Gender and schizophrenia (original) (raw)
Related papers
Sex and schizophrenia: a review of gender differences
Psychosis, 2014
Gender differences in schizophrenia have been noted since conceptualisation of the illness. Female onset is typically later, with a second peak post-menopause. Whilst incidence is higher in men, prevalence does not differ. Research has explored possible biopsychosocial causes of these differences. Evidence for genetic and neurodevelopmental factors is weak but support has garnered for the "estrogen hypothesis," which emphasises the possible neuroprotective effect of estrogen in women. Differences have also been attributed to a differing psychological vulnerability between men and women based on symptomatology: "negative" symptoms are more common in men, whilst "positive" symptoms differ in content between the genders. Social factors might also play a role: whilst women experience more sexual assault, socioeconomic disadvantage and provide more care for dependents, men experience less familial engagement and more environmental hostility. The relevance of gender differences in schizophrenia has meaning beyond academic interest, since they can affect treatment: recent research has, for instance, begun to explore the efficacy of estrogen therapy. The aetiology of gender differences in schizophrenia is only partially understood and more research is needed to elucidate the causal roles of Biopsychosocial factors: understanding these will ultimately improve the treatment of all who suffer from this serious mental illness.
Gender Differences in Schizophrenia: Hormonal Effect or Subtypes?
Schizophrenia Bulletin, 1995
Compared with their male counterparts, females with schizophrenia, on average, show better premorbid functioning, later onset, and a more benign course of illness. They are also more likely to have a family history of schizophrenia and/or affective illness, to exhibit "atypical" and affective features, and to show a seasonal pattern of hospital admission that mimics that of patients with mania. However, there exists a paradox. Although schizophrenia in females has much in common with affective disorder, the "schizophrenogenic" effect of maternal influenza also appears to be more significant in female than in male schizophrenia. Perhaps females with a predisposition to affective psychosis who have also been subject to the effects of maternal viral infection during gestation develop some subtle neurodevelopmental damage that renders their psychosis schizophrenia-like.
The Role of Estrogens in Schizophrenia Gender Differences
Schizophrenia Bulletin, 1990
The male/female differences that have been described in schizophrenia are important because they may ultimately shed light on factors that mediate the expression of schizophrenic illness. The hypothesis of this article is that estrogens, either directly or indirectly, modify symptom expression and account for many of the observed gender differences. The role of sex hormones is divided into organizational and activational effects. Organizational effects take place during a critical period in fetal life and put a permanent stamp on the developing brain. Activational effects are the direct influences of circulating hormones that appear when hormonal levels rise, and wane when hormonal levels drop. Because levels of sex hormones in adult women fluctuate during the menstrual cycle, cyclic effects of high and low female hormones may induce specific responses by the adult female brain. All these effects have implications for genetic, environmental, pharmacological, neurocognitive, clinical, and epidemiological research in schizophrenia.
Women and schizophrenia: new findings
Neuropsychiatry, 2013
Schizophrenia has long been known to affect men and women somewhat differently. It has been shown that men have a higher incidence, a younger age of onset, more impaired functioning, and poorer response to treatment.
Sex differences in schizophrenia
International Review of Psychiatry, 2010
Evidence suggests sex differences in schizophrenia reflect differences in both neurodevelopmental processes and social effects on disease risk and course. Male:female incidence approximates 1.4:1 but at older onset women predominate. Prevalence differences appear smaller. Men have poorer premorbid adjustment and present with worse negative and less depressive symptoms than women, which may explain their worse medium term outcome according to a range of measures. Substance abuse is a predominantly male activity in this group, as elsewhere. Findings of sex differences in brain morphology are inconsistent but occur in areas that normally show sexual dimorphism, implying that the same factors are important drivers of sex differences in both normal neurodevelopmental processes and those associated with schizophrenia. There are sex differences in antipsychotic responses but sex-specific endocrine effects on illness and response to antipsychotics are potentially complex. Oestrogen's role as an adjunctive medication is not yet clear due to methodological differences between the few randomized controlled trials. Services that are sensitive to differences in gender can better meet their patients' specific needs and potentially improve outcome. Int Rev Psychiatry Downloaded from informahealthcare.com by The University of Manchester on 10/23/13 For personal use only. Int Rev Psychiatry Downloaded from informahealthcare.com by The University of Manchester on 10/23/13
Current outcome in schizophrenia: women vs men
Acta Psychiatrica Scandinavica, 1986
ABSTRACT: This article reviews the 1980's literature on gender differences in schizophrenia outcome. Neuroleptic response, long-term course, and housing, appear to be superior in women. Mortality ratios are advantageous to schizophrenic men. After menopause, women may require higher neuroleptic doses than men and are more at risk for severe tardive dyskinesia. The antidopaminergic effects of estrogens appear to be responsible for some of the outcome differences.
Causes and Consequences of the Gender Difference in Age at Onset of Schizophrenia
Schizophrenia Bulletin, 1998
The ABC (age, beginning, course) schizophrenia study was commenced in 1987 to generate and test hypotheses about pathogenic aspects of schizophrenia. One of the main branches of the study focused on how gender influences the age distribution of onset, symptomatology, illness behavior, and early course in schizophrenia. Proceeding from one of the rare, strikingly deviating, consistent findings-the gender difference in age at first admission-we launched a systematic search for explanations by generating and testing hypotheses in a series of substudies. We moved from the epidemiological to the neurobiological and finally to the clinical level. The present article is an attempt to provide a brief overview of the individual stages of the ABC study and the different levels of investigation involved in formulating and testing the estrogen hypothesis in animal experiments and in demonstrating its applicability to human schizophrenia. From these results, three hypotheses were formulated and tested on data from an ABC study sample of 232 first-episode cases of schizophrenia. The analyses described here represent the latest stages of the ABC study.
Journal of Personalized Medicine
Background: Sex and gender differences have been reported in the prevalence, expression, treatment response, and outcome of schizophrenia, but most reports are based on relatively small samples that have not been stratified for the impact of sex hormone levels. This literature review aims to show how women’s hormone levels can impact the results of male/female comparisons. Methods: This is a narrative review of data from publications of the last decade. Results: Epidemiologic evidence, reports of the impact of hormones on cognition, results of sexually dimorphic responses to treatment, and male/female trajectories of illness over time all suggest that female hormone fluctuations exert major effects on male/female differences in schizophrenia. Conclusions: Information on hormonal status in women participants is rarely available in clinical studies in schizophrenia, which makes male/female comparisons largely uninterpretable. These are the current challenges. Opportunities for individ...
Potential Explanatory Models of the Female Preponderance in Very Late Onset Schizophrenia
Women
Epidemiological and clinical studies have uniformly reported an overrepresentation of females with very-late-onset schizophrenia-like psychotic disorder (VLOS), in stark contrast to the sex distribution of early-onset schizophrenia. Various explanatory models have been proposed to account for these sex differences, including (a) antidopaminergic effects of estrogen, (b) differential vulnerability to subtypes, (c) neurodegenerative differences between the sexes, and (d) and sex differences in age-related psychosocial and neurological risk factors; however, these models have not yet been critically evaluated for their validity. Keywords related to VLOS symptomatology, epidemiology, and sex/gender were entered into the PubMed, MEDLINE, and Google Scholar databases spanning all years. Through a narrative review of symptomatology and pathophysiology of VLOS, we examine the strengths and limitations of the proposed models. We present a comprehensive biopsychosocial perspective to integrat...
The role of estrogen in schizophrenia
Journal of Psychiatry and Neuroscience, 1996
This paper reviews 3 recent studies from different clinics correlating psychotic symptoms with phases of the menstrual cycle in women with schizophrenia. The aim of the paper is to focus on the estrogen protection hypothesis which would suggest that low estrogen phases correlate with more severe symptoms, and high estrogen phases correlate with less severe symptoms. Although the methodology of the 3 studies was different, the hypothesis was essentially upheld. High levels of estrogens protect against symptom exacerbations in women with schizophrenia. A corollary to this finding is that, for optimal efficacy and safety, neuroleptic doses could be reduced at certain times of the month and increased at others.