psychotic aspects of presentation in both diagnostic groups at baseline and after 2 years of follow-up. Men had more severe affective symptoms, and more positive and low negative scores compared with women in the nonaffective psychosis group. Although nonsignificant, the affective group had higher cognitive functions and a faster rate of improvement compared with the nonaffective group. Conclusion and recommendation Study of sex differences in first-episode psychosis is still a challenging and a controversial issue in the short term, especially in clinical presentation. Longitudinal studies and long-term follow-up where biological and psychosocial variables are interacting are highly recommended.