Similarities in early course among men and women with a first episode of schizophrenia and schizophreniform disorder

Abstract

The aims of this study were to analyze the presence of gender differences in the phenotypic expression of schizophrenia at the onset of illness and to explore whether these differences determine clinical and functional outcome 2 years after the initiation of treatment. Data from 231 first-episode-psychosis non-substance-dependent patients (156 men and 75 women) participating in a large-scale naturalistic open-label trial with risperidone were recorded at inclusion and months 1, 6, 12, and 24. Men presented a significant earlier age of onset (24.89 years vs. 29.01 years in women), poorer premorbid functioning, and a higher presence of prodromal and baseline negative symptoms. Women were more frequently married or lived with their partner and children and more frequently presented acute stress during the year previous to onset than men. No other significant clinical or functional differences were detected at baseline. The mean dose of antipsychotic treatment was similar for both genders during the study, and no significant differences in UKU scores were found. The number of hospitalizations was similar between groups, and adherence was more frequent among women. At the 2-year follow-up, both groups obtained significant improvements in outcome measures: PANSS, CGI severity, and GAF scores. Significant gender * time interactions were detected for negative and general PANSS subscales, with the improvement being more pronounced for men. However, no differences were detected for the mean scores obtained during the study in any outcome measure, and the final profile was similar for men and women. Our results suggest that although the initial presentation of schizophrenia can differ according to gender, these differences are not sufficient enough to determine differentiated outcome 2 years after the initiation of treatment in non-substance-dependent patients. The influence of gender on the early course of schizophrenia does not seem to be clinically or functionally decisive in this population.

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References

  1. 1.

    Addington D, Addington J, Patten S (1996) Gender and affect in schizophrenia. Can J Psychiatry 41(5):265–268

    PubMed  CAS  Google Scholar 

  2. 2.

    Aichhorn W, Whitworth AB, Weiss EM, Marksteiner J (2006) Second-generation antipsychotics: is there evidence for sex differences in pharmacokinetic and adverse effect profiles? Drug Saf 29(7):587–598

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Alda M, Ahrens B, Lit W, Dvorakova M, Labelle A, Zvolsky P, Jones B (1996) Age of onset in familial and sporadic schizophrenia. Acta Psychiatr Scand 93(6):447–450

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Altamura AC, Bassetti R, Bignotti S, Pioli R, Mundo E (2003) Clinical variables related to suicide attempts in schizophrenic patients: a retrospective study. Schizophr Res 60(1):47–55

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    American Psychiatric Association (1994) A diagnostic and statistical manual of mental disorders, 4 edn. APA, Washington DC

    Google Scholar 

  6. 6.

    Angermeyer MC, Kuhn L, Goldstein JM (1990) Gender and the course of schizophrenia: differences in treated outcomes. Schizophr Bull 16(2):293–307

    PubMed  CAS  Google Scholar 

  7. 7.

    Baldessarini RJ, Viguera AC (1995) Neuroleptic withdrawal in schizophrenic patients. Arch Gen Psychiatry 52(3):189–192

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Biehl H, Maurer K, Schubart C, Krumm B, Jung E (1986) Prediction of outcome and utilization of medical services in a prospective study of first onset schizophrenics. Results of a prospective 5-year follow-up study. Eur Arch Psychiatry Neurol Sci 236(3):139–147

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Brabban A, Tai S, Turkington D (2009) Predictors of outcome in brief cognitive behavior therapy for schizophrenia. Schizophr Bull 35(5):859–864

    PubMed  Article  Google Scholar 

  10. 10.

    Cannon-Spoor HE, Potkin SG, Wyatt RJ (1982) Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull 8(3):470–484

    PubMed  CAS  Google Scholar 

  11. 11.

    Cannon TD, Kaprio J, Lonnqvist J, Huttunen M, Koskenvuo M (1998) The genetic epidemiology of schizophrenia in a Finnish twin cohort. A population-based modeling study. Arch Gen Psychiatry 55(1):67–74

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Carrillo JA, Herraiz AG, Ramos SI, Gervasini G, Vizcaino S, Benitez J (2003) Role of the smoking-induced cytochrome P450 (CYP)1A2 and polymorphic CYP2D6 in steady-state concentration of olanzapine. J Clin Psychopharmacol 23(2):119–127

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Castle D, Sham P, Murray R (1998) Differences in distribution of ages of onset in males and females with schizophrenia. Schizophr Res 33(3):179–183

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Castle DJ, McGrath JA, Kulkarni J (2000) Women and schizophrenia. Cambridge University Press, Cambridge

    Google Scholar 

  15. 15.

    Castle DJ, Sham PC, Wessely S, Murray RM (1994) The subtyping of schizophrenia in men and women: a latent class analysis. Psychol Med 24(1):41–51

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Cotton SM, Lambert M, Schimmelmann BG, Foley DL, Morley KI, McGorry PD, Conus P (2009) Gender differences in premorbid, entry, treatment, and outcome characteristics in a treated epidemiological sample of 661 patients with first episode psychosis. Schizophr Res 114(1–3):17–24

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    de Leon J, Diaz FJ, Aguilar MC, Jurado D, Gurpegui M (2006) Does smoking reduce akathisia? Testing a narrow version of the self-medication hypothesis. Schizophr Res 86(1–3):256–268

    PubMed  Article  Google Scholar 

  18. 18.

    Dervaux A, Laqueille X (2007) Tobacco and schizophrenia: therapeutic aspects. Encephale 33(4 Pt 1):629–632

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33(6):766–771

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    First M, Spittzer R, Gibbon M, Williams J (1995) Structured clinical interview for DSM-IV axis I disorders, patient ediction (SCID-P, Version 2). N. Y. S. P. Institute, Biometrics Research, New York

    Google Scholar 

  21. 21.

    Goldstein JM (1988) Gender differences in the course of schizophrenia. Am J Psychiatry 145(6):684–689

    PubMed  CAS  Google Scholar 

  22. 22.

    Goldstein JM, Link BG (1988) Gender and the expression of schizophrenia. J Psychiatr Res 22(2):141–155

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Goldstein JM, Santangelo SL, Simpson JC, Tsuang MT (1990) The role of gender in identifying subtypes of schizophrenia: a latent class analytic approach. Schizophr Bull 16(2):263–275

    PubMed  CAS  Google Scholar 

  24. 24.

    Gureje O, Bamidele RW (1998) Gender and schizophrenia: association of age at onset with antecedent, clinical and outcome features. Aust N Z J Psychiatry 32(3):415–423

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Guy W (1976) Assessment manual for psychopharmacology, Revised edition, ECDEU. US Department of Health, Education and Welfare, Rockville

  26. 26.

    Hafner H (1998) Onset and course of the first schizophrenic episode. Kaohsiung J Med Sci 14(7):413–431

    PubMed  CAS  Google Scholar 

  27. 27.

    Hafner H (2003) Gender differences in schizophrenia. Psychoneuroendocrinology. 28(Suppl 2):17–54

    PubMed  Article  Google Scholar 

  28. 28.

    Hafner H, an der Heiden W, Behrens S, Gattaz WF, Hambrecht M, Loffler W, Maurer K, Munk-Jorgensen P, Nowotny B, Riecher-Rossler A, Stein A (1998) Causes and consequences of the gender difference in age at onset of schizophrenia. Schizophr Bull 24(1):99–113

    PubMed  CAS  Google Scholar 

  29. 29.

    Hafner H, Maurer K, Loffler W, Fatkenheuer B, van der Heiden W, Riecher-Rossler A, Behrens S, Gattaz WF (1994) The epidemiology of early schizophrenia. Influence of age and gender on onset and early course. Br J Psychiatry 164(Suppl 23):29–38

    Google Scholar 

  30. 30.

    Hafner H, Maurer K, Loffler W, Riecher-Rossler A (1993) The influence of age and sex on the onset and early course of schizophrenia. Br J Psychiatry 162:80–86

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Hafner H, Riecher-Rossler A, van der Heiden W, Maurer K, Fatkenheuer B, Loffler W (1993) Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia. Psychol Med 23(4):925–940

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Hafner H, Riecher A, Maurer K, Loffler W, Munk-Jorgensen P, Stromgren E (1989) How does gender influence age at first hospitalization for schizophrenia? A transnational case register study. Psychol Med 19(4):903–918

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Hales R, Yudoofsky S, Talbot J (1999) The american psychiatric press textbook of psychiatry. American Psychiatric Press, Washington DC

    Google Scholar 

  34. 34.

    Hamilton M (1967) Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 6(4):278–296

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Iacono WG, Beiser M (1992) Where are the women in first-episode studies of schizophrenia? Schizophr Bull 18(3):471–480

    PubMed  CAS  Google Scholar 

  36. 36.

    Kelly BD, Feeney L, O’Callaghan E, Browne R, Byrne M, Mulryan N, Scully A, Morris M, Kinsella A, Takei N, McNeil T, Walsh D, Larkin C (2004) Obstetric adversity and age at first presentation with schizophrenia: evidence of a dose-response relationship. Am J Psychiatry 161(5):920–922

    PubMed  Article  Google Scholar 

  37. 37.

    Kendler KS, Walsh D (1995) Gender and schizophrenia. Results of an epidemiologically-based family study. Br J Psychiatry 167(2):184–192

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Kohler S, van der Werf M, Hart B, Morrison G, McCreadie R, Kirkpatrick B, Verkaaik M, Krabbendam L, Verhey F, van Os J, Allardyce J (2009) Evidence that better outcome of psychosis in women is reversed with increasing age of onset: a population-based 5-year follow-up study. Schizophr Res 113:226–232

    PubMed  Article  Google Scholar 

  39. 39.

    Koster A, Lajer M, Lindhardt A, Rosenbaum B (2008) Gender differences in first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 43(12):940–946

    PubMed  Article  Google Scholar 

  40. 40.

    Kring AM, Moran EK (2008) Emotional response deficits in schizophrenia: insights from affective science. Schizophr Bull 34(5):819–834

    PubMed  Article  Google Scholar 

  41. 41.

    Lambert M, Conus P, Lubman DI, Wade D, Yuen H, Moritz S, Naber D, McGorry PD, Schimmelmann BG (2005) The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. Acta Psychiatr Scand 112(2):141–148

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Larsen TK, Moe LC, Vibe-Hansen L, Johannessen JO (2000) Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first-episode psychosis. Schizophr Res 45(1–2):1–9

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Leung A, Chue P (2000) Sex differences in schizophrenia, a review of the literature. Acta Psychiatr Scand Suppl 401:3–38

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Lewis SW, Owen MJ, Murray RM (1989) Obstetric complications and schizophrenia: methodology and mechanisms. In: Schulz SC, Tamminga CA (eds) Schizophrenia. A scientific focus. Oxford University Press, New York

    Google Scholar 

  45. 45.

    Lindstrom E, von Knorring L (1994) Symptoms in schizophrenic syndromes in relation to age, sex, duration of illness and number of previous hospitalizations. Acta Psychiatr Scand 89(4):274–278

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K (1987) The UKU side effect rating scale. A new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand Suppl 334:1–100

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    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

    PubMed  Article  Google Scholar 

  48. 48.

    Mattsson M, Flyckt L, Edman G, Nyman H, Cullberg J, Forsell Y (2007) Gender differences in the prediction of 5-year outcome in first episode psychosis. Int J Methods Psychiatr Res 16(4):208–218

    PubMed  Article  Google Scholar 

  49. 49.

    McGlashan TH, Bardenstein KK (1990) Gender differences in affective, schizoaffective, and schizophrenic disorders. Schizophr Bull 16(2):319–329

    PubMed  CAS  Google Scholar 

  50. 50.

    McGrath JJ (2006) Variations in the incidence of schizophrenia: data versus dogma. Schizophr Bull 32(1):195–197

    PubMed  Article  Google Scholar 

  51. 51.

    Moller HJ, Jager M, Riedel M, Obermeier M, Strauss A, Bottlender R (2010) The Munich 15-year follow-up study (MUFUSSAD) on first-hospitalized patients with schizophrenic or affective disorders: comparison of psychopathological and psychosocial course and outcome and prediction of chronicity. Eur Arch Psychiatry Clin Neurosci 260(5):367–384

    PubMed  Article  Google Scholar 

  52. 52.

    Morgan VA, Castle DJ, Jablensky AV (2008) Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Aust N Z J Psychiatry 42(1):74–82

    PubMed  Article  Google Scholar 

  53. 53.

    Murray RM, Lewis SW, Reveley AM (1985) Towards an aetiological classification of schizophrenia. Lancet 1(8436):1023–1026

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Nicole L, Shiriqui CH (1995) Gender differences in schizophrenia. In: Shiriqui CH, Nasrallah HA (eds) Contemporary issues in the treatment of schizophrenia. American Psychiatric Press, Washington, pp 225–243

    Google Scholar 

  55. 55.

    Peralta V, Cuesta M (1994) Validación de la escala de los síndromes positivo y negativo (PANSS) en una muestra de esquizofrénicos españoles. Actas Luso- Esp Neurol Psiquiatr 22(4):171–177

    Google Scholar 

  56. 56.

    Pinals DA, Malhotra AK, Missar CD, Pickar D, Breier A (1996) Lack of gender differences in neuroleptic response in patients with schizophrenia. Schizophr Res 22(3):215–222

    PubMed  Article  CAS  Google Scholar 

  57. 57.

    Preston NJ, Orr KG, Date R, Nolan L, Castle DJ (2002) Gender differences in premorbid adjustment of patients with first episode psychosis. Schizophr Res 55(3):285–290

    PubMed  Article  Google Scholar 

  58. 58.

    Scully PJ, Quinn JF, Morgan MG, Kinsella A, O’Callaghan E, Owens JM, Waddington JL (2002) First-episode schizophrenia, bipolar disorder and other psychoses in a rural Irish catchment area: incidence and gender in the Cavan-Monaghan study at 5 years. Br J Psychiatry Suppl 43:s3–s9

    PubMed  Article  Google Scholar 

  59. 59.

    Seeman MV (2000) Women and schizophrenia. Medscape Womens Health 5(2):2

    PubMed  CAS  Google Scholar 

  60. 60.

    Seeman MV (2004) Gender differences in the prescribing of antipsychotic drugs. Am J Psychiatry 161(8):1324–1333

    PubMed  Article  Google Scholar 

  61. 61.

    Seeman MV, Lang M (1990) The role of estrogens in schizophrenia gender differences. Schizophr Bull 16(2):185–194

    PubMed  CAS  Google Scholar 

  62. 62.

    Szymanski S, Lieberman JA, Alvir JM, Mayerhoff D, Loebel A, Geisler S, Chakos M, Koreen A, Jody D, Kane J et al (1995) Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients. Am J Psychiatry 152(5):698–703

    PubMed  CAS  Google Scholar 

  63. 63.

    Thorup A, Petersen L, Jeppesen P, Ohlenschlaeger 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

    PubMed  Google Scholar 

  64. 64.

    Usall J, Haro JM, Ochoa S, Marquez M, Araya S (2002) Influence of gender on social outcome in schizophrenia. Acta Psychiatr Scand 106(5):337–342

    PubMed  Article  CAS  Google Scholar 

  65. 65.

    Usall J, Ochoa S, Araya S, Gost A, Busquets E (2000) Symptomatology and gender in schizophrenia. Actas Esp Psiquiatr 28(4):219–223

    PubMed  CAS  Google Scholar 

  66. 66.

    Usall J, Ochoa S, Araya S, Marquez M (2003) Gender differences and outcome in schizophrenia: a 2-year follow-up study in a large community sample. Eur Psychiatry 18(6):282–284

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Usall J, Suarez D, Haro JM (2007) Gender differences in response to antipsychotic treatment in outpatients with schizophrenia. Psychiatry Res 153(3):225–231

    PubMed  Article  CAS  Google Scholar 

  68. 68.

    Verdoux H, Geddes JR, Takei N, Lawrie SM, Bovet P, Eagles JM, Heun R, McCreadie RG, McNeil TF, O’Callaghan E, Stober G, Willinger MU, Wright P, Murray RM (1997) Obstetric complications and age at onset in schizophrenia: an international collaborative meta-analysis of individual patient data. Am J Psychiatry 154(9):1220–1227

    PubMed  CAS  Google Scholar 

  69. 69.

    Verdoux H, Liraud F, Bergey C, Assens F, Abalan F, van Os J (2001) Is the association between duration of untreated psychosis and outcome confounded? A two year follow-up study of first-admitted patients. Schizophr Res 49(3):231–241

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    Wechsler D (1974) Wechsler intelligence scale for children-revised manual. Psychological Corporation, New York

    Google Scholar 

  71. 71.

    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

    PubMed  Article  Google Scholar 

  72. 72.

    Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133:429–435

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

This study was sponsored by Janssen-Cilag. The sponsor played no role in the study design, data collection/analysis/interpretation, writing of the report, or the decision to submit the paper for publication. The authors had unlimited access to data. Arantzazu Zabala was supported by the University of the Basque Country UPV/EHU GIU 09/37.

Conflict of interest

Dr Gutierrez has acted as consultant, advisor, or speaker for the following companies: Janssen-Cilag, Lundbeck, and Servier. Dr Eguiluz has acted as consultant, advisor, or speaker for the following companies: AstraZeneca, Bristol-Myers Squibb, Elli Lilly, and Janssen-Cilag. Dr Segarra has acted as consultant, advisor, or speaker for the following companies: Bristol-Myers Squibb, Elli Lilly, and Janssen-Cilag. The other authors have no conflict of interest.

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Segarra, R., Ojeda, N., Zabala, A. et al. Similarities in early course among men and women with a first episode of schizophrenia and schizophreniform disorder. Eur Arch Psychiatry Clin Neurosci 262, 95–105 (2012). https://doi.org/10.1007/s00406-011-0218-2

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Keywords

  • Schizophrenia
  • Psychosis
  • First episode
  • Gender