Abstract
While sex differences in schizophrenia have long been reported and discussed, long-term sex differences in outcomes among first episode of psychosis (FEP) patients in terms of the efficacy of Early Intervention Services (EIS) has been an under-explored area. A total of 209 FEP patients (95 females and 114 males) were reassessed after a time window ranging from 8 to 16 years after their first contact with an EIS program (PAFIP) that we will call the 10-year PAFIP cohort. Multiple clinical, cognitive, functioning, premorbid, and sociodemographic variables were explored at 1-year, 3-year and 10-year follow-ups. At first contact, females were older at illness onset, had higher premorbid adjustment and IQ, and were more frequently employed, living independently, and accompanied by a partner and/or children. Existence of a schizophrenia diagnosis, and cannabis and alcohol consumption were more probable among men. During the first 3 years, women showed a significantly better response to minimal antipsychotic dosages and higher rates of recovery than men (50% vs. 30.8%). Ten years later, more females continued living independently and had partners, while schizophrenia diagnoses and cannabis consumption continued to be more frequent among men. Females also presented a lower severity of negative symptoms; however, functionality and recovery differences did not show significant differences (46.7% vs. 34.4%). Between the 3- and 10-year follow-up sessions, an increase in dosage of antipsychotics was observed. These results suggest that the better outcomes seen among women during the first 3 years (while they were treated in an EIS) were in the presence of more favourable premorbid and baseline characteristics. After an average period of 10 years, with the only difference being in negative symptoms course, outcomes for women approximated those of men, drawing particular attention to the increase in dosage of antipsychotic medication once FEP patients were discharged from the EIS program towards community-based services. These findings help to pose the question of whether it is advisable to target sexes and lengthen EIS interventions.
Highlights
It is commonly believed that women with schizophrenia have better disease courses and better overall outcomes than men
In a recent observational study, Dama et al.[7], found that sex differences in outcomes among patients treated over 2 years in an Early Intervention Services (EIS) for psychosis in Canada could be largely affected by the disparity of other factors that exist between the two sexes
Our results suggest that better outcomes for women found after 3 years of treatment at an EIS were underpinned by the presence of more favorable premorbid and baseline characteristics
Summary
It is commonly believed that women with schizophrenia have better disease courses and better overall outcomes than men. In the Danish OPUS trial, designed for 2-, 5-, and 10-year follow-ups, it was found that almost 30% of all FEP patients improved their outcomes between 5-year and 10-year follow-ups, indicating that improvement is still possible late in illness course[8,9] These findings were similar to those reported in AESOP-10 (Etiology and Ethnicity in Schizophrenia and Other Psychosis 10-year follow-up), wherein three course and outcome domains (clinical, social, and service use) were worse for men[5]. Morgan et al.[5], noted that symptom remission and recovery are more common than social re/integration following an FEP Both OPUS and AESOP cohort studies suggest that short-term and long-term outcomes may differ. To the best of our knowledge, no study has explored long-term sex differences in FEP patients after being discharged from an EIS for psychosis
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