Literature on schizophrenia in women abounds. Gender-based differences span the whole schizophrenic syndrome contours. This has been largely attributed to estrogen protection hypothesis. Here, we would try to sum up these salient differences and meanwhile highlighting its prognostic and therapeutic implications.

FormalPara Incidence

A meta-analysis by Aleman et al. (2003) found that the pooled male to female ratio was 1:4. This simply translates into for every three men developing schizophrenia, two women are affected. This contrasts with the dogmatic belief that schizophrenia affects both sexes equally. Early-onset schizophrenia that is below age of 18 remains male-preponderant.

FormalPara Onset

The mean age of onset in women is 25–35 years that is 3–4 years later than male counterpart. It has bimodality with the other peak perimenopausal.

FormalPara Phenomenology

Paranoid type predominates. Affective symptoms are common. Negative and cognitive domains are less affected. Good premorbid functioning. Better social adjustment. More suicidal attempts are reported. Lower substance use is noted.

FormalPara Course and Prognosis

All these would portend an overall better prognostication. Fewer hospitalizations are typical and better quality of life is shown.

FormalPara Treatment

Women respond generally to lower antipsychotic doses. They tend to have a more favourable antipsychotic response. They are more vulnerable to metabolic and hormonal side effects as shown in CATIE study. Old women are more susceptible to TD. Add-on estrogen helped positive domain and general psychopathology in 2 RCTs by Kulkarni et al. (2015) and Akhondzadeh et al. (2003).

To extrapolate, raloxifene, SERM, has been demonstrated to improve positive symptoms. An RCT by Usall et al. (2016) of raloxifene for negative domain was positive. Another RCT by Huerta-Ramos et al. (2014) demonstrated efficacy in cognitive domain.