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.

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

Schizophrenia Research and Treatment ◽

10.1155/2012/916198 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 143

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.

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Personal Aging Is Political: A Feminist Perspective on Subjective Aging

Innovation in Aging ◽

10.1093/geroni/igaa057.1827 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 556-556

Author(s):

Anne Barrett ◽

Cherish Michael ◽

Jessica Noblitt

Keyword(s):

Gender Differences ◽

Feminist Perspective ◽

Social Embeddedness ◽

Extensive Literature ◽

Life Stages ◽

Age Identity ◽

Individual Level ◽

Level Characteristic ◽

Aging Anxiety ◽

Subjective Aging

Abstract An extensive literature examines subjective aging – a construct encompassing many aspects of individuals’ views of aging, such as age identity, aging anxiety, awareness of aging, and views of life stages. A factor receiving attention within this research is gender, with studies revealing much about gender differences not only in subjective aging but also its health and behavioral consequences. However, we argue that the literature is limited by its focus on gender as an individual-level characteristic – rather than a profoundly social element emerging within interactions, pervading institutions, and constituting a system of inequality that intersects with others, including age. Addressing this limitation, our chapter applies a feminist perspective to the study of subjective aging. This perspective draws into focus the implications for subjective aging of gender’s social embeddedness and provides an illustration of the interconnection between the personal and political spheres.

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Clinical symptoms, mainly negative symptoms, mediate the influence of neurocognition and social cognition on functional outcome of schizophrenia

Schizophrenia Research ◽

10.1016/j.schres.2013.02.009 ◽

2013 ◽

Vol 146 (1-3) ◽

pp. 231-237 ◽

Cited By ~ 97

Author(s):

Chieh-Hsin Lin ◽

Chieh-Liang Huang ◽

Yue-Cune Chang ◽

Po-Wei Chen ◽

Chun-Yuan Lin ◽

...

Keyword(s):

Social Cognition ◽

Functional Outcome ◽

Negative Symptoms ◽

Clinical Symptoms

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Gender and Schizophrenia: Association of Age at Onset with Antecedent, Clinical and Outcome Features

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048679809065536 ◽

1998 ◽

Vol 32 (3) ◽

pp. 415-423 ◽

Cited By ~ 13

Author(s):

Oye Gureje ◽

Rotimi W. Bamidele

Keyword(s):

Functional Outcome ◽

Early Onset ◽

Late Onset ◽

Age At Onset ◽

Early Age ◽

Illness Onset ◽

Gender And Age ◽

Males And Females ◽

Clear Method ◽

Illness Outcome

Objective: There is evidence that gender and age at onset may have a bearing on schizophrenia. The extent to which this differential age at onset influences the clinical features of schizophrenia and its outcome in males and females is not clear. Method: One hundred and twenty outpatients with DSM-III-R schizophrenia were studied to determine the association of antecedent, historical, clinical and 13–year outcome features with age at onset in females (n = 64) and in males (n = 56). Results: Males were significantly younger at illness onset but were not otherwise different from females in antecedent features of illness. For males, age at onset bore little relationship to outcome after 13 years. Females with early onset of illness were more likely to have experienced obstetric complications, to evidence poorer premor-bid functioning, and to have a worse clinical, social and functional outcome than females with late onset. Conclusions: Even though females may have a more benign illness than males, among females, those with early age at onset may be characterised by neurodevel-opmental deviance and worse illness outcome.

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Factor Analysis of Negative Symptom Items in the Structured Interview for Prodromal Syndromes

Schizophrenia Bulletin ◽

10.1093/schbul/sby177 ◽

2018 ◽

Vol 45 (5) ◽

pp. 1042-1050 ◽

Cited By ~ 9

Author(s):

Matilda Azis ◽

Gregory P Strauss ◽

Elaine Walker ◽

William Revelle ◽

Richard Zinbarg ◽

...

Keyword(s):

Factor Analysis ◽

Functional Outcome ◽

Negative Symptom ◽

Negative Symptoms ◽

Psychotic Disorders ◽

The United States ◽

Structured Interview ◽

Symptom Dimensions ◽

Increased Risk ◽

Active Research

Abstract Background Negative symptoms occur early in the clinical high risk (CHR) state and indicate increased risk of conversion to psychotic disorder and poor functional outcome. However, while the negative symptom domain has shown to be parsimoniously explained by a 2-factor construct in schizophrenia, there has yet to be an established factor structure of negative symptoms in CHR. Methods 214 individuals meeting the Structured Interview for Psychosis-Risk Syndromes (SIPS) criteria for CHR were recruited through 3 active research programs in the United States. Exploratory Factor Analysis was conducted on the 6 negative symptom items of the SIPS, and factors were evaluated with respect to functional outcome and depression. Results Factor analysis indicated a 2-factor hierarchical model with 2 negative symptom dimensions reflecting volition (Occupational Functioning and Avolition) and emotion (Expression of Emotion, Experience of Emotion and Social Anhedonia). Linear Regression showed that the emotion factor was associated with poor social function, and the volition factor was associated with poor role function and depression. Conclusions Similar to factor solutions identified in adults diagnosed with psychotic disorders, results indicated that the SIPS negative symptom subscale is not a unidimensional construct. Rather, the SIPS negative subscale has 2 distinct factors that have different associations with clinical outcome and should be interpreted independently. Results have significant relevance for informing the valid assessment and conceptual interpretation of early clinical phenomenology in the psychosis prodrome.

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The core dimensions of schizophrenia

New Oxford Textbook of Psychiatry ◽

10.1093/med/9780198713005.003.0057 ◽

2020 ◽

pp. 565-573

Author(s):

Nancy C Andreasen

Keyword(s):

Intelligence Quotient ◽

Negative Symptoms ◽

Three Dimensions ◽

Psychotic Symptoms ◽

Outcome Predictors ◽

Positive Symptoms ◽

Illness Onset ◽

Premorbid Adjustment ◽

High Intelligence ◽

Over Time

Schizophrenia is a devastating illness that usually affects many aspects of a person’s life. The symptoms may be divided into two groups. ‘Positive’ symptoms include a variety of psychotic symptoms such as delusions and hallucinations. Although severe, they are less handicapping than negative symptoms such as avolition or anhedonia. Positive symptoms involve the presence of things that should be absent, while negative symptoms involve the absence of things that should be present. Dimensional approaches for classifying symptoms have also become popular in current nosology, proposing three dimensions: positive, negative, and disorganized. The course of the illness evolves over time; a prodrome is often present, followed by illness onset and a variable outcome. Good outcome predictors include good premorbid adjustment, high intelligence quotient, and good social relationships. The pathophysiology of the illness includes genetic, neuropathological, and neurodevelopmental components. A possible association with creativity may suggest reasons why the illness has persisted over many centuries.

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Gender differences of patients at-risk for psychosis regarding symptomatology, drug use, comorbidity and functioning – Results from the EU-GEI study

European Psychiatry ◽

10.1016/j.eurpsy.2019.04.007 ◽

2019 ◽

Vol 59 ◽

pp. 52-59 ◽

Cited By ~ 5

Author(s):

Stephanie Menghini-Müller ◽

Erich Studerus ◽

Sarah Ittig ◽

Ulrike Heitz ◽

Laura Egloff ◽

...

Keyword(s):

Gender Differences ◽

At Risk ◽

Drug Use ◽

Anxiety Disorders ◽

Statistical Power ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Cannabis Use ◽

First Episode ◽

Global Functioning

AbstractBackground:Gender differences in symptomatology in chronic schizophrenia and first episode psychosis patients have often been reported. However, little is known about gender differences in those at risk of psychotic disorders. This study investigated gender differences in symptomatology, drug use, comorbidity (i.e. substance use, affective and anxiety disorders) and global functioning in patients with an at-risk mental state (ARMS) for psychosis.Methods:The sample consisted of 336 ARMS patients (159 women) from the prodromal work package of the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI; 11 centers). Clinical symptoms, drug use, comorbidity and functioning were assessed at first presentation to an early detection center using structured interviews.Results:In unadjusted analyses, men were found to have significantly higher rates of negative symptoms and current cannabis use while women showed higher rates of general psychopathology and more often displayed comorbid affective and anxiety disorders. No gender differences were found for global functioning. The results generally did not change when corrected for possible cofounders (e.g. cannabis use). However, most differences did not withstand correction for multiple testing.Conclusions:Findings indicate that gender differences in symptomatology and comorbidity in ARMS are similar to those seen in overt psychosis and in healthy controls. However, observed differences are small and would only be reliably detected in studies with high statistical power. Moreover, such small effects would likely not be clinically meaningful.

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O3.1. CLUSTER ANALYSIS FINDS THREE CLINICALLY-RELEVANT SUBGROUPS OF TRAIT EMOTIONAL EXPERIENCE IN SCHIZOPHRENIA OUTPATIENTS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa028.012 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S5-S6

Author(s):

Henry Cowan ◽

Vijay Mittal ◽

Daniel Allen ◽

James Gold ◽

Gregory Strauss

Keyword(s):

Negative Affect ◽

Functional Outcome ◽

Schizoaffective Disorder ◽

Negative Symptoms ◽

Clinical Symptoms ◽

Emotional Experience ◽

Symptom Presentation ◽

Cross Sectional ◽

Affective Traits ◽

Trait Affect

Abstract Background Previous research shows that trait emotion is more affected than state emotion in schizophrenia. This literature is also somewhat inconsistent, particularly in terms of specific links between affective traits and clinical symptoms. The current study examined whether subgroups of trait emotional experience predict symptom presentation and functional outcome in schizophrenia. Methods In this cross-sectional observational study, 192 outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ) and 149 matched healthy controls completed the trait version of the Positive and Negative Affect Scale and symptom and functional outcome assessments. Cluster and discriminant function analyses identified distinct profiles of trait affect, which were then compared on clinical and functional variables. Results Three SZ clusters reflected normative affect (n = 80, 42%), low trait positive affect (PA; n = 54, 28%), and high trait negative affect (NA; n = 58, 30%), compared to controls. Symptom profiles differentiated the three subgroups. Compared to the Normative Affect cluster, the Low PA cluster had more severe negative symptoms; the High NA cluster had more severe positive symptoms, disorganization, anxiety, and depression; and both the Low PA and High NA cluster had poorer overall functioning. Diagnostic and medication status also differentiated the three subgroups. The Low PA subgroup was most likely to be prescribed 1st-generation antipsychotics, while the High NA subgroup was most likely to be diagnosed with schizoaffective disorder. Discussion Distinct subgroups with unique trait affect profiles can be identified within the broader diagnosis of schizophrenia. These subgroups show meaningful clinical differences in presentation, with theoretical and clinical implications.

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Gender Differences in Individuals at High-Risk of Psychosis: A Comprehensive Literature Review

The Scientific World JOURNAL ◽

10.1155/2015/430735 ◽

2015 ◽

Vol 2015 ◽

pp. 1-13 ◽

Cited By ~ 47

Author(s):

Ana Barajas ◽

Susana Ochoa ◽

Jordi E. Obiols ◽

Lluís Lalucat-Jo

Keyword(s):

Gender Differences ◽

High Risk ◽

Social Functioning ◽

Negative Symptoms ◽

Psychotic Disorders ◽

Control Variable ◽

Prodromal Phase ◽

Men And Women ◽

Conversion Rates ◽

High Risk Populations

Introduction. To date, few studies have focused on the characterization of clinical phenomenology regarding gender in population at high-risk of psychosis. This paper is an attempt to summarize the findings found in the scientific literature regarding gender differences in high-risk populations, taking into account parameters studied in populations with schizophrenia and other psychotic disorders, such as incidence, clinical expression, duration of untreated illness (DUI), social functioning, and cognitive impairment prior to full-blown psychosis development.Method. Studies were systematically searched in PubMed. Studies using gender variable as a control variable were excluded. 12 studies met inclusion criteria.Results. Most of the studies found a differential pattern between women and men as regards clinical, social, and cognitive variables in the prodromal phase, with worse performance in men except in cognitive functioning (more severe negative symptoms, worse social functioning, and longer DUI in men). Similar conversion rates over time were found between men and women.Conclusions. Many of the studies analyzed suggest that differences between men and women in the expression of psychosis extend across a continuum, from the subclinical forms of illness to the debut of psychosis. However, the small number of studies and their significant methodological and clinical limitations do not allow for firm conclusions.

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