Gender Differences In Schizophrenia Research Articles

Sex, gender, and outcome in first-episode psychosis: The role of premorbid functioning

We examined the associations of sex (biological distinction) and gender (societal distinction) with psychopathology, depressive symptoms and social and occupational functioning over 24 months. We found that lower masculinity scores were associated with worse psychopathology outcomes, independent of sex and other neurodevelopmental factors. These effects were mediated by poor premorbid adjustment, which also mediated the relationship between childhood trauma and masculinity scores as predictors of disorganized symptom outcomes. Our findings highlight the importance of considering gender as a separate construct and the need for further research to understand the clinical implications of sex and gender differences in schizophrenia.

STUDY OF GENDER DIFFERENCES IN SOCIODEMOGRAPHIC CHARACTERISTICS IN SCHIZOPHRENIA

Background: Studying ner aspects of gender differences in sociodemographic and clinical characteristics of schizophrenia patients can pave way for better understanding of etiology, preventive strategies, and personalized medicine whereas only few studies have been done to study the gender differences in schizophrenia in India specially in Northeast region. Objective: To examine gender related differences in sociodemographic characteristics of Schizophrenia patients. Cross sectional study Methods: in 70 Schizophrenia patients diagnosed as per ICD 10 criteria, excluding other psychiatric comorbidities (except substance use disorder) aged 18- 60yrs attending psychiatry department, of a tertiary care medical college hospital in GMCH, Guwahati with Sociodemographic proforma & statistical software SPSS26 Predominance of female patients, majori Results: ty in age group 26-32 yrs., Hindu religion, rural domicile, upper lower socioeconomic background, secondary level education, unemployment for more than one month and statistically signicant difference of male: female education & employment status Findings of our study mostly ma Conclusion: tched the ndings of different earlier studies. However, statistically signicant difference between male vs. female educational and employment status and predominance of rural background patients calls for further exploration.

Sex/Gender differences in schizophrenia: Thinking back and thinking forward

This commentary summarizes my view of my life's work in psychiatry, which has mainly been devoted to my obsessive interest in sex and gender differences in schizophrenia. I summarize the influences that guided my research and I take the opportunity to make some personal recommendations to future researchers.

Gender Differences in Clinical and Psychosocial Features Among Persons With Schizophrenia: A Mini Review

An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. In the present review, we summarize the literature on gender differences in schizophrenia relevant to clinical and social outcome as well as their determinants, focusing on clinical variables, while gender differences on biological factors which may have an impact on the outcome of the disorder were not included herewith. Consistent findings include, in male with respect to female patients, an earlier age of illness onset limited to early- and middle-onset schizophrenia, a worse premorbid functioning, a greater severity of negative symptoms, a lower severity of affective symptoms and a higher rate of comorbid alcohol/substance abuse. Discrepant findings have been reported on gender differences in positive symptoms and in social and non-social cognition, as well as in functional outcome and rates of recovery. In fact, despite the overall finding of a more severe clinical picture in males, this does not seem to translate into a worse outcome. From the recent literature emerges that, although some findings on gender differences in schizophrenia are consistent, there are still aspects of clinical and functional outcome which need clarification by means of further studies taking into account several methodological issues.

The clinical course of schizophrenia in women and men\u2014a nation-wide cohort study

Gender differences in schizophrenia have been reported in different aspect of the course of disease and may urge special clinical interventions for female patients. Current literature provides insufficient information to design guidelines for treating women with schizophrenia. We aim to quantify the clinical course of schizophrenia in men and women on premorbid hospitalizations and prescription drugs, age at diagnosis, pharmacological treatment, comorbidity, number of re-hospitalizations, and mortality. Our nationwide cohort study included all patients admitted for the first time to hospital during 2000–2014 for schizophrenia or schizo-affective disorder in Finland. Gender differences were compared with logistic regression, by calculating incidence rates, and mortality was assessed with Cox proportional hazard model. We included 7142 women and 9006 men with schizophrenia/schizo-affective disorder and found that both women (71%) and men (70%) had often been hospitalized for another psychiatric disorder in the 5 years before diagnosis. In women, the last psychiatric hospitalization before schizophrenia/schizo-affective diagnosis was often for mood disorders (62%, OR 2.56, 95% CI 2.28–2.87). Men were diagnosed earlier (mean 34.4 [SD12.6] vs. 38.2 [SD 13.8]) with peak incidence around 22, while incidence in women declining only slowly between age 18 and 65. During ten years follow-up, 69.5% of both genders needed at least one re-hospitalization, with slightly more hospitalizations in women. Women were less often prescribed clozapine or long-acting antipsychotics. Mortality was lower in women (HR = 0.54, 95% CI 0.50–0.60), with fewer suicide and cardiovascular deaths, but more cancer deaths. These results suggest a diagnostic delay for women, which might be shortened by screening women aged 20–65 participating in affective disorder programs. As number of hospitalizations is not lower for women, clinicians should take care not to undertreat women with schizophrenia.

A Review on Gender Differences in Schizophrenia in Indian Settings

A Review on Gender Differences in Schizophrenia in Indian Settings

Gender differences in schizophrenia: A multicentric study from three Latin-America countries

This study was aimed to explore clinical differences between women and men with schizophrenia (SZ) in Latin-America. It was conducted in public mental health centers in Bolivia, Peru and Chile.Two hundred forty-seven SZ patients participated in the study, 83 (33.6%) were women and 115 (46.6%) were Aymara. Compared to men, SZ women had slightly lower negative symptoms, reported slightly less social cognitive impairments, lower Family Relationships scores and higher Sentimental Life scores, independently of marital status, illness duration, age at illness onset and type of mental health treatment. All these differences have been replicated in the Aymara subgroup except for Sentimental Life scores. Aymara SZ women reported to be significantly less adherent into treatment compared to Aymara men. SZ women were found to have a better clinical profile and higher sentimental life scores than men. However, while SZ women reported more impaired Family Relationships compared to men, they were found to receive less psychotherapy in addition to pharmacological treatment. SZ Aymara women were also identified as a specific subgroup that may be targeted for increased observance strategies.

F2. CHILDHOOD TRAUMA AND LACK OF CULTURAL IDENTITY AS RISK FACTORS OF ATTENUATED PSYCHOSIS SYMPTOMS AMONG AFRICAN AMERICAN YOUNG ADULTS

BackgroundSchizophrenia spectrum diagnosis is more commonly assigned to African Americans. Failing to understand and appropriately manage cultural differences will have significant mental health consequences for varied racial/ethnic groups in particular (Betancourt, Green, & Carrillo, 2002). The purpose of the present study was to examine risk factors of attenuated psychosis syndrome in a sample of African American young adults, specifically to investigate whether lack of ethnic identity and adverse childhood experiences (ACEs) put an individual at a higher risk of developing attenuated psychotic symptoms.Adverse Childhood Experiences (ACE) as Risk Factor of APS:The Comorbidity Survey (NCS) Part 2 data showed that the effects of neglect and sexual abuse, along with physical abuse similarly put a child at risk for psychosis. People who had suffered childhood adversity were 2.8 times more likely to develop psychosis than those who had not. Studies have also begun to look at gender differences in schizophrenia by way of ACEs.Lack of Ethnic Identity as Risk Factors of APS:The African worldview reflects psychological communal, spiritual, collective survival thrust as opposed to the European worldview of individualism and materialism. Cultural Misorientation (CM) represents that foreign psychological or psychopathological disposition in the African personality, which allows African Americans to unknowingly value and participate in European cultural indoctrination through the practice of European cultural values, rituals, and customs. The purpose of this study was to explore the roles that CM play on the overall presentation of attenuated psychotic symptoms, by way of ACE exposure.MethodsParticipants: Participants included 304 African American college students, 199 (65.46%) women and 105 (34.54%) men from a Historically Black College and University in the southeastern region of the United States. Participants were between 18 and 25 years of age.InstrumentsAdverse Childhood Experiences Scale measures the association of multiple types of abuse with different types of health outcomes. Prodromal Questionnaire- Brief (PQ-B) measures the presence of negative symptoms, perceptual abnormalities such as hallucinations, and unusual thought content like delusional ideas and paranoia. Cultural Misorientation - Short Form assesses the condition of cultural misorientation across 6 subscales-- materialism orientation, individualism orientation, alien-self orientation, anti-self orientation, self-destructive orientation, and integration orientation.ResultsThe Pearson correlation analysis indicated no significant relationship (r = -.073, p = .206) between ACE exposure and APS total scores on PQ-B. However, an unexpected negative significant relationship between childhood abuse exposures and symptom severity was observed (r = -.126*, p = .028), indicating that participants who reported more instances of childhood abuse tended to report less symptom severity. In addition, Cultural Misorientation (CM) was significantly positively correlated to PBQ total scores r = .194**, p = .001) and the severity of those symptoms (r = .171**, p = .003). CM materialism and individualism subscales mediated the relationship between childhood abuse and PQ-B total scores and symptom severity.DiscussionThis study provides support that some aspects of cultural misorientation can be detrimental to African Americans. Helping to reduce material and individualistic desires that have become detrimental should also be a central focus of implemented mental health programs.

Gender differences in the relationship of childhood trauma and the course of illness in schizophrenia

IntroductionDifferent types of childhood trauma have been repeatedly shown to contribute to psychotic symptoms. Gender differences in schizophrenia are well known. Some studies argue that trauma history means a significantly higher risk of psychosis for women than men. However, there is evidence of early adverse life events to be associated with higher stress-sensitivity in men. Little is known about the connection of specific type of trauma and specific psychotic symptoms as well as the course of illness with explicit regard to gender differences. Methods102 men and women with schizophrenia spectrum disorder were tested using Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Scale for Assessing Positive Symptoms, Early Trauma Inventory-SR. ResultsAlthough, women had a later age at onset without regarding trauma history (d = 0.74), this difference became non-significant when introducing trauma variables. Patients reporting physical abuse had a significantly earlier age at onset, regardless of their sex (V = 0.13, F = 3.11, p = 0.03. Physical abuse predicted an earlier age at onset only in women (R2 = 0.23). History of general trauma predicted more frequent hospitalizations only in men (R2 = 0.55). ConclusionsAlthough women generally tend to have a more favorable course of illness including a later age at onset men, women with CPA seem to lose this “advantage”. It is necessary to investigate the contribution of gender interacting with adverse life events in contribution to the phenomenology and etiology of schizophrenia.

Sex versus gender differences in schizophrenia: The case for normal personality differences

Schizophrenia has generally been viewed as having a unique preschizophrenia personality or destructive to the personality post-onset. This view is reflected in the scarcity of studies of personality in schizophrenia with the exception of schizotypal personality considered by many as an endophenotype of schizophrenia. What is missing is the study of personality as independent of schizophrenia and as a potential source of schizophrenia heterogeneity. In this study we examine sex versus gender as an initial effort to introduce personality as a normal variant that influences how schizophrenia is expressed. Gender, a personality construct, was associated with the presence of depression in a large sample of schizophrenia patients controlling for sex, age of onset, severity of disorder, and education. The results suggest that gender, rather than sex, as a representative personality trait may yield important insights into how schizophrenia is expressed.

Gender differences in the clinical manifestations and course of schizophrenia: neurobiological and psychosocial aspects

The paper discusses gender differences in the clinic presentations, course and outcomes of schizophrenia from the standpoint of a biopsychosocial approach. It reviews foreign publications on this matter. Neuromorphological and hormonal factors in gender differences are given paramount consideration in foreign countries. The author presents the results of his own empirical studies in this area. It is concluded that psychosocial factors and traditional gender stereotypes play a no less important role in gender differences in schizophrenia rather than hormonal and neuromorphological factors.

Why sex differences in schizophrenia?

Clinical observation shows that men and women are different in prevalence, symptoms, and responses to treatment of several psychiatric disorders, including schizophrenia. While the etiology of gender differences in schizophrenia is only partially understood, recent genetic studies suggest significant sex-specific pathways in the schizophrenia between men and women. More research is needed to understand the causal roles of sex differences in schizophrenia in order to ultimately develop sex-specific treatment of this serious mental illness. In the present review, we will outline the current evidence on the sex-related factors interaction with disease onset, symptoms and treatment of schizophrenia, and discuss the potential molecular mechanisms that may mediate their cooperative actions in schizophrenia pathogenesis.

Contribution of sex hormones to gender differences in schizophrenia: A review

Female patients with schizophrenia tend to have a more benign course and better outcomes than males. One proposed explanation is the differential influence of male and female sex hormones, including estrogen, progesterone, testosterone, and dehydroepiandrosterone (DHEA) and its sulfate (DHEAS). Such benefit may be mediated by their effects on neurotransmitters and neuroprotection. Besides altered estrogen and DHEA/DHEAS levels in female patients, data is equivocal on hormonal differences between patients and controls. However, several reports note a mostly negative correlation between estrogen levels and symptom severity in both genders, and a positive correlation between estrogen levels and neurocognition but mainly in females. Adjunctive estrogen appears to improve symptoms in both genders. Progesterone levels have inconsistent links to symptom severity in both genders, and correlate positively with neurocognition but only in males. Estrogen-progesterone combination shows preliminary benefits as augmentation for both symptoms and neurocognition in females. Testosterone levels correlate inversely with negative symptoms in males and have inconsistent associations with neurocognition in both genders. Testosterone augmentation reduced negative symptoms in male patients in a pilot investigation, but has not been evaluated for neurocognition in either gender. DHEA/DHEAS have mixed results for their association with, and clinical utility for, symptoms and neurocognition in both genders. Overall, data on the impact of sex hormones on clinical course or as treatment for schizophrenia is limited, but estrogen has most evidence for positive influence and clinical benefit. The possibly greater tolerability and broader impact of these hormones versus existing medications support further exploration of their use.

A Role for Estrogen in Schizophrenia: Clinical and Preclinical Findings.

Gender differences in schizophrenia have been extensively researched and it is being increasingly accepted that gonadal steroids are strongly attributed to this phenomenon. Of the various hormones implicated, the estrogen hypothesis has been the most widely researched one and it postulates that estrogen exerts a protective effect by buffering females against the development and severity of the illness. In this review, we comprehensively analyse studies that have investigated the effects of estrogen, in particular 17β-estradiol, in clinical, animal, and molecular research with relevance to schizophrenia. Specifically, we discuss the current evidence on estrogen dysfunction in schizophrenia patients and review the clinical findings on the use of estradiol as an adjunctive treatment in schizophrenia patients. Preclinical research that has used animal models and molecular probes to investigate estradiol's underlying protective mechanisms is also substantially discussed, with particular focus on estradiol's impact on the major neurotransmitter systems implicated in schizophrenia, namely, the dopamine, serotonin, and glutamate systems.

1665 – Gender differences in depressive co-morbidity and suicidal behaviour among delusional disorder patients

Introduction Although gender differences in schizophrenia are well known, this topic in delusional disorder (DD) has been poorly studied. Previous studies have shown an earlier mean age at onset in men than in women, and in those with depressive co-morbidity. Objectives To examine demographic and clinical differences by gender in DD. Aims To compare depressive co-morbidity and suicidality between men and women. Methods Ninety-seven patients with delusional disorder (DSM-IV-RT), attended at the Department of Psychiatry (Hospital Clinic-BCN) from 2000 to 2012, were included and followed up for one year. Demographic and clinical features at index admission, pharmacological treatment, compliance, presence of depressive co-morbidity and suicidal behaviour at follow-up were recorded. For comparisons, T, Chi-square tests and analysis of covariance (ANCOVA) were used. Results Seventy-six per cent were women and the most common delusional idea was delusion of persecution (74.2%). Gender differences regarding demographic features and depressive co-morbidity were not found. 22.7% of the sample presented suicidal ideation and 12.4% attempted suicide during follow-up. Women became ill later than men (50.07 vs.44.57 years), but when ANCOVA model is used with age at onset as dependent variable, sex as factor, and depressive co-morbidity and suicidal behaviour as covariates, this difference was not significant for sex effect. Women attempted suicide more often than men (13.5% vs. 8.7%) and showed less compliance during the evaluation period. Conclusions No gender differences in age at onset, types of DD, presence of depression and severity of global functioning were found. Women showed higher suicidal behaviour.

Combination of Estrogen and Antipsychotics in the Treatment of Women with Chronic Schizophrenia

Gender differences in schizophrenia include the age of onset, better treatment response, a better outcome, and the peak of the disease in postmenopausal women. Some evidence indicates that these variations are due to estrogen's effect. The intention of this study was to evaluate the effectiveness of estrogen as an adjuvant agent in the treatment of women with chronic schizophrenia. Study participants were 32 women of childbearing age with chronic schizophrenia. These patients were hospitalized in an institute for the chronically mentally ill. Participants were randomized into two groups: the first group (16 cases) received conjugated estrogens 0.625 mg/day 4 weeks with their previous antipsychotic treatment, while the second group (16 cases) received placebo booster and antipsychotics. The Positive and Negative Syndrome Scale (PANSS) was used as a measurement tool for assessing psychopathology. The combination of conjugated estrogens with antipsychotic treatment showed a significant decrease in positive (p=0.003), negative (p<0.001), general (p<0.001) and total (p<0.001) PANSS scores over 4 weeks. Estrogen may be an effective adjuvant agent in the treatment of women with chronic schizophrenia.

DNA Methylation in Schizophrenia Subjects: Gender and MTHFR 677C/T Genotype Differences

In schizophrenia, metabolic syndrome incidence is double that of the general population, with women having a higher incidence. Pharmacogenetically regulated folic acid may be related to this risk. DNA methylation and metabolic syndrome within this group has not been previously studied. Metabolic syndrome was evaluated with fasting laboratory measurements, and dietary and lifestyle assessments. Methylation analysis used a peripheral sample for the LINE-1 assay. DNA was also genotyped for MTHFR 677C/T. This analysis included 133 subjects. We found a significant relationship between LINE-1 methylation, and an interaction between MTHFR and gender, controlling for serum folate (p = 0.008). Females with the 677TT genotype had the lowest methylation (56%) compared with the other groups (75%). TT genotype females had the lowest methylation, which may explain metabolic syndrome gender differences in schizophrenia. Folate supplementation may be a suggested intervention within schizophrenia; however, additional work is required.

Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review.

Recent studies have begun to look at gender differences in schizophrenia and first-episode psychosis in an attempt to explain the heterogeneity of the illness. However, a number of uncertainties remain. This paper tries to summarize the most important findings in gender differences in schizophrenia and first-psychosis episodes. Several studies indicate that the incidence of schizophrenia is higher in men. Most of the studies found the age of onset to be earlier in men than in women. Findings on symptoms are less conclusive, with some authors suggesting that men suffer more negative symptoms while women have more affective symptoms. Premorbid functioning and social functioning seem to be better in females than males. However, cognitive functioning remains an issue, with lack of consensus on differences in neuropsychological profile between women and men. Substance abuse is more common in men than women with schizophrenia and first-episode psychosis. In terms of the disease course, women have better remission and lower relapse rates. Lastly, there is no evidence of specific gender differences in familial risk and obstetric complications. Overall, gender differences have been found in a number of variables, and further study in this area could help provide useful information with a view to improving our care of these patients.

P-1463 - Menopause and schizophrenia: wich links?

In the past, some authors postulated that many women with schizophrenia showed signs of “hypoestrogenism”, suggesting that women became psychotic mainly before or during menstruation. Kraepelin created the diagnostic category “Menstrual Psychosis”. Understand a possible relationship between menopause/estrogens and the development of schizophrenia. Bibliographic search in Pubmed and textbooks. Several authors observed a relationship between estrogen levels and psychotic symptoms. Some facts contribute to this hypothesis like late-onset schizophrenia being more frequent in women, a second peak for onset of the disease, psychosis in temporal relationship with ovary surgery, puerperium and oscillations throughout the menstrual cycle, lower doses of antipsychotics during pregnancy. For some authors, estrogens also exert a “protective” effect over psychotic symptoms, beyond other several known effects on various psychopathological aspects, namely through antidopaminergic actions as well as modulation of apoptosis and improvement of depressive and negative symptoms. Although some evidence confirms this theory, the estrogen hypothesis is not universally accepted, some authors claiming the existence of other biological, emotional and social factors that should be considered in menopause. The etiology of the gender differences in schizophrenia is not yet well understood, but hormone-gene interactions may explain part of the mechanism. The psychiatric interview should explore menstrual irregularities or galactorrhoea, and, with increasing evidence, serum levels of prolactin and estrogens may become part of the routine tests. In the future, treatment with hormone replacement therapy may be a possibility for these patients.

P-1259 - Schizophrenia in a woman with polycystic ovarian disease

Empirical evidence suggested systematic differences in clinical features between women and men with schizophrenia. Specifically, high levels of estrogens were suggested to be protective against symptom exacerbations in women with schizophrenia and to contribute to the later age of onset observed in women. The objective of the study is to characterize the role of estrogens in schizophrenia gender differences. To support a model of schizophrenia in which circulating sex hormones contribute to the developmental pattern and clinical presentation of the illness. Based on a case of schizophrenia in a woman with a diagnosis of polycystic ovarian disease, we will discuss the different clinical, epidemiological and experimental data through a studies review. BM was a 29-year-old, single woman. Since she was 18, BM presented an increasing isolation, persecutory, paranoid delusions and aggression directed toward her neighbors. On assessment following admission, she exhibited prominent negative symptoms including blunted affect and emotional withdrawal along with auditory hallucinations, mystic delusions, hostility, combativeness and no insight. She met DSM-IV criteria for diagnosis of schizophrenia, undifferentiated type. Since menarche, BM presented slowly progressing hirsutism and irregular menses that have never been treated. Hormonal studies and pelvic ultrasound confirmed the diagnosis of polycystic ovarian disease. Hypoestrogenism and long-standing hyperandrogenism, either directly or indirectly, modify symptom expression and account for many of the observed gender differences in schizophrenia.