Abstract
Early detection and prompt treatment of psychosis is of the utmost importance. The great variability in clinical onset, illness course, and response to pharmacological and psychosocial treatment is in great part gender-related. Our aim has been to review narratively the literature focusing on gender related differences in the psychoses, i.e., schizophrenia spectrum disorders. We searched the PubMed/Medline, Scopus, Embase, and ScienceDirect databases on 31 July 2021, focusing on recent research regarding sex differences in early psychosis. Although women, compared to men, tend to have better overall functioning at psychotic symptom onset, they often present with more mood symptoms, may undergo misdiagnosis and delay in treatment and are at a higher risk for antipsychotic drug-induced metabolic and endocrine-induced side effects. Furthermore, women with schizophrenia spectrum disorders have more than double the odds of having physical comorbidities than men. Tailored treatment plans delivered by healthcare services should consider gender differences in patients with a diagnosis of psychosis, with a particular attention to early phases of disease in the context of the staging model of psychosis onset.
Highlights
It is widely recognized that prolonged duration of untreated psychosis predicts worse symptoms and poorer social functioning and quality of life
Given the importance of the presence of differential characteristics at the start of a clinical course [14], which points to the need to avoid delays in care, we focused on the first episode of psychosis (FEP)
Low agreement between self- and clinician-rated assessment; higher association with positive symptoms in FEP compared to at-risk and in women with respect to men, which became not significant after correction for multiple testing
Summary
It is widely recognized that prolonged duration of untreated psychosis predicts worse symptoms and poorer social functioning and quality of life. It is widely recognized that schizophrenia and first-episode psychosis may show great variability in clinical onset, illness course, and response to pharmacological and psychosocial treatment [2] Some aspects of this observed heterogeneity may be in great part gender-related. There is sexual dimorphism in the development of brain areas [3,4] and this results in differences in the final volumes of gray and white matter [5,6,7] This in turn results in the development of differential emotional skills between the two genders [8]
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