October 27, 2005

Gender Differences in Schizophrenia

A recent study by the Central Institute of Mental Health in Germany, explores gender differences in patients with schizophrenia. The study gathered data from relevant literature on the topic as well as a population-based sample of 232 people admitted to the hospital with their first illness episode. The object of the study was to determine whether gender differences in schizophrenia are due to the disease process, genetic, hormonal or structural differences in the brain, or gender-specific behavioral patterns. The possible protective effect of oestrogen is also explored.

Some previous studies have found a higher incidence of schizophrenia in men than in women. However, data from the current study indicates that this imbalance is probably due to low age cutoffs in the samples surveyed. The results of the current study indicate that men and women have an equal lifetime risk for schizophrenia. However, schizophrenia tends to strike women 3-4 years later than men. Most men develop schizophrenia between 15 and 25 years of age. For women the period of maximum onset is between 15 and 30 with a smaller peak between 45 and 50 (after menopause). Women also tend to have milder forms of the disease in their younger year than their male counterparts do. But, in the later years, symptoms in men tend to decrease in severity while women often have a renewed onset of psychotic symptoms and a worse course of the disease.

The authors of this study attribute the delayed onset of schizophrenia in women to the protective affects of oestrogen (also known as estrogen), one of the main hormones responsible for secondary sex characteristics (i.e. those that develop during puberty) in women. Several studies have demonstrated experimentally that oestrogen has an antipsychotic effect. Higher levels of oestrogen in women than in men may delay the onset and decrease the severity of schizophrenia. After menopause, women’s oestrogen levels decrease and disease symptoms that were delayed manifest.

There is no difference, other than age, in the symptom-related course of the disease between men and women. However, when interviewed about the social course of the disease and life satisfaction, women tended to have a better prognosis than men. Schizophrenia is a debilitating disease and its onset tends to halt or severely hinder social and emotional development. Girls tend to mature faster during childhood than boys and tend to develop schizophrenia several years later. So even though social development decreases equally in women and men, women have higher baseline of development when they become ill, which may help them cope. In addition, the authors of this study observed that women patients had a stronger tendency towards social conformity and therapy compliance where men showed more self-neglect, social withdrawal, and substance abuse. Women with schizophrenia also lowered their expectations of life (i.e. job, relationships) more than men with the disease did. For these reasons women generally rated their life satisfaction somewhat higher than their male counterparts did.

Based on the article reviewed here, it seems that any differences in the manifestation of schizophrenia, other than age, are due to gender specific behavioral patterns found in men and women regardless of whether or not they have schizophrenia. The disease seems to affect men and women equally. The most consistent result found is the 3-4 year age difference between men and women. The protective effects of oestrogen raise the question of new treatments using oestrogen or oestrogen-like molecules as anti-psychotics. Unfortunately, taking oestrogen supplements can have harmful side effects (feminization in men and possibly increased risk of cancer in both sexes as well as other unknown side effects) and more research is needed in order to develop a reliable treatment option.

Source: Hafner, H. "Gender differences in schizophrenia". Psychoneuroendocrinology. vol 28 pp. 17-54 (2003) www.sciencedirect.com

Related entries from scizophrenia.com:
Women With Schizophrenia Outperform Men
OT and VP Studied for Drug Uses
Predicting the Course of SZ
Women May Need Different Med Doses


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