Abstract
BackgroundThe aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients.MethodsMedical file audit assessment of 118 (male = 71; female = 47) patients with FEPM aged 15 to 29 years was undertaken on clinical and functional measures.ResultsMales with FEPM had increased likelihood of substance use (OR = 13.41, p <.001) and forensic issues (OR = 4.71, p = .008), whereas females were more likely to have history of sexual abuse trauma (OR = 7.12, p = .001). At service entry, males were more likely to be using substances, especially cannabis (OR = 2.15, p = .047), had more severe illness (OR = 1.72, p = .037), and poorer functioning (OR = 0.96, p = .045). During treatment males were more likely to decrease substance use (OR = 5.34, p = .008) and were more likely to be living with family (OR = 4.30, p = .009). There were no gender differences in age of onset, psychopathology or functioning at discharge.ConclusionsClinically meaningful gender differences in FEPM were driven by risk factors possibly associated with poor outcome. For males, substance use might be associated with poorer clinical presentation and functioning. In females with FEPM, the impact of sexual trauma on illness course warrants further consideration.
Highlights
The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients
Similar to previous studies into patients with chronic illness and bipolar I disorder, we found an array of gender differences in patients with FEPM between the ages of 15 to 29 years
A further study limitation was the lack of information recorded regarding psychopathology and type and dosage of pharmacological treatments; these factors could have had an effect on the degree of gender difference at discharge. It appears that there are substantial differences between males and females with FEPM in terms of past histories, presentation, and discharge outcomes; these differences may be driven by putative risk factors such as substance use and exposure to sexual abuse
Summary
The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients. Pre-illness characteristics, onset and course have been widely documented in psychotic disorders such as schizophrenia [1,2,3,4]. There are epidemiological studies indicating substantive gender differences in the incidence, presentation and course of bipolar I disorder; the extent of these differences is yet to be fully delineated. An equal gender ratio has been reported for bipolar I disorders [5]; other studies indicate that males may be more likely to be at risk of bipolar I disorder [6], or that there is a higher incidence of bipolar I disorder in females [7]. Males with bipolar I disorder may be more likely to have mania as their first episode whereas females are more likely to have a depressive episode [8]
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