Sex differences in schizophrenia

Schizophrenia is diagnosed in more men than women, with a male to female ratio of 1.4:1.[1][2][3] Women are more likely than men to experience an emergence of psychotic features later in life.[4][3] Women tend to display more emotional and psychotic symptoms than men.[4] Researchers are finding that gender is also useful in understanding schizophrenia.[5]

Clinical considerations

According to the DSM-V, women diagnosed with schizophrenia are more likely than men to experience the first major symptoms of the disorder at a later age. Women often experience more emotional and psychotic symptoms while men tend to have more disorganization and negative symptoms. Women tend to show a worsening of psychotic symptoms as they age. Men tend to have greater social impairment from their symptoms.[4]

Although these trends have been observed, men and women living with this disorder still may vary significantly from their sex while still meeting the criteria for the schizophrenia diagnosis.[4]

Development

Sex differences in childhood-onset

Children diagnosed with childhood-onset schizophrenia, a rare form of schizophrenia with an onset of psychotic symptoms prior to adolescence, have very few sex differences. Males tend to have a younger age of onset by about one year. Females tend to have lower verbal IQ scores at this age.[6]

Sex differences in onset during young adulthood

Onset is most common for men and women between their late teens and mid-30s. Females are most prone to experience their first psychotic episode in their late 20s, and males in their mid 20s.[3][4]

Female prevalence in onset during middle age

During middle age, more women than men experience onset of schizophrenia.[4][3] The reason for this phenomenon is unknown. Theories include differential brain aging to explain the consistent lag of onset in females compared to men as well as hormone depletion during menopause, citing the anti-psychotic nature of estrogen.[7]

Marriage and motherhood

Most men diagnosed with schizophrenia do not marry and have limited social networks.[4] Women diagnosed with schizophrenia, especially in cases of late onset, are more likely than men to be married.[4]

Women diagnosed with schizophrenia tend to have fewer offspring than those not affected; however, this difference is less pronounced than men.[8] Women diagnosed with schizophrenia often experience pressure from their community to not have children due to their mental disorder.[9]

Hospitalization

The first hospital admission in people with schizophrenia tends to be at a younger age in males than in females, regardless of age of onset.[10] The first manifestations of schizophrenia may occur at the same age in both males and females, but the time that elapses between onset and first admission to a hospital is considerably shorter in males than in females. Gender differences in age at the first hospital admission are typically due to a more acute onset in females.[11]

Tobacco usage

Smoking is more prevalent in people with schizophrenia (80%) than in the general population (20%).[12] However, schizophrenia is only seen as a risk factor for smoking in men, with social factors associated with mental illness contributing to increased rate of smoking in both genders.[13]

Cognitive performance and phenotype

There are differences within respect to cognitive function between male and female individuals with schizophrenia. Male patients have been found to have a significant negative association between cognitive variables and the PANSS (negative symptom scale) scores. Significant decrease in immediate memory and delayed memory, language and total RBANS scores have been seen in people with schizophrenia for both genders. Males were found to have lower immediate memory, delayed memory and total RBANS scores than females, although this gender difference was also seen in the healthy control group. In female patients there were positive correlations between the positive symptom scale and immediate memory, visuospatial, and total score. Attention and language indices were negatively associated with the symptom scales. Lower education, higher negative symptoms, older age and male gender were associated with cognitive impairments in schizophrenia.[14]

Biological causes

Biological causes for gender differences in schizophrenia remain unclear. One hypothesis suggests that the differences are due to the protective effects of estrogen. After menopausal age, there is a third peak of onsets in females.[15], and symptoms tend to become more severe than in men.[16] Evidence also shows that sex-related differences are correlated with estrogen expression.[16] Furthermore, estradiol has been found to be effective in treating schizophrenia when added to antipsychotic therapy. [17]

Gender roles

Different genders often exhibit what has been known to be called role reversal because each gender shows features opposite to their stereotyped gender role.[18] More recent studies do not support this idea.[19]

Recent research is finding trends when using non-biological gender to separate those diagnosed with schizophrenia.[5]

References

  1. ↑ McGrath, John; Saha, Sukanta; Chant, David; Welham, Joy (2008). "Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality" (PDF). Epidemiologic Reviews. 30: 67–76. doi:10.1093/epirev/mxn001.
  2. ↑ Aleman; Kahn; Selten (2003). "Sex differences in the risk of schizophrenia: evidence from meta-analysis". Archives of General Psychiatry. 60 (6): 565–71. doi:10.1001/archpsyc.60.6.565 – via NCBI.
  3. 1 2 3 4 Abel, Kathryn; Drake, Richard; Goldstein, Jill (2010). "Sex differences in schizophrenia". International Review of Psychiatry (22(5)): 417–428 – via Ebsco.
  4. 1 2 3 4 5 6 7 8 Diagnostic and Statistical Manual of Mental Disorders. Arlington Virginia: American Psychological Association. 2013. ISBN 9780890425596.
  5. 1 2 Lewine, Richard; Martin, Morgan; Hart, Mara (2017). "Sex versus gender differences in schizophrenia: The case for normal personality differences". Schizophrenia Research. 189: 57–60. doi:10.1016/j.schres.2017.02.015 – via Elsevier Science Direct.
  6. ↑ Ordóñez, Anna E.; et al. (September 2016). "Lack of Gender-Related Differences in Childhood-Onset Schizophrenia". Journal of the American Academy of Child & Adolescent Psychiatry. 55 (9): 792–799. doi:10.1016/j.jaac.2016.05.022.
  7. ↑ Castle, David; McGrath, John; Kulkarni, Jayashri (2000). Women and Schizophrenia. Cambridge: Cambridge University Press. ISBN 0521786177.
  8. ↑ Jablensky, A. (2007). "Chapter 12. The Epidemiological Horizon". Schizophrenia. doi:10.1002/9780470987353.ch12.
  9. ↑ Hearle, Jenny; McGrath, John (2000). "Motherhood and Schizophrenia". Women and Schizophrenia. Cambridge: Cambridge University Press. pp. 79–94. ISBN 0521786177.
  10. ↑ Häfner, H.; Riecher, A.; Maurer, K.; Löffler, W.; Munk-Jørgensen, P.; Strömgren, E. (2009). "How does gender influence age at first hospitalization for schizophrenia? A transnational case register study". Psychological Medicine. 19 (4): 903–918. doi:10.1017/S0033291700005626. PMID 2594886.
  11. ↑ Angermeyer, M. C.; Kühn, L. (1988). "Gender differences in age at onset of schizophrenia. An overview". European Archives of Psychiatry and Neurological Sciences. 237 (6): 351–364. doi:10.1007/BF00380979. PMID 3053193.
  12. ↑ Keltner, N. L.; Grant, J. S. (2006). "Smoke, Smoke, Smoke That Cigarette". Perspectives in Psychiatric Care. 42 (4): 256–261. doi:10.1111/j.1744-6163.2006.00085.x. PMID 17107571.
  13. ↑ Johnson, J.; Ratner, P.; Malchy, L.; Okoli, C.; Procyshyn, R.; Bottorff, J.; Groening, M.; Schultz, A.; Osborne, M. (2010). "Gender-specific profiles of tobacco use among non-institutionalized people with serious mental illness". BMC Psychiatry. 10: 101. doi:10.1186/1471-244X-10-101. PMC 3002315. PMID 21118563.
  14. ↑ Han, M.; Huang, X. F.; Chen, D. C.; Xiu, M. H.; Hui, L.; Liu, H.; Kosten, T. R.; Zhang, X. Y. (2012). "Gender differences in cognitive function of patients with chronic schizophrenia". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 39 (2): 358–363. doi:10.1016/j.pnpbp.2012.07.010. PMID 22820676.
  15. ↑ Castle D, Sham P, Murray R.. Differences in distribution of ages of onset in males and females with schizophrenia. Schizophrenia Research. 1998;33(3):179–183. doi:10.1016/s0920-9964(98)00070-x.
  16. 1 2 Häfner, H. "Gender differences in schizophrenia". Psychoneuroendocrinology. 28: 17–54. doi:10.1016/s0306-4530(02)00125-7.
  17. ↑ Kulkarni J, Riedel A, de Castella AR, et al.. Estrogen – A potential treatment for schizophrenia. Schizophrenia Research. 2001;48(1):137–144. doi:10.1016/s0920-9964(00)00088-8. PMID 11278160.
  18. ↑ Ecker, J.; Levine, J.; Zigler, E. (1973). "Impaired Sex-Role Identification in Schizophrenia Expressed in the Comprehension of Humor Stimuli". The Journal of Psychology. 83 (1st Half): 67–77. doi:10.1080/00223980.1973.9915592. PMID 4688199.
  19. ↑ Angermeyer, M. C.; Grottker, D. (1990). "Do schizophrenic psychoses lead to a reversal of sex-specific role behavior? Results of an explorative study". Psychiatrische Praxis. 17 (2): 85–90. PMID 2343069.
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