Abstract
Sex differences may be important for understanding underlying pathophysiological mechanisms and developing effective preventions and treatments of mental disorders. Despite sex differences in the onset of psychosis, patients at clinical high risk for psychosis (CHR) are underinvestigated for sex effects, especially with respect to models for prediction of conversion to psychosis. We studied psychopathological sex differences in referrals to a German early detection service and in its subgroup of converters and examined sex-specific psychopathological prediction models. In 152 male and 90 female referrals (88% at CHR; 35% converters), symptoms assessed with the Structured Interview for Psychosis-Risk Syndromes were investigated for sex differences using effect sizes. Sex-specific prediction models of psychosis were separately generated using Cox regressions with a LASSO operator. We found different small sex effects (0.10 < Rosenthal’s r < 0.30) in the referral and in the converter sample. In the referral sample, exclusively, males showed more pronounced symptoms (all negative symptoms incl. reduced stress tolerance, grandiosity, and disorganized communication); in converters, females experienced more pronounced perceptual abnormalities, bizarre thinking, and odd behaviors, while males expressed and experienced emotions to a lower degree. Furthermore, sexes differed in psychosis-predictive symptoms: “suspiciousness” and “disorganized communication” were prominent in prediction of psychosis in males, whereas “trouble with focus and attention” was so in females. While most sex differences in patients attending an early detection service seem to reflect general differences that are not specifically related to psychosis, others might be psychosis-specific. These results can inform the development of more individualized and effective interventions for CHR patients based on more precise sex-specific prediction models.
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References
Addington J, Schultze-Lutter F (2006) Prodromal phase of psychosis in adolescent women. In: Romans S, Seeman MV (eds) Women’s mental health: a life cycle approach. Lippincott Williams & Wilkins, Philadelphia, pp 123–132
Aleman A, Kahn RS, Selten JP (2003) Sex differences in the risk of schizophrenia: evidence from meta-analysis. Arch Gen Psychiatry 60(6):565–571. https://doi.org/10.1001/archpsyc.60.6.565
Andreasen N, Black D (2001) Introductory textbook of psychiatry, 3rd edn. Arlington American Psychiatric Publishing, Arlington
Azis M, Strauss GP, Walker E, Revelle W, Zinbarg R, Mittal V (2018) Factor analysis of negative symptom items in the structured interview for prodromal syndromes. Schizophr Bull. https://doi.org/10.1093/schbul/sby177
Barajas A, Ochoa S, Obiols JE, Lalucat-Jo L (2015) Gender differences in individuals at high-risk of psychosis: a comprehensive literature review. Sci World J. https://doi.org/10.1155/2015/430735
Bora E, Baysan Arabaci L (2009) Effect of age and gender on schizotypal personality traits in the normal population. Psychiatry Clin Neurosci 63(5):663–669. https://doi.org/10.1111/j.1440-1819.2009.02011.x
Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins D, Tsuang M, McGlashan T, Heinssen R (2008) Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 65(1):28–37. https://doi.org/10.1001/archgenpsychiatry.2007.3
Cannon TD, Yu C, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Heinssen R, Jeffries CD, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Kattan MW (2016) An individualized risk calculator for research in prodromal psychosis. Am J Psychiatry 173(10):980–988. https://doi.org/10.1176/appi.ajp.2016.15070890
Cocchi A, Lora A, Meneghelli A, La Greca E, Pisano A, Cascio MT, Preti A (2014) Sex differences in first-episode psychosis and in people at ultra-high risk. Psychiatry Res 215(2):314–322. https://doi.org/10.1016/j.psychres.2013.11.023
Comparelli A, Savoja V, Kotzalidis GD, Woods SW, Mosticoni S, Vassallo F, Soscia F, Piccione R, Palma G, Pucci D, Girardi P, Conti L, Tatarelli R (2011) Factor–structure of the Italian version of the Scale Of Prodromal Symptoms (SOPS): a comparison with the English version. Epidemiol Psychiatr Sci 20(1):45–54
Corcoran CM, Kimhy D, Parrilla-Escobar MA, Cressman VL, Stanford AD, Thompson J, David SB, Crumbley A, Schobel S, Moore H, Malaspina D (2011) The relationship of social function to depressive and negative symptoms in individuals at clinical high risk for psychosis. Psychol Med 41(2):251–261. https://doi.org/10.1017/S0033291710000802
Danaher H, Allott K, Killackey E, Hester R, Cotton S (2018) An examination of sex differences in neurocognition and social cognition in first-episode psychosis. Psychiatry Res 259:36–43. https://doi.org/10.1016/j.psychres.2017.09.053
Drake RJ, Addington J, Viswanathan AC, Lewis SW, Cotter J, Yung AR, Abel KM (2016) How age and gender predict illness course in a first-episode nonaffective psychosis cohort. J Clin Psychiatry 77(3):e283–e289. https://doi.org/10.4088/JCP.14m09369
Flückiger R, Michel C, Grant P, Ruhrmann S, Vogeley K, Hubl D, Schimmelmann BG, Klosterkötter J, Schmidt SJ, Schultze-Lutter F (2019) The interrelationship between schizotypy, clinical high risk for psychosis and related symptoms: cognitive disturbances matter. Schizophr Res. https://doi.org/10.1016/j.schres.2018.12.039
Friedman J, Hastie T, Tibshirani R (2010) Regularization paths for generalized linear models via coordinate descent. J Stat Softw 33(1):1–22
Fusar-Poli P (2017) Why ultra high risk criteria for psychosis prediction do not work well outside clinical samples and what to do about it. World Psychiatry 16(2):212–213. https://doi.org/10.1002/wps.20405
Fusar-Poli P, Borgwardt S, Bechdolf A, Addington J, Riecher-Rössler A, Schultze-Lutter F, Keshavan M, Wood S, Ruhrmann S, Seidman LJ, Valmaggia L, Cannon T, Velthorst E, De Haan L, Cornblatt B, Bonoldi I, Birchwood M, McGlashan T, Carpenter W, McGorry P, Klosterkötter J, McGuire P, Yung A (2013) The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70(1):107–120. https://doi.org/10.1001/jamapsychiatry.2013.269
González-Rodríguez A, Studerus E, Spitz A, Bugra H, Aston J, Borgwardt S, Rapp C, Riecher-Rössler A (2014) Gender differences in the psychopathology of emerging psychosis. Isr J Psychiatry Relat Sci 51(2):85–93
Gur RE, Gur RC (2016) Sex differences in brain and behavior in adolescence: findings from the Philadelphia Neurodevelopmental Cohort. Neurosci Biobehav Rev 70:159–170. https://doi.org/10.1016/j.neubiorev.2016.07.035
Haidl T, Seves M, Eggers S, Rostamzadeh A, Genske A, Jünger S, Woopen C, Jessen F, Ruhrmann S, Vogeley K (2019) Health literacy in clinical-high-risk individuals for psychosis: a systematic mixed-methods review. Early Interv Psychiatry. https://doi.org/10.1111/eip.12776
Harrell FE Jr (2015) Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis. Springer
Hartung CM, Lefler EK (2019) Sex and gender in psychopathology: DSM-5 and beyond. Psychol Bull. https://doi.org/10.1037/bul0000183
Heckers S, Barch DM, Bustillo J, Gaebel W, Gur R, Malaspina D, Owen MJ, Schultz S, Tandon R, Tsuang M, Van Os J, Carpenter W (2013) Structure of the psychotic disorders classification in DSM-5. Schizophr Res 150(1):11–14. https://doi.org/10.1016/j.schres.2013.04.039
Heitz U, Papmeyer M, Menghini-Müller S, Egloff L, Ittig S, Navarra A, Studerus E, Riecher-Rössler A (2017) Gender differences in first self-perceived signs and symptoms in patients with an at-risk mental state and first episode psychosis. Early Interv Psychiatry. https://doi.org/10.1111/eip.12528
Jung MH, Jang JH, Kang DH, Choi JS, Shin NY, Kim HS, An SK, Shin MS, Kwon JS (2010) The reliability and validity of the Korean version of the structured interview for prodromal syndrome. Psychiatry Investig 7(4):257–263. https://doi.org/10.4306/pi.2010.7.4.257
Kaczkurkin AN, Raznahan A, Satterthwaite TD (2018) Sex differences in the developing brain: insights from multimodal neuroimaging. Neuropsychopharmacology. https://doi.org/10.1038/s41386-018-0111-z
Kirkbride JB, Errazuriz A, Croudace TJ, Morgan C, Jackson D, Boydell J, Murray RM, Jones PB (2012) Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLoS One 7(3):e31660. https://doi.org/10.1371/journal.pone.0031660
Kirkbride JB, Hameed Y, Ioannidis K, Ankireddypalli G, Crane CM, Nasir M, Kabacs N, Metastasio A, Jenkins O, Espandian A, Spyridi S, Ralevic D, Siddabattuni S, Walden B, Adeoye A, Perez J, Jones PB (2017) Ethnic minority status, age-at-immigration and psychosis risk in rural environments: evidence from the SEPEA study. Schizophr Bull 43(6):1251–1261. https://doi.org/10.1093/schbul/sbx010
Klaassen RM, Velthorst E, Nieman DH, De Haan L, Becker HE, Dingemans PM, van de Fliert JR, van der Gaag M, Linszen DH (2011) Factor analysis of the scale of prodromal symptoms: differentiating between negative and depression symptoms. Psychopathology 44(6):379–385. https://doi.org/10.1159/000325169
Klose M, Jacobi F (2004) Can gender differences in the prevalence of mental disorders be explained by sociodemographic factors? Arch Womens Ment Health 7(2):133–148. https://doi.org/10.1007/s00737-004-0047-7
Kotlicka-Antczak M, Pawełczyk T, Podgórski M, Żurner N, Karbownik MS, Pawełczyk A (2018) Polish individuals with an at-risk mental state: demographic and clinical characteristics. Early Interv Psychiatry 12(3):391–399. https://doi.org/10.1111/eip.12333
Lemos-Giráldez S, Vallina-Fernández O, Fernández-Iglesias P, Vallejo-Seco G, Fonseca-Pedrero E, Paíno-Piñeiro M, Sierra-Baigrie S, García-Pelayo P, Pedrejón-Molino C, Alonso-Bada S, Gutiérrez-Pérez A, Ortega-Ferrández JA (2009) Symptomatic and functional outcome in youth at ultra-high risk for psychosis: a longitudinal study. Schizophr Res 115(2-3):121–129. https://doi.org/10.1016/j.schres.2009.09.011
Maric N, Krabbendam L, Vollebergh W, de Graaf R, van Os J (2003) Sex differences in symptoms of psychosis in a non-selected, general population sample. Schizophr Res 63(1-2):89–95
McGlashan TH, Miller TJ, Woods SW (2001). Structured interview for prodromal syndromes (version 3.0, unpublished manuscript): PRIME Research Clinic, Yale School of Medicine, New Haven
McGrath J, Saha S, Chant D, Welham J (2008) Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev 30:67–76. https://doi.org/10.1093/epirev/mxn001
Moukas G, Gourzis P, Beratis IN, Beratis S (2010) Sex differences in prepsychotic “prodromal” symptomatology and its association with Positive and Negative Syndrome Scale active phase psychopathology in male and female patients. Compr Psychiatry 51(5):546–551. https://doi.org/10.1016/j.comppsych.2009.11.003
Nam SK, Chu HJ, Lee MK, Lee JH, Kim N, Lee SM (2010) A meta-analysis of gender differences in attitudes toward seeking professional psychological help. J Am Coll Heal 59(2):110–116. https://doi.org/10.1080/07448481.2010.483714
Nelson B, Yuen HP, Wood SJ, Lin A, Spiliotacopoulos D, Bruxner A, Broussard C, Simmons M, Foley DL, Brewer WJ, Francey SM, Amminger GP, Thompson A, McGorry PD, Yung AR (2013) Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 study. JAMA Psychiatry 70(8):793–802. https://doi.org/10.1001/jamapsychiatry.2013.1270
Ochoa S, Usall J, Cobo J, Labad X, Kulkarni J (2012) Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treat 2012:916198. https://doi.org/10.1155/2012/916198
Pruessner M, Faridi K, Shah J, Rabinovitch M, Iyer S, Abadi S, Pawliuk N, Joober R, Malla AK (2017) The Clinic for Assessment of Youth at Risk (CAYR): 10 years of service delivery and research targeting the prevention of psychosis in Montreal, Canada. Early Interv Psychiatry 11(2):177–184. https://doi.org/10.1111/eip.12300
Rector NA, Seeman MV (1992) Auditory hallucinations in women and men. Schizophr Res 7(3):233–236
Riecher-Rössler A, Butler S, Kulkarni J (2018) Sex and gender differences in schizophrenic psychoses—a critical review. Arch Womens Ment Health:1–22. https://doi.org/10.1007/s00737-018-0847-9
Rietdijk J, Ising HK, Dragt S, Klaassen R, Nieman D, Wunderink L, Cuijpers P, Linszen D, van der Gaag M (2013) Depression and social anxiety in help-seeking patients with an ultra-high risk for developing psychosis. Psychiatry Res 209(3):309–313. https://doi.org/10.1016/j.psychres.2013.01.012
Rietschel L, Lambert M, Karow A, Zink M, Müller H, Heinz A, de Millas W, Janssen B, Gaebel W, Schneider F, Naber D, Juckel G, Krüger-Özgürdal S, Wobrock T, Wagner M, Maier W, Klosterkötter J, Bechdolf A, PREVENT study group (2017) Clinical high risk for psychosis: gender differences in symptoms and social functioning. Early Interv Psychiatry 11(4):306–313. https://doi.org/10.1111/eip.12240
Royston P, Altman DG (2013) External validation of a Cox prognostic model: principles and methods. BMC Med Res Methodol 13(1):33. https://doi.org/10.1186/1471-2288-13-33
Ruhrmann S, Schultze-Lutter F, Klosterkotter J (2010a) Sub-threshold states of psychosis—a challenge to diagnosis and treatment. Clin Neuropsychiatry 7(2):72–88
Ruhrmann S, Schultze-Lutter F, Salokangas RK, Heinimaa M, Linszen D, Dingemans P, Birchwood M, Patterson P, Juckel G, Heinz A, Morrison A, Lewis S, von Reventlow HG, Klosterkötter J (2010b) Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatry 67(3):241–251. https://doi.org/10.1001/archgenpsychiatry.2009.206
Rutter M, Caspi A, Moffitt TE (2003) Using sex differences in psychopathology to study causal mechanisms: unifying issues and research strategies. J Child Psychol Psychiatry 44(8):1092–1115
Schimmelmann BG, Michel C, Martz-Irngartinger A, Linder C, Schultze-Lutter F (2015) Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: findings from the BEAR and BEARS-kid studies. World Psychiatry 14(2):189–197. https://doi.org/10.1002/wps.20216
Schulte Holthausen B, Habel U (2018) Sex differences in personality disorders. Curr Psychiatry Rep 20:107. https://doi.org/10.1007/s11920-018-0975-y
Schultze-Lutter F, Ruhrmann S, Hoyer C, Klosterkötter J, Leweke FM (2007) The initial prodrome of schizophrenia: different duration, different underlying deficits? Compr Psychiatry 48(5):479–488. https://doi.org/10.1016/j.comppsych.2007.04.001
Schultze-Lutter F, Ruhrmann S, Klosterkötter J (2009) Early detection of psychosis—establishing a service for persons at risk. Eur Psychiatry 24(1):1–10. https://doi.org/10.1016/j.eurpsy.2008.08.004
Schultze-Lutter F, Klosterkötter J, Ruhrmann S (2014) Improving the clinical prediction of psychosis by combining ultra-high risk criteria and cognitive basic symptoms. Schizophr Res 154(1-3):100–106. https://doi.org/10.1016/j.schres.2014.02.010
Schultze-Lutter F, Michel C, Schmidt SJ, Schimmelmann BG, Maric NP, Salokangas RK, Riecher-Rössler A, van der Gaag M, Nordentoft M, Raballo A, Meneghelli A, Marshall M, Morrison A, Ruhrmann S, Klosterkötter J (2015a) EPA guidance on the early detection of clinical high risk states of psychoses. Eur Psychiatry 30(3):405–416. https://doi.org/10.1016/j.eurpsy.2015.01.010
Schultze-Lutter F, Rahman J, Ruhrmann S, Michel C, Schimmelmann BG, Maier W, Klosterkötter J (2015b) Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients. Soc Psychiatry Psychiatr Epidemiol 50(12):1831–1841. https://doi.org/10.1007/s00127-015-1093-3
Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, Demyttenaere K, de Girolamo G, Haro JM, Jin R, Karam EG, Kovess-Masfety V, Levinson D, Medina Mora ME, Ono Y, Ormel J, Pennell BE, Posada-Villa J, Sampson NA, Williams D, Kessler RC (2009) Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry 66(7):785–795. https://doi.org/10.1001/archgenpsychiatry.2009.36
Seeman MV (2018) Women who suffer from schizophrenia: critical issues. World J Psychiatry 8(5):125. https://doi.org/10.5498/wjp.v8.i5.125
Sharma RP, Dowd SM, Janicak PG (1999) Hallucinations in the acute schizophrenic-type psychosis: effects of gender and age of illness onset. Schizophr Res 37(1):91–95
Shimamoto A, Rappeneau V (2017) Sex-dependent mental illnesses and mitochondria. Schizophr Res 187:38–46. https://doi.org/10.1016/j.schres.2017.02.025
Sigmon ST, Pells JJ, Edenfield TM, Hermann BA, Schartel JG, LaMattina SM, Boulard NE (2007) Are we there yet? A review of gender comparisons in three behavioral journals through the 20th century. Behav Ther 38(4):333–339. https://doi.org/10.1016/j.beth.2006.10.003
Simon N, Friedman J, Hastie T, Tibshirani R (2011) Regularization paths for Cox’s proportional hazards model via coordinate descent. J Stat Softw 39(5):1–13. https://doi.org/10.18637/jss.v039.i05
Szymanski S, Lieberman JA, Alvir JM, Mayerhoff D (1995) Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients. Am J Psychiatry 152(5):698. https://doi.org/10.1176/ajp.152.5.698
Theodoridou A, Hengartner MP, Heekeren K, Dvorsky D, Schultze-Lutter F, Gerstenberg M, Walitza S, Rössler W (2019) Influence of demographic characteristics on attenuated positive psychotic symptoms in a young, help-seeking, at-risk population. Early Interv Psychiatry 13(1):53–56. https://doi.org/10.1111/eip.12444
Thorup A, Petersen L, Jeppesen P, Ohlenschlæger J, Christensen T, Krarup G, Jorgensen P, Nordentoft M (2007) Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study. J Nerv Ment Dis 195(5):396–405. https://doi.org/10.1097/01.nmd.0000253784.59708.dd
Tseliou F, Johnson S, Major B, Rahaman N, Joyce J, Lawrence J, Mann F, Tapfumaneyi A, Chisholm B, Chamberlain-Kent N, Hinton MF, Fisher HL, MiData C (2017) Gender differences in one-year outcomes of first-presentation psychosis patients in inner-city UK Early Intervention Services. Early Interv Psychiatry 11(3):215–223. https://doi.org/10.1111/eip.12235
Tso IF, Taylor SF, Grove TB, Niendam T, Adelsheim S, Auther A, Cornblatt B, Carter CS, Calkins R, Ragland JD, Sale T, McFarlane WR (2017) Factor analysis of the Scale of Prodromal Symptoms: data from the Early Detection and Intervention for the Prevention of Psychosis Program. Early Interv Psychiatry 11(1):14–22. https://doi.org/10.1111/eip.12209
van der Ven E, Veling W, Tortelli A, Tarricone I, Berardi D, Bourque F, Selten JP (2016) Evidence of an excessive gender gap in the risk of psychotic disorder among North African immigrants in Europe: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 51(12):1603–1613. https://doi.org/10.1007/s00127-016-1261-0
Van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychol Med 39(2):179–195. https://doi.org/10.1017/S0033291708003814
Velthorst E, Nieman DH, Becker HE, van de Fliert R, Dingemans PM, Klaassen R, de Haan L, van Amelsvoort T, Linszen DH (2009) Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophr Res 109(1-3):60–65. https://doi.org/10.1016/j.schres.2009.02.002
Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165(6):710–718. https://doi.org/10.1093/aje/kwk052
Waford RN, MacDonald A, Goines K, Novacek DM, Trotman HD, Elaine FW, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Heinssen R, Mathalon DH, Tsuang MT, Perkins DO, Seidman LJ, Woods SW, McGlashan TH (2015) Demographic correlates of attenuated positive psychotic symptoms. Schizophr Res 166(1-3):31–36. https://doi.org/10.1016/j.schres.2015.04.035
Walder DJ, Holtzman CW, Addington J, Cadenhead K, Tsuang M, Cornblatt B, Cannon TD, McGlashan TH, Woods SW, Perkins DO, Seidman LJ, Heinssen R, Walker EF (2013) Sexual dimorphisms and prediction of conversion in the NAPLS psychosis prodrome. Schizophr Res 144(1-3):43–50. https://doi.org/10.1016/j.schres.2012.11.039
Willhite RK, Niendam TA, Bearden CE, Zinberg J, O’Brien MP, Cannon TD (2008) Gender differences in symptoms, functioning and social support in patients at ultra-high risk for developing a psychotic disorder. Schizophr Res 104(1-3):237–245. https://doi.org/10.1016/j.schres.2008.05.019
World Health Organization (2016) Gender Disparities in Mental Health. https://www.who.int/mental_health/media/en/242.pdf?ua=1. Accessed 12 January 2019
Zhang T, Xu L, Tang Y, Li H, Tang X, Cui H, Wei Y, Wang Y, Hu Q, Liu X, Li C, Lu Z, McCarley RW, Seidman LJ, Wang J, SHARP (ShangHai At Risk for Psychosis) Study Group (2018) Prediction of psychosis in prodrome: development and validation of a simple, personalized risk calculator. Psychol Med 14:1–9. https://doi.org/10.1017/S0033291718002738
Ziermans TB, Schothorst PF, Sprong M, van Engeland H (2011) Transition and remission in adolescents at ultra-high risk for psychosis. Schizophr Res 126(1-3):58–64. https://doi.org/10.1016/j.schres.2010.10.022
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This work was supported by a grant from the Koeln Fortune Program/Faculty of Medicine, University of Cologne (grant numbers 8/2005, 27/2006) to Dr. Schultze-Lutter. The study’s sponsor had no role in the study design, data collection, or analysis, or in interpretation, writing, or submission of the report.
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Rosen, M., Haidl, T.K., Ruhrmann, S. et al. Sex differences in symptomatology of psychosis-risk patients and in prediction of psychosis. Arch Womens Ment Health 23, 339–349 (2020). https://doi.org/10.1007/s00737-019-01000-3
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DOI: https://doi.org/10.1007/s00737-019-01000-3