scholarly journals Gender differences in clinical presentation and illicit substance use during first episode psychosis: a natural language processing, electronic case register study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042949
Author(s):  
Jessica Irving ◽  
Craig Colling ◽  
Hitesh Shetty ◽  
Megan Pritchard ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Gender Differences ◽  
Substance Use ◽  
Language Processing ◽  
Negative Symptoms ◽  
Clinical Presentation ◽  
First Episode Psychosis ◽  
First Episode ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Episode Psychosis

ObjectiveTo determine whether gender differences in symptom presentation at first episode psychosis (FEP) remain even when controlling for substance use, age and ethnicity, using natural language processing applied to electronic health records (EHRs).Design, setting and participantsData were extracted from EHRs of 3350 people (62% male patients) who had presented to the South London and Maudsley NHS Trust with a FEP between 1 April 2007 and 31 March 2017. Logistic regression was used to examine gender differences in the presentation of positive, negative, depressive, mania and disorganisation symptoms.Exposure(s) (for observational studies)Gender (male vs female).Main outcome(s) and measure(s)Presence of positive, negative, depressive, mania and disorganisation symptoms at initial clinical presentation.ResultsEight symptoms were significantly more prevalent in men (poverty of thought, negative symptoms, social withdrawal, poverty of speech, aggression, grandiosity, paranoia and agitation). Conversely, tearfulness, low energy, reduced appetite, low mood, pressured speech, mood instability, flight of ideas, guilt, mutism, insomnia, poor concentration, tangentiality and elation were more prevalent in women than men. Negative symptoms were more common among men (OR 1.85, 95% CI 1.33 to 2.62) and depressive and manic symptoms more common among women (OR 0.30, 95% CI 0.26 to 0.35). After adjustment for illicit substance use, the strength of associations between gender and negative, manic and depression symptoms increased, whereas gender differences in aggression, agitation, paranoia and grandiosity became insignificant.ConclusionsThere are clear gender differences in the clinical presentation of FEP. Our findings suggest that gender can have a substantial influence on the nature of clinical presentation in people with psychosis, and that this is only partly explained by exposure to illicit substance use.

scholarly journals T127. GENDER DIFFERENCES IN CLINICAL PRESENTATION AND ILLICIT SUBSTANCE USE DURING FIRST EPISODE PSYCHOSIS: AN ELECTRONIC CASE REGISTER NATURAL LANGUAGE PROCESSING ANALYSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S278-S279
Author(s):  
Jessica Irving ◽  
Craig Colling ◽  
Hitesh Shetty ◽  
Megan Pritchard ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Gender Differences ◽  
Substance Use ◽  
Language Processing ◽  
Negative Symptoms ◽  
Clinical Presentation ◽  
Psychiatric Symptoms ◽  
First Episode ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Male Patients

Abstract Background Gender differences in the clinical presentation of first episode psychosis (FEP) and its relationship to illicit substance use are inconclusive and underexplored. We conducted an electronic health record (EHR) study applying natural language processing (NLP) techniques to investigate gender differences in psychiatric symptoms when controlling for age, ethnicity, and illicit substance use. Methods Data were extracted from EHRs of 3,340 people presenting to the South London and Maudsley (SLaM) NHS Trust between April 2007 and March 2017 with FEP. Logistic regression was used to examine gender differences in presentation of 42 psychiatric symptoms, grouped into positive, negative, depressive, mania and disorganisation symptoms. We controlled for age of onset, ethnicity and illicit substance use (cocaine, amphetamine, MDMA or cannabis) and adjusted p-values for multiple comparisons. Results Patients were predominantly male (62%). Eight symptoms were more prevalent in males (poverty of thought, negative symptoms, social withdrawal, poverty of speech, aggression, grandiosity, paranoia and agitation), and thirteen in females (tearfulness, low energy, reduced appetite, low mood, pressured speech, mood instability, flight of ideas, guilt, mutism, insomnia, poor concentration, tangentiality and elation), before adjustment for age, ethnicity and substance use. Male patients were significantly more likely to experience negative symptoms than females (e.g. poverty of thought, OR 1.85, 95% CI 1.33 to 2.62); female patients showed increased likelihood of depressive and manic symptoms (e.g. tearfulness, 0.30, 0.26 to 0.35). Male patients were significantly more likely to misuse amphetamines, cannabis and cocaine (e.g. cannabis, OR 3.18, 2.75 to 3.70). All significant differences survived controls for age and ethnicity. After adjustment for illicit substance use gender differences in aggression, agitation, paranoia and grandiosity became insignificant (p > 0.05). However, adjustment for illicit substance use resulted in increased strength of gender associations with negative, manic and depression symptoms. Discussion There are clear gender differences in the clinical presentation of FEP which are modified by exposure to illicit substances. These findings highlight a need to better understand the impact of gender on clinical presentation and treatment outcomes in psychosis, and to ensure that clinicians are aware of how gender differences in presentation could be modified by illicit substance use.

One year follow-up of alcohol and illicit substance use in first-episode psychosis: Does gender matter?

2014 ◽  
Vol 55 (2) ◽  
pp. 274-282 ◽  
Author(s):  
Elisabeth Heffermehl Lange ◽  
Ragnar Nesvåg ◽  
Petter Andreas Ringen ◽  
Cecilie Bhandari Hartberg ◽  
Unn Kristin Haukvik ◽  
...  
Keyword(s):  
Substance Use ◽  
First Episode Psychosis ◽  
First Episode ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Episode Psychosis ◽  
One Year

Illicit substance use and its correlates in first episode psychosis

2010 ◽  
Vol 121 (5) ◽  
pp. 351-358 ◽  
Author(s):  
R. Mazzoncini ◽  
K. Donoghue ◽  
J. Hart ◽  
C. Morgan ◽  
G. A. Doody ◽  
...  
Keyword(s):  
Substance Use ◽  
First Episode Psychosis ◽  
First Episode ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Episode Psychosis

scholarly journals Gender Differences in Schizophrenia and First-Episode Psychosis: A Comprehensive Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Susana Ochoa ◽  
Judith Usall ◽  
Jesús Cobo ◽  
Xavier Labad ◽  
Jayashri Kulkarni
Keyword(s):  
Gender Differences ◽  
Negative Symptoms ◽  
Age Of Onset ◽  
Familial Risk ◽  
First Episode Psychosis ◽  
First Episode ◽  
Neuropsychological Profile ◽  
Affective Symptoms ◽  
Episode Psychosis ◽  
Premorbid Functioning

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.

Gender differences in first-episode psychosis at 5-year follow-up – two different courses of disease? Results from the OPUS study at 5-year follow-up

2014 ◽  
Vol 29 (1) ◽  
pp. 44-51 ◽  
Author(s):  
A. Thorup ◽  
N. Albert ◽  
M. Bertelsen ◽  
L. Petersen ◽  
P. Jeppesen ◽  
...  
Keyword(s):  
Gender Differences ◽  
Substance Abuse ◽  
Social Functioning ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Intervention Programme ◽  
Episode Psychosis ◽  
Symptom Patterns

AbstractObjectiveGender differences in psychosis have been investigated, and the results have contributed to a better understanding of the disease, but many questions are unanswered. In clinical terms, women and men with psychosis differ in terms of access to social support, tendency of substance abuse, level of functioning and symptom patterns. We aimed to investigate how gender differences at onset of psychosis develop during the first 5 years of treatment.MethodA total of 578 patients with a first-episode psychosis in the schizophrenia spectrum were included in the Danish OPUS trial – a randomized clinical trial comparing 2 years of intensive early-intervention programme with standard treatment. All patients were assessed with validated instruments at inclusion, and after 2 and 5 years. Data were analysed for significant gender differences.ResultsMales have significantly higher levels of negative symptoms at all times, and are more likely to live alone and suffer from substance abuse. Females reach higher levels of social functioning at follow-up, and show a greater tendency to be employed or in education than males. Markedly more women than men live with children. More women than men reach a state of recovery and are more compliant with medication.ConclusionThere are significant gender differences at 2- and 5-year follow-up in this large cohort of first-episode psychotic patients. Males and females show different symptomatology and different levels of social functioning.

Comorbidities in Patients with an At-risk Mental State and First Episode Psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S198-S198 ◽  
Author(s):  
U. Heitz ◽  
J. Cherbuin ◽  
S. Menghini-Müller ◽  
L. Egloff ◽  
S. Ittig ◽  
...  
Keyword(s):  
Gender Differences ◽  
Substance Use ◽  
Anxiety Disorders ◽  
Substance Use Disorders ◽  
Mental State ◽  
First Episode Psychosis ◽  
First Episode ◽  
Episode Psychosis ◽  
Axis I ◽  
At Risk Mental State

IntroductionNon-psychotic axis I diagnoses are highly prevalent in at-risk mental state (ARMS) and first episode psychosis (FEP) patients, the most common being affective and anxiety disorders. Few studies have examined differences between ARMS and FEP patients or gender effects regarding such diagnoses.ObjectiveTo examine current and lifetime comorbidities in ARMS and FEP patients. Furthermore, to examine gender differences, and differences between patients with (ARMS-T) and without later transition to psychosis (ARMS-NT).MethodsThis study was part of the Früherkennung von Psychosen (FePsy) study. Current and lifetime axis I comorbidities were assessed using the Structured Clinical Interview for DSM-IV (SCID-I).ResultsOne hundred and thirty-two ARMS and 98 FEP patients were included. Current comorbidities were present in 53.1% of FEP and 64.4% of ARMS patients, the most common being affective, anxiety and substance use disorders. Current affective disorders were significantly more common in ARMS than FEP. Lifetime comorbidities were diagnosed in 58.2% of FEP and 69.7% of ARMS patients, with significantly more affective and anxiety disorders in ARMS than FEP. Male FEP patients had more current and lifetime substance use disorders (across all substances) compared to female FEP. No differences emerged between ARMS-T and ARMS-NT.ConclusionsAs expected ARMS patients have many comorbidities, while clearly diagnosed FEP have less comorbidities. There were few gender differences in axis I comorbidities. Moreover, no differences between ARMS-T and NT emerged, suggesting that axis I comorbidities do not improve prediction of transition. Nevertheless, the high comorbidity prevalence is relevant for global functioning and clinical treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

FIRST-EPISODE PSYCHOSIS: GENDER DIFFERENCES IN SUBSTANCE USE

2010 ◽  
Vol 117 (2-3) ◽  
pp. 424-425
Author(s):  
Luis San ◽  
Belen Arranz ◽  
Victor Perez ◽  
Bernardo Sanchez ◽  
Montse Dolz ◽  
...  
Keyword(s):  
Gender Differences ◽  
Substance Use ◽  
First Episode Psychosis ◽  
First Episode ◽  
Episode Psychosis

Substance abuse in first episode psychosis: Baseline characteristics and clinical outcome

2016 ◽  
Vol 33 (S1) ◽  
pp. S587-S587 ◽  
Author(s):  
A. Toll ◽  
A. Mané ◽  
D. Bergé ◽  
V. Pérez-Solà
Keyword(s):  
Substance Use ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Younger Age ◽  
Episode Psychosis ◽  
Baseline Characteristics ◽  
Competing Interest ◽  
Gaf Scores

IntroductionThere are high rates of substance use disorders (SUD) amongst first episode psychosis (FEP). SUD have been linked to better premorbid adjustment, more severe positive and negative symptoms at presentation and poorer symptomatic and functional outcome [1]. Moreover, shorter duration of untreated psychosis (DUP) has been described as an important predictor of outcome in FEP [2].AimsWith this study, we want to know which baseline characteristics and clinical outcomes differ between FEP patients with and without substance use.MethodsOne hundred and seventy-five FEP were consecutively admitted to Hospital del Mar since January 2008 to September 2014 and entered the FEP programme of the institution. The included evaluation was socio-demographic and clinical data at baseline and 1 year follow-up. We studied differences in age, gender, DUP, GAF scores at baseline and 1 year follow-up and PANSS subscale scores at base and 1 year follow-up between substance users and non-users.ResultsCannabis: we found that users were significative younger (P < 0.01), had a higher proportion of males (P < 0.01) and a significative shorter DUP in users (P = 0.008).Alcohol: we found that users were significative younger (P < 0.009), had a higher proportion of males (P < 0.003) and a significative lower PANNS negative scores at baseline (P = 0.01) and 1 year follow-up (P = 0.03).ConclusionsIn our sample of first episode psychosis, cannabis and alcohol use is linked with a younger age and a high proportion of males. Moreover, it seems that cannabis use could be associated with a shorter DUP.References not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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