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Li Y, Zhou Y, Li Y, Luo RCX, B Ganapathi P, Wu HE, Liu H, Wang D, Zhang X. Gender differences in empathy and clinical symptoms in chronic schizophrenia patients: a large sample study based on a Chinese Han population. Int J Psychiatry Clin Pract 2023; 27:264-271. [PMID: 36719702 DOI: 10.1080/13651501.2023.2171889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Empathy is social cognition and reduced empathy in schizophrenia (SCZ) has been noted; however, whether there are gender differences in empathy remains unclear. Therefore, the purpose of this study was to explore this issue by examining a large sample of the population with SCZ. METHODS We recruited 987 SCZ patients (M/F = 638/349). The empathy was assessed by The Interpersonal Reactivity Index (IRI). The Positive and Negative Syndrome Scale (PANSS) was adopted to assess their clinical psychiatric symptoms and their ability to recognise the facial emotions of others was assessed by the Pictures Of Facial Affect (POFA). RESULTS Female SCZ patients had higher IRI total score than male patients. In male patients, Pearson correlation analysis showed that empathy was negatively correlated with PANSS total score and negative symptom subscale scores, but positively correlated with anger identification. In female patients, IRI total score was negatively correlated with PANSS total score as well as its positive and negative symptom subscale scores (all p < 0.05). CONCLUSION There are gender differences in the empathy of SCZ patients, with female patients having greater empathy and a correlation with their clinical symptoms. This gender difference may provide potential clinical value for the treatment of SCZ.KEY POINTSFemale SCZ were more likely to empathise than males;Female patients had more severe clinical symptoms than males;There were gender differences in the association between certain specific clinical presentations and empathy.In future studies, it may be useful to investigate gender differences in schizophrenia empathy for the diagnosis and treatment of the disorder.
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Affiliation(s)
- Yanli Li
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yuchen Li
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Rui-Chen-Xi Luo
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Pallavi B Ganapathi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, USA
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiangyang Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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First-episode psychotic disorders in the wake of the COVID-19 pandemic: a descriptive review of casereports. Acta Neuropsychiatr 2022; 34:289-310. [PMID: 35357298 DOI: 10.1017/neu.2022.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Since the onset of COVID-19 pandemic, many case reports and case series dealt with new-onset psychotic disorders in patients either infected with SARS-CoV-2 or thematically linked to the pandemic, but without an infection. Our aim was to provide a comprehensive collection of these reports to illustrate the nature of these psychoses. METHODS We conducted a literature search in MEDLINE, Embase, PsycINFO, using search terms regarding first-episode psychotic disorders in the context of corona. RESULTS 96 case reports or case series covering 146 patients (62 without and 84 with SARS-CoV-2 infection) were found. Compared to patients without infection, patients with infection showed significantly more often visual hallucinations (28.6% vs 8.1%), confusion (36.9% vs 11.3%), an acute onset of illness (88.5% vs 59.6%) and less often depression (13.1% vs 35.5%) and a delusional content related to the pandemic (29.5% vs 78.3%). Both groups had an equally favourable outcome with a duration of psychosis ≤2 weeks in half and full remission in two-thirds of patients. In patients with infection, signs of inflammation were reported in 78.3% and increased CRP in 58.6%. While reports on patients with infection are continuously published, no report about patients without infection was found after July 2020. CONCLUSION Cases without infection were considered reactive and originated all from the first wave of the corona pandemic. In cases with infection, inflammation was considered as the main pathogenetic factor but was not found in all patients. Diagnosis was impeded by the overlap of psychosis with delirium.
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3
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Vázquez-Reyes A, Ángeles Pérez-San-Gregorio M, Martín-Rodríguez A, Vázquez-Morejón AJ. Ten-year follow-up of social functioning and behaviour problems in people with schizophrenia and related disorders. Int J Soc Psychiatry 2022; 68:1324-1335. [PMID: 34096361 DOI: 10.1177/00207640211023083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In recent years, several variables in the course of schizophrenia and related psychotic disorders have been studied. However, an instrumental analysis of the evolution of social functioning and behaviour problems has scarcely been explored. AIM To analyse the evolution of social functioning and behaviour problems and find any diagnosis or gender differences. METHOD The Social Functioning Scale (SFS) and the Behaviour Problems Inventory (BPI) were administered in Stages I (2003-2007) and II (2014-2017) to 100 close relatives of patients under treatment at a Community Mental Health Unit. A related samples t-test, analysis of variance and multivariate analysis of variance were performed to study the evolution and differences in social functioning and behaviour problems. Then a stepwise multiple linear regression analysis was done to predict the evolution of social functioning. RESULTS No deterioration in the evolution of social functioning or behaviour problems was observed, and schizophrenia patient scores were lower. Women scored higher in withdrawal/social engagement, interpersonal behaviour, independence-performance, independence-competence and total social functioning, with no significant differences in behaviour problems. Previous social functioning, underactivity/social withdrawal and education are predictive factors in the evolution of social functioning. Conclusion: The results show the need for implementing psychosocial intervention programs that promote functional recovery and keep problems from becoming chronic.
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Affiliation(s)
| | - María Ángeles Pérez-San-Gregorio
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Agustín Martín-Rodríguez
- Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
| | - Antonio J Vázquez-Morejón
- Mental Health Service, University Hospital Virgen del Rocío, Seville, Spain.,Faculty of Psychology, Department of Personality, Assessment, and Psychological Treatment, University of Seville, Seville, Spain
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Freeman HB, Lee J. Sex Differences in Cognition in Schizophrenia: What We Know and What We Do Not Know. Curr Top Behav Neurosci 2022; 63:463-474. [PMID: 36271194 DOI: 10.1007/7854_2022_394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Cognitive impairment is a core feature of schizophrenia. This selective review examines whether schizophrenia patients show preserved sexual dimorphism in cognition. Existing studies using performance tasks largely show comparable sex effects between schizophrenia patients and healthy populations. This pattern appears to be similar across multiple cognitive domains and across phase of illness. Our selective review also identifies several unresolved questions about sex differences in cognition in schizophrenia. A better understanding of sex differences in cognition in schizophrenia may provide important clues to probing the relationship between cognitive impairment and pathophysiological processes of the disorder.
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Affiliation(s)
- Hyun Bin Freeman
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Junghee Lee
- Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, USA.
- Comprehensive Neuroscience Center, The University of Alabama at Birmingham, Birmingham, AL, USA.
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5
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Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis. Arch Womens Ment Health 2022; 25:679-691. [PMID: 35748930 DOI: 10.1007/s00737-022-01247-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/12/2022] [Indexed: 11/02/2022]
Abstract
First-episode psychosis (FEP) can be quite variable in clinical presentation, and both sex and gender may account for some of this variability. Prior literature on sex or gender differences in symptoms of psychosis have been inconclusive, and a comprehensive summary of evidence on the early course of illness is lacking. The objective of this study was to conduct a systematic review and meta-analysis of the literature to summarize prior evidence on the sex and gender differences in the symptoms of early psychosis. We conducted an electronic database search (MEDLINE, Scopus, PsycINFO, and CINAHL) from 1990 to present to identify quantitative studies focused on sex or gender differences in the symptoms of early psychosis. We used random effects models to compute pooled standardized mean differences (SMD) and risk ratios (RR), with 95% confidence intervals (CI), for a range of symptoms. Thirty-five studies met the inclusion criteria for the systematic review, and 30 studies were included in the meta-analysis. All studies examined sex differences. Men experienced more severe negative symptoms (SMD = - 0.15, 95%CI = - 0.21, - 0.09), whereas women experienced more severe depressive symptoms (SMD = 0.21, 95%CI = 0.14, 0.27) and had higher functioning (SMD = 0.16, 95%CI = 0.10, 0.23). Women also had a lower prevalence of substance use issues (RR = 0.65, 95%CI = 0.61, 0.69). Symptoms of early psychosis varied between men and women; however, we were limited in our ability to differentiate between biological sex and gender factors. These findings may help to inform early detection and intervention efforts to better account for sex and gender differences in early psychosis presentation.
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Brand BA, Haveman YRA, de Beer F, de Boer JN, Dazzan P, Sommer IEC. Antipsychotic medication for women with schizophrenia spectrum disorders. Psychol Med 2022; 52:649-663. [PMID: 34763737 PMCID: PMC8961338 DOI: 10.1017/s0033291721004591] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.
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Affiliation(s)
- Bodyl A. Brand
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yudith R. A. Haveman
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Franciska de Beer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janna N. de Boer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Iris E. C. Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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The effect of sex on social cognition and functioning in schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:57. [PMID: 34853324 PMCID: PMC8636592 DOI: 10.1038/s41537-021-00188-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/03/2021] [Indexed: 12/04/2022]
Abstract
Social cognitive impairment is a core feature of schizophrenia and plays a critical role in poor community functioning in the disorder. However, our understanding of the relationship between key biological variables and social cognitive impairment in schizophrenia is limited. This study examined the effect of sex on the levels of social cognitive impairment and the relationship between social cognitive impairment and social functioning in schizophrenia. Two hundred forty-eight patients with schizophrenia (61 female) and 87 healthy controls (31 female) completed five objective measures and one subjective measure of social cognition. The objective measures included the Facial Affect Identification, Emotion in Biological Motion, Self-Referential Memory, MSCEIT Branch 4, and Empathic Accuracy tasks. The subjective measure was the Interpersonal Reactivity Index (IRI), which includes four subscales. Patients completed measures of social and non-social functional capacity and community functioning. For objective social cognitive tasks, we found a significant sex difference only on one measure, the MSCEIT Branch 4, which in both patient and control groups, females performed better than males. Regarding the IRI, females endorsed higher empathy-related items on one subscale. The moderating role of sex was found only for the association between objective social cognition and non-social functional capacity. The relationship was stronger in male patients than female patients. In this study, we found minimal evidence of a sex effect on social cognition in schizophrenia across subjective and objective measures. Sex does not appear to moderate the association between social cognition and functioning in schizophrenia.
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8
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Catalan A, Richter A, Salazar de Pablo G, Vaquerizo-Serrano J, Mancebo G, Pedruzo B, Aymerich C, Solmi M, González-Torres MÁ, Gil P, McGuire P, Fusar-Poli P. Proportion and predictors of remission and recovery in first-episode psychosis: Systematic review and meta-analysis. Eur Psychiatry 2021; 64:e69. [PMID: 34730080 PMCID: PMC8668449 DOI: 10.1192/j.eurpsy.2021.2246] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To determine the proportion of patients in symptomatic remission and recovery following a first-episode of psychosis (FEP). Methods A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, and trial registries from database inception to November 5, 2020, was performed. Cohort studies and randomized control trials (RCT) investigating the proportion of remission and recovery following a FEP were included. Two independent researchers searched, following PRISMA and MOOSE guidelines and using a PROSPERO protocol. We performed meta-analyses regarding the proportion of remission/recovery (symptomatic plus functional outcomes). Heterogeneity was measured employing Q statistics and I2 test. To identify potential predictors, meta-regression analyses were conducted, as well as qualitative reporting of studies included in a systematic review. Sensitivity analyses were performed regarding different times of follow-up and type of studies. Results One hundred articles (82 cohorts and 18 RCTs) were included in the meta-analysis. The pooled proportion of symptomatic remission was 54% (95%CI [30, 49–58]) over a mean follow-up period of 43.57 months (SD = 51.82) in 76 studies. After excluding RCT from the sample, the proportion of remission remained similar (55%). The pooled proportion of recovery was 32% (95%CI [27–36]) over a mean follow-up period of 71.85 months (SD = 73.54) in 40 studies. After excluding RCT from the sample, the recovery proportion remained the same. No significant effect of any sociodemographic or clinical predictor was found. Conclusions Half of the patients are in symptomatic remission around 4 years after the FEP, while about a third show recovery after 5.5 years.
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Affiliation(s)
- Ana Catalan
- Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Barakaldo, Spain.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Anja Richter
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.,Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Julio Vaquerizo-Serrano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gonzalo Mancebo
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Borja Pedruzo
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Claudia Aymerich
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, University of Ottawa, Ontario, Canada.,Department of Mental Health, The Ottawa Hospital, Ontario, Canada.,Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario
| | - Miguel Á González-Torres
- Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Barakaldo, Spain
| | - Patxi Gil
- Mental Health Department, Biocruces Bizkaia Health Research Institute, Early Intervention Service, Bizkaia Mental Health System, Bilbao, Spain
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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9
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Zorkina Y, Morozova A, Abramova O, Reznik A, Kostyuk G. Sex differences in social functioning of patients with schizophrenia depending on the age of onset and severity of the disease. Early Interv Psychiatry 2021; 15:1197-1209. [PMID: 33040482 DOI: 10.1111/eip.13063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/18/2020] [Accepted: 09/26/2020] [Indexed: 01/10/2023]
Abstract
AIM Schizophrenia manifests differently in women and men. This disease starts at a young age, leads to disability at working age. The aim of our work was to study sex differences, association between social factors and different parameters of the clinical picture and the course of the disease. METHODS This study was performed using population of Russian patients (men: 345, women: 310). Patients were examined using DSM-V, Bush-Francis catatonia rating scale (BFCRS), Positive and Negative Syndrome Scale (PANSS), 4-Items Negative Symptoms Assessment (NSA-4) and Frontal Assessment Battery (FAB). RESULTS Sex differences were mainly shown through negative symptoms, which were more severe in male patients. Men were shown to experience a decrease in social functioning and earlier age of onset. A positive family history further influenced negative symptoms and age of onset. When comparing scores before and after inpatient treatment (4 weeks), sex differences were not so pronounced. Female patients and patients with high levels of education, no conflictual relationship with family and active labour activity showed a later age of onset of the prodromal events and manifestation age. The decrease in the number of social contacts correlated with lower age of disability. The association between social factors and the severity of psychotic symptoms was shown across DSM-V, PANSS, NSA-4 and FAB, but not for BFCRS. Social factors were associated with negative symptoms of schizophrenia, but not with positive. CONCLUSION For successful treatment of patients with schizophrenia, the discussed factors must be considered and schizophrenia treatment methods should be primarily aimed at improving social functioning.
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Affiliation(s)
- Yana Zorkina
- Department of Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
| | - Anna Morozova
- Department of Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia.,N.A. Alekseev Psychiatric Clinical Hospital № 1, Moscow, Russia
| | - Olga Abramova
- Department of Basic and Applied Neurobiology, V.P. Serbsky Federal Medical Research Centre of Psychiatry and Narcology, Moscow, Russia
| | | | - Georgiy Kostyuk
- N.A. Alekseev Psychiatric Clinical Hospital № 1, Moscow, Russia
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10
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Abstract
PURPOSE OF REVIEW Clinical practice guidelines (CPGs) do not usually offer a sex-specific approach for the management of schizophrenia. With this narrative review, we aim to give an integrated and synthesized overview of the current state of knowledge regarding sex-specific aspects in schizophrenia and how this topic may be adapted in the development of CPGs. RECENT FINDINGS Recent studies further suggest sex-specific differences in epidemiologic features, the course of illness, underlying pathomechanisms, response likelihood to antipsychotic medication and differences in tolerability. Beyond this, selective estrogen receptor modulators like raloxifene have shown beneficial effects on symptom severity and cognition in women with schizophrenia. SUMMARY Sex-specific aspects can already be integrated in clinical guideline recommendations, especially with regard to efficacy and tolerability of antipsychotic treatment. Moreover, these aspects may be used for an individual risk-stratification. Recent studies provide evidence supporting the hypothesis of sex-specific modulation in schizophrenia and build the groundwork for sex-specific novel treatment options. However, there remains a clear need for additional studies focusing on women with schizophrenia to substantiate current findings.
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11
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Tikkanen V, Siira V, Wahlberg KE, Hakko H, Läksy K, Roisko R, Niemelä M, Räsänen S. Adolescent social functioning in offspring at high risk for schizophrenia spectrum disorders in the Finnish Adoptive Family Study of Schizophrenia. Schizophr Res 2020; 215:293-299. [PMID: 31699628 DOI: 10.1016/j.schres.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/17/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Children and adolescents with a genetic risk for schizophrenia are often found to have poorer social functioning compared to their controls. However, less is known about high-risk offspring who have not been reared by a biological parent with schizophrenia. The purpose of this study was to examine deficits in social functioning in adolescence as a possible factor related to genetic vulnerability to schizophrenia spectrum disorders, and also to examine possible gender differences in these associations. METHOD The present sample consisted of 88 genetic high-risk (HR) adoptees whose biological mothers were diagnosed with schizophrenia spectrum disorders and 83 genetic low-risk (LR) adoptees with biological mothers with non-schizophrenia spectrum disorders or no psychiatric disorders. Adoptees' social functioning at ages 16-20 was assessed using the UCLA Social Attainment Survey. RESULTS Compared to LR adoptees, HR adoptees displayed statistically significant deficits in their peer relationships, involvement in activities and overall social functioning during adolescence. HR males were distinguished from LR males by their significantly poorer overall social functioning. Compared to HR females, HR males showed significant deficits in their romantic relationships. Of marginal significance was that HR females displayed more social functioning deficits relative to LR females, mainly in the areas of peer relationships, involvement in activities and overall social functioning. CONCLUSIONS These results from the adoption and high-risk study design suggest that deficits in social functioning in adolescence may be related to genetic vulnerability to schizophrenia spectrum disorders and that some of these deficits may be gender-specific.
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Affiliation(s)
- Ville Tikkanen
- Faculty of Education, P.O. Box 2000, 90014, University of Oulu, Finland; University of Oulu, Department of Psychiatry, Unit of Clinical Neuroscience, P.O. Box 5000, 90014, University of Oulu, Finland.
| | - Virva Siira
- Faculty of Education, P.O. Box 2000, 90014, University of Oulu, Finland
| | - Karl-Erik Wahlberg
- University of Oulu, Department of Psychiatry, Unit of Clinical Neuroscience, P.O. Box 5000, 90014, University of Oulu, Finland
| | - Helinä Hakko
- Oulu University Hospital, Department of Psychiatry, P.O. Box 26, 90029, Oulu University Hospital, Finland
| | | | - Riikka Roisko
- Oulu University Hospital, Department of Psychiatry, P.O. Box 26, 90029, Oulu University Hospital, Finland
| | - Mika Niemelä
- Oulu University Hospital, Department of Psychiatry, P.O. Box 26, 90029, Oulu University Hospital, Finland; University of Oulu, Department of Medicine, Center for Life Course Health, Research, P.O. Box 5000, 90014, University of Oulu, Finland
| | - Sami Räsänen
- Oulu University Hospital, Department of Psychiatry, P.O. Box 26, 90029, Oulu University Hospital, Finland
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12
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Positive and negative affect as predictors of social functioning in Spanish children. PLoS One 2018; 13:e0201698. [PMID: 30071086 PMCID: PMC6072041 DOI: 10.1371/journal.pone.0201698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/20/2018] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to analyze the relationship between affect in its two commonly used theoretical categories, positive affect (PA) and negative affect (NA), and social functioning dimensions (school performance, family relationships, peer relationships and home duties/self-care). The sample comprised 390 students of primary education aged 8–11 years (M = 9.39; SD = 1.15). The short-form of the Positive and Negative Affect Schedule for children (PANAS-C-SF) and the Child and Adolescent Social Adaptive Functioning Scale (CASAFS) were used. Student’s t tests indicated that those reporting high levels on all the social functioning dimensions also reported significantly higher levels of PA than peers who reported low levels; by contrast, students reporting high levels of social functioning reported significantly lower levels of NA than peers who reported low levels. Similarly, logistic regression analyses showed that an increase in PA increased probability of high levels of social functioning, and that an increase in NA decreased the probability of presenting high levels of social functioning dimensions, with the exception of school performance. These results expand the PA and NA relationship with social functioning reported in adults to Spanish children, which is potentially of interest in the fields of Education and Psychology.
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Jordan G, Veru F, Lepage M, Joober R, Malla A, Iyer SN. Pathways to functional outcomes following a first episode of psychosis: The roles of premorbid adjustment, verbal memory and symptom remission. Aust N Z J Psychiatry 2018; 52:793-803. [PMID: 29250962 DOI: 10.1177/0004867417747401] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Most studies have investigated either the singular or relative contributions of premorbid adjustment, verbal memory and symptom remission to functional outcomes in first-episode psychosis. Fewer studies have examined the pathways of these factors in impacting functioning. Our study addresses this gap. The objective was to determine whether the relationship between premorbid adjustment and functional outcomes was mediated by verbal memory and symptom remission. METHOD A total of 334 first-episode psychosis participants (aged 14-35 years) were assessed on premorbid adjustment, verbal memory upon entry, and positive and negative symptom remission and functioning at multiple time points over a 2-year follow-up. RESULTS Mediation analyses showed that over the first year, the relationship between premorbid adjustment and functioning was mediated by verbal memory and positive symptom remission (β = -0.18; 95% confidence interval = [-0.51, -0.04]), as well as by verbal memory and negative symptom remission (β = -0.41; 95% confidence interval = [-1.11, -1.03]). Over 2 years, the relationship between premorbid adjustment and functioning was mediated by verbal memory and only negative symptom remission (β = -0.38; 95% confidence interval = [-1.46, -0.02]). CONCLUSION Comparatively less malleable factors (premorbid adjustment and verbal memory) may contribute to functional outcomes through more malleable factors (symptoms). Promoting remission may be an important parsimonious means to achieving better functional outcomes.
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Affiliation(s)
- Gerald Jordan
- 1 Department of Psychiatry, McGill University, Montreal, QC, Canada.,2 Douglas Mental Health University Institute, Montreal, QC, Canada.,3 Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Montreal, QC, Canada.,4 ACCESS Open Minds, Strategy for Patient-Oriented Research, Canadian Institutes of Health Research, Montreal, QC, Canada
| | - Franz Veru
- 1 Department of Psychiatry, McGill University, Montreal, QC, Canada.,2 Douglas Mental Health University Institute, Montreal, QC, Canada.,3 Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Montreal, QC, Canada
| | - Martin Lepage
- 1 Department of Psychiatry, McGill University, Montreal, QC, Canada.,2 Douglas Mental Health University Institute, Montreal, QC, Canada.,3 Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Montreal, QC, Canada
| | - Ridha Joober
- 1 Department of Psychiatry, McGill University, Montreal, QC, Canada.,2 Douglas Mental Health University Institute, Montreal, QC, Canada.,3 Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Montreal, QC, Canada.,4 ACCESS Open Minds, Strategy for Patient-Oriented Research, Canadian Institutes of Health Research, Montreal, QC, Canada
| | - Ashok Malla
- 1 Department of Psychiatry, McGill University, Montreal, QC, Canada.,2 Douglas Mental Health University Institute, Montreal, QC, Canada.,3 Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Montreal, QC, Canada.,4 ACCESS Open Minds, Strategy for Patient-Oriented Research, Canadian Institutes of Health Research, Montreal, QC, Canada
| | - Srividya N Iyer
- 1 Department of Psychiatry, McGill University, Montreal, QC, Canada.,2 Douglas Mental Health University Institute, Montreal, QC, Canada.,3 Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Montreal, QC, Canada.,4 ACCESS Open Minds, Strategy for Patient-Oriented Research, Canadian Institutes of Health Research, Montreal, QC, Canada
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Comparison of the long-term treatment outcomes of women and men diagnosed with schizophrenia over a period of 20 years. A prospective study. Compr Psychiatry 2018; 84:62-67. [PMID: 29694934 DOI: 10.1016/j.comppsych.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/02/2018] [Accepted: 03/31/2018] [Indexed: 11/23/2022] Open
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15
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Crocker CE, Tibbo PG. The interaction of gender and cannabis in early phase psychosis. Schizophr Res 2018; 194:18-25. [PMID: 28506705 DOI: 10.1016/j.schres.2017.04.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/25/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022]
Abstract
Cannabis is the third most common recreational drug used world-wide after tobacco and alcohol. Globally, cannabis legalization is becoming more common. In light of its known link to psychosis development, it is imperative that we are well-informed regarding the impact of cannabis on the course of psychosis, in both males and females. However, the majority of the work to date on the role of cannabis in psychosis outcomes has not had a gender focus, important when considering patient specific treatments. This review examines what is currently known, from gender focused studies, about the interaction of gender, cannabis use and psychotic disorders.
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Affiliation(s)
- Candice E Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Diagnostic Radiology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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16
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Predictors of functional recovery in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies. Clin Psychol Rev 2017; 58:59-75. [DOI: 10.1016/j.cpr.2017.09.007] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/16/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022]
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17
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Abstract
The aim of this narrative review is to provide readers with a summary of the recent literature on women and schizophrenia and to address commonly asked questions about the role of gender in this illness. Important gender distinctions were found in the knowledge base around schizophrenia, particularly in the areas of symptom onset, hormonal and immune effects, and antipsychotic drug kinetics and their consequences. We also discuss and address commonly asked questions about gender and schizophrenia. This review concludes that gender differences influence the effectiveness of various treatments and need to be taken into account when planning comprehensive care services for individuals with schizophrenia.
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Affiliation(s)
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, 260 Heath St. W. Suite 605, Toronto, ON M5P 3L6, Canada
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18
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Lange B, Mueller JK, Leweke FM, Bumb JM. How gender affects the pharmacotherapeutic approach to treating psychosis - a systematic review. Expert Opin Pharmacother 2017; 18:351-362. [PMID: 28129701 DOI: 10.1080/14656566.2017.1288722] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The effectiveness, effective dosages and side effect profiles of antipsychotic medication differ significantly between the sexes. Areas covered: We present a systematic review of gender-differences in the treatment of psychosis focusing on randomized, controlled trials and meta-analyses. Expert opinion: Despite many years of research, the database on gender-differences affecting the pharmacotherapeutic approach to treating psychosis is insufficient. Currently, the US National Institute of Health encouraged the enrolment of female participants in federally supported phase III clinical trials to increase the data available of female patients. Emerging evidence points to a superior antipsychotic response in women, with men requiring higher dosages. In general, women metabolize drugs differently, resulting in side effects occuring more frequently when compared to men. In any case, women require electrocardiograms or bone density scans as well as diabetes and cardiovascular workups when treated with antipsychotics. Dose adjustments during the menstrual cycle (e.g. to raise antipsychotic doses premenstrually) should be considered. First-generation antipsychotics, drugs that are known to prolong QTc interval and increase prolactin levels should be avoided in postmenopausal female patients. Furthermore, the effects of antipsychotics during pregnancy and breastfeeding have been investigated insufficiently, and more research is urgently needed.
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Affiliation(s)
- Bettina Lange
- a Department of Psychiatry and Psychotherapy , Central Institute of Mental Health , Mannheim , Germany
| | - Juliane K Mueller
- a Department of Psychiatry and Psychotherapy , Central Institute of Mental Health , Mannheim , Germany
| | - F Markus Leweke
- a Department of Psychiatry and Psychotherapy , Central Institute of Mental Health , Mannheim , Germany
| | - J Malte Bumb
- b Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health , Medical Faculty Mannheim/Heidelberg University , Mannheim , Germany
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Butjosa A, Gómez-Benito J, Huerta-Ramos E, Del Cacho N, Barajas A, Baños I, Usall J, Dolz M, Sánchez B, Carlson J, Maria Haro J, Ochoa S. Incidence of stressful life events and influence of sociodemographic and clinical variables on the onset of first-episode psychosis. Psychiatry Res 2016; 245:108-115. [PMID: 27541345 DOI: 10.1016/j.psychres.2016.08.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 01/01/2023]
Abstract
This study presents a quantitative analysis of the incidence of stressful life events (SLEs) and the variables gender, age at onset, family history and psychotic symptoms in patients with first-episode psychosis (FEP). A descriptive, cross-sectional methodology was used to interview 68 patients with FEP between 13 and 47 years of age. The Psychiatric Epidemiology Research Interview Life Events Scale collected one-year period prior to onset of FEP - used to analyse the subcategories academic, work, love and marriage, children, residence, legal affairs, finances and social activities-, Positive and Negative Syndrome Scale, and Clinical Global Impression-Schizophrenia scale were used to assess the relevance of certain SLEs during adolescence. Age at onset showed a significant negative correlation with the categories academic and social activities. By contrast, it showed a positive correlation with work and children. A significant relationship was found between paternal family history and social activities and between maternal family history and academic and love and marriage. Finally, an inverse relationship was observed between negative symptoms and the categories children and finance. Depressive symptoms were significantly correlated with the category academic. Our results show the importance of SLEs during adolescence and suggest that there is a clear need to develop preventive actions that promote effective strategies for dealing with the accumulation of psychosocial stress.
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Affiliation(s)
- Anna Butjosa
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain; Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Barcelona, Spain.
| | - Juana Gómez-Benito
- Department of Personality, Evaluation and Psychological Treatment, Faculty of Psychology, University of Barcelona, Spain; Institute for Brain, Cognition, and Behaviour (IR3C), University of Barcelona, Spain
| | - Elena Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Núria Del Cacho
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Ana Barajas
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain; Hospital Sant Joan de Déu, Acute Unit, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain; Centro de Higiene Mental de Les Corts Research Unit, Barcelona, Spain
| | - Iris Baños
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Montserrat Dolz
- Hospital Sant Joan de Déu, Acute Unit, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Bernardo Sánchez
- Hospital Sant Joan de Déu, Acute Unit, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Janina Carlson
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain; Sant Joan de Déu Research Foundation, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain; Hospital Sant Joan de Déu, Acute Unit, CIBERSAM, Esplugues de Llobregat, Barcelona, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
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20
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Rubio-Abadal E, Usall J, Barajas A, Carlson J, Iniesta R, Huerta-Ramos E, Baños I, Dolz M, Sánchez B, Ochoa S. Relationship between menarche and psychosis onset in women with first episode of psychosis. Early Interv Psychiatry 2016; 10:419-25. [PMID: 25263663 DOI: 10.1111/eip.12194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 08/19/2014] [Indexed: 12/17/2022]
Abstract
AIM The aim of this study was to explore the relationship between age at menarche and age at first episode of psychosis, as well as clinical severity and outcome, in a population of women with first-episode psychosis. METHODS Clinical and socio-demographical data, age at menarche and at first-episode psychosis, parental history of psychosis and cannabis-use habits were obtained from 42 subjects with a first episode of psychosis. Positive and Negative Syndrome Scale, Clinical Global Impression, Global Assessment Function, Disability Assessment Schedule, Wechsler Adult Intelligence Scale and Wechsler Intelligence Scale for Children, European Quality of Life, and Lewis and Murray Obstetric Complication Scales were administered. Statistical analysis was performed by means of zero-order correlations and Mann-Whitney U and Kruskal-Wallis tests using SPSS version 17.0. RESULTS We found no significant correlation between age at menarche and age at first-episode psychosis, or with the clinical scores performed. We observed that subjects with earlier age at menarche had more parental history of psychosis. CONCLUSIONS Our negative results do not support the theory of a possible protective role of oestrogen, which seems to be more complex than previously thought. We would suggest that further research is needed to investigate developmental influences of sex steroids on the onset of psychosis and potentially therapeutic benefits based upon oestrogen.
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Affiliation(s)
- Elena Rubio-Abadal
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, CIBERSAM. GTRDSM, Spain.
| | - Judith Usall
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, CIBERSAM. GTRDSM, Spain
| | - Anna Barajas
- Research Unit, Centre d'Higiene Mental Les Corts, Barcelona, Spain
| | - Janina Carlson
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, CIBERSAM. GTRDSM, Spain
| | - Raquel Iniesta
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, CIBERSAM. GTRDSM, Spain
| | - Elena Huerta-Ramos
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, CIBERSAM. GTRDSM, Spain
| | - Iris Baños
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, CIBERSAM. GTRDSM, Spain
| | - Montserrat Dolz
- Psychiatry Department, Hospital Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Bernardo Sánchez
- Psychiatry Department, Hospital Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | | | - Susana Ochoa
- Research Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, CIBERSAM. GTRDSM, Spain
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Kelly DL, Rowland LM, Patchan KM, Sullivan K, Earl A, Raley H, Liu F, Feldman S, McMahon RP. Schizophrenia clinical symptom differences in women vs. men with and without a history of childhood physical abuse. Child Adolesc Psychiatry Ment Health 2016; 10:5. [PMID: 26941836 PMCID: PMC4776423 DOI: 10.1186/s13034-016-0092-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/09/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Childhood abuse has been implicated as an environmental factor that increases the risk for developing schizophrenia. A recent large population-based case-control study found that abuse may be a risk factor for schizophrenia in women, but not men. Given the sex differences in onset and clinical course of schizophrenia, we hypothesized that childhood abuse may cause phenotypic differences in the disorder between men and women. METHODS We examined the prevalence of childhood physical abuse in a cohort of men and women with schizophrenia and schizoaffective disorder. Specifically, we examined differences in positive, negative, cognitive and depressive symptoms in men and women who reported a history of childhood physical abuse. We recruited 100 subjects for a single visit and assessed a history of childhood physical abuse using the childhood trauma questionnaire (CTQ) and clinical symptoms and cognition using the brief psychiatric rating scale (BPRS), the calgary depression scale (CDS) and the repeatable battery of the assessment of neuropsychological status (RBANS) for cognition. RESULTS Ninety-two subjects completed the full CTQ with abuse classified as definitely present, definitely absent or borderline. Twelve subjects who reported borderline abuse scores were excluded. Of the 80 subjects whose data was analyzed, 10 of 24 (41.6 %) women and 11 of 56 (19.6 %) men reported a history of childhood physical abuse (χ(2) = 4.21, df = 1, p = 0.04). Women who reported such trauma had significantly more psychotic (sex by abuse interaction; F = 4.03, df = 1.76, p = 0.048) and depressive (F = 4.23, df = 1.76, p = 0.04) symptoms compared to women who did not have a trauma history and men, regardless of trauma history. There were no differences in negative or cognitive symptoms. CONCLUSIONS Women with schizophrenia and schizoaffective disorder may represent a distinct phenotype or subgroup with distinct etiologies and may require different, individually tailored treatments.
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Affiliation(s)
- Deanna L. Kelly
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Laura M. Rowland
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Kathleen M. Patchan
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Kelli Sullivan
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Amber Earl
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Heather Raley
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Fang Liu
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Stephanie Feldman
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
| | - Robert P. McMahon
- Department of Psychiatry, Maryland Psychiatric Research Center, Spring Grove Hospital Grounds, University of Maryland School of Medicine, Box 21247, Baltimore, MD 21228 USA
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Sex Differences in Severity, Social Functioning, Adherence to Treatment, and Cognition of Adolescents with Schizophrenia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2016; 2016:1928747. [PMID: 27703813 PMCID: PMC5039268 DOI: 10.1155/2016/1928747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/10/2016] [Accepted: 08/23/2016] [Indexed: 11/18/2022]
Abstract
Background. Previous studies have reported sex differences in the clinical presentation and outcome of adult patients with schizophrenia; the aim of present study was to compare the clinical characteristics, social functioning, adherence to treatment, and cognition of adolescents with this diagnosis in a six-month followup. Methods. A total of 87 adolescents with a DSM-IV diagnosis of schizophrenia or schizophreniform disorder were evaluated with the Positive and Negative Symptoms Scale (PANSS), the Matrics Consensus Cognitive Battery (MCCB), Personal and Social Performance Scale (PSP), and the Rating of Medication Influences (ROMI). Results. Both groups showed a similar improvement in all PANSS factors and in the PSP scores during the followup. Males better adhered to treatment. Females displayed better results in the area of social cognition (F = 6.3, df = 2,52, and p = 0.003) and attention/vigilance (F = 8.3, df = 2,51, and p = 0.001). Conclusions. Male and female adolescents showed similar clinical presentation and functioning but a different pattern of cognitive improvement and adherence to treatment. This trial is registered with Clinicaltrials.gov II3/02/0811..
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23
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Gender differences in the treatment of first-episode schizophrenia: Results from the European First Episode Schizophrenia Trial. Schizophr Res 2015; 169:303-307. [PMID: 26545298 DOI: 10.1016/j.schres.2015.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 11/21/2022]
Abstract
Gender differences in the response to antipsychotic treatment have been detected in the past, but not studied in great detail. The results of the European First-Episode Schizophrenia Trial (EUFEST) were analyzed with a focus on gender differences in the response to randomized treatment of first-episode schizophrenia. A total of 498 patients (298 men and 200 women) were randomly assigned by a web-based online system to open-label treatment with haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone. Treatment response was evaluated using the positive and negative syndrome scale (PANSS). Data were collected at baseline and then prospectively for one year. Baseline characteristics (age and proportion of patients assigned to individual antipsychotics) were the same between the male and female patients with the exception of ziprasidone: significantly fewer men, proportionately, were prescribed ziprasidone. There was no significant difference between genders between the initial total PANSS and subscale scores. A significant interaction between time and gender was found, with more robust PPANSS and TPANSS score improvement in women during the course of treatment. Of all of the antipsychotics used, only olanzapine led to significantly greater improvement in the total PANSS score in women during the follow-up period. Gender differences should be given more attention in research and clinical practice. Their causes require clarification, and future strategies for dealing with them may be considered in early intervention programs and guidelines.
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Abstract
Impaired insight is common in the first episode of psychosis (FEP). Although considerable research has examined the factors that are associated with impaired insight in chronic psychosis, less is known about the factors that underlie and sustain poor insight in FEP. Impaired metacognition, or the ability to form integrated representations of self and others, is a promising potential contributor to poor insight in FEP. To explore this possibility, the authors assessed insight and metacognition in 40 individuals with FEP and then examined the relationship between these areas and social cognition domains, neurocognitive domains, and psychotic symptoms. Correlation analyses revealed that improved insight was associated with higher metacognition, better vocabulary and Theory of Mind scores, and fewer symptoms. The domain of metacognitive mastery also predicted clinical insight. Results support the need to develop an integrative therapeutic approach focused on improving metacognition, hence addressing poor insight in FEP.
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25
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Garcia-Oscos F, Peña D, Housini M, Cheng D, Lopez D, Cuevas-Olguin R, Saderi N, Salgado Delgado R, Galindo Charles L, Salgado Burgos H, Rose-John S, Flores G, Kilgard MP, Atzori M. Activation of the anti-inflammatory reflex blocks lipopolysaccharide-induced decrease in synaptic inhibition in the temporal cortex of the rat. J Neurosci Res 2015; 93:859-65. [DOI: 10.1002/jnr.23550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Francisco Garcia-Oscos
- School of Behavioral and Brain Sciences; University of Texas at Dallas; Richardson Texas
- Department of Psychiatry; University of Texas Southwestern; Dallas Texas
| | - David Peña
- School of Behavioral and Brain Sciences; University of Texas at Dallas; Richardson Texas
| | - Mohammad Housini
- School of Behavioral and Brain Sciences; University of Texas at Dallas; Richardson Texas
| | - Derek Cheng
- School of Behavioral and Brain Sciences; University of Texas at Dallas; Richardson Texas
| | - Diego Lopez
- Department of Chemistry and Biochemistry; University of Texas at Arlington; Arlington Texas
| | - Roberto Cuevas-Olguin
- Facultad de Ciencias; Universidad Autónoma de San Luis Potosí; San Luis Potosí México
| | - Nadia Saderi
- Facultad de Ciencias; Universidad Autónoma de San Luis Potosí; San Luis Potosí México
| | | | | | - Humberto Salgado Burgos
- Centro de Investigaciones Regionales Hideyo Noguchi, Universidad Autonoma de Yucatan; Mérida Yucatán México
| | - Stefan Rose-John
- Department of Biochemistry; Christian Albrecht University; Kiel Germany
| | - Gonzalo Flores
- Instituto de Fisiología, Benemérita Universidad de Puebla; Puebla México
| | - Michael P. Kilgard
- School of Behavioral and Brain Sciences; University of Texas at Dallas; Richardson Texas
| | - Marco Atzori
- School of Behavioral and Brain Sciences; University of Texas at Dallas; Richardson Texas
- Facultad de Ciencias; Universidad Autónoma de San Luis Potosí; San Luis Potosí México
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Negative symptoms, past and present: a historical perspective and moving to DSM-5. Eur Neuropsychopharmacol 2014; 24:710-24. [PMID: 24314851 DOI: 10.1016/j.euroneuro.2013.10.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/21/2013] [Accepted: 10/31/2013] [Indexed: 11/27/2022]
Abstract
The diagnosis of schizophrenia includes "positive" and "negative" symptoms. These titles were developed to respectively reflect if the symptoms are additions to normal experiences, such as delusions and hallucinations, or if they refer to the absence or the loss of normal emotional function or behavior. This paper describes the history of the negative symptom concept, from its origins up to the considerations for the DSM-5, including the steps that produced the current conceptualizations. The DSM-5 only includes deficits in emotional expression and avolition as negative symptoms, which can be assessed from interview information. Factor analyses show they encompass most other negative symptom items. In addition to using these negative symptoms in a categorical manner to make a diagnosis, the DSM-5 has quantitative severity ratings of the negative symptoms, along with ratings of delusions, cognitive symptoms, motor symptoms, disorganization, depression and mania. With this approach, the different symptom domains, including negative symptoms, can be measured and tracked over time. Another change in the DSM-5 is the dropping of the schizophrenia subtypes that have been included in earlier volumes, as they were not useful in treatment decisions or prognosis. An intended outcome of these changes in DSM-5 is for clinicians to directly treat the individual psychopathological domains of the disorder for optimizing individual outcomes. Finally, this paper includes descriptions of the negative symptom items from over a dozen different scales.
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Abstract
OBJECTIVE We conducted a comparative analysis of gender differences in patients with primary psychotic disorders with concurrent substance use and in those with substance-induced psychoses. METHODS A total of 385 individuals admitted to psychiatric emergency departments with early-onset psychosis and recent substance use were interviewed at baseline and at six-month intervals for two years. Using a standardized research diagnostic assessment instrument, we classified patients at baseline into primary and substance-induced psychosis groups and analyzed the effects of gender on demographic, family, and clinical characteristics at baseline, the interaction of gender and diagnosis, and gender main effects on illness course, adjustment, and service use over the two-year follow-up period. RESULTS Women had better premorbid adjustment, less misattribution of symptoms, and a later age at onset of regular drug use compared to men. Women, however, showed greater depression and histories of abuse compared to men. Men had greater arrest histories. No interactions between gender and diagnosis were significant. Both genders in the primary and substance-induced psychosis groups showed clinical and functional improvement over the follow-up period despite the overall minimal use of mental health and substance abuse treatment services. CONCLUSIONS Women and men with psychosis and substance use differ on several dimensions. Our findings suggest the need for gender-specific treatment programming across both diagnostic groups.
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Affiliation(s)
- Carol L M Caton
- a Columbia University Department of Psychiatry and the New York State Psychiatric Institute , New York , New York , USA
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Ceskova E, Prikryl R. Importance of gender in the treatment of schizophrenia. Prim Care Companion CNS Disord 2012; 14:12m01407. [PMID: 23586000 DOI: 10.4088/pcc.12m01407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To compare male and female patients participating in e-STAR (electronic Schizophrenia Treatment Adherence Registry), an international, prospective, observational study assessing use of risperidone long-acting injection in patients with schizophrenia or schizoaffective disorder in both the Czech and Slovak Republics. METHOD The demographic, clinical, and treatment-related data were collected at baseline and then prospectively for 24 months. We focused on gender differences in demographic and clinical data (hospitalizations, concomitant medication, and clinical improvement using Clinical Global Impressions-severity of illness [CGI-S], Global Assessment of Functioning [GAF], and Personal and Social Performance [PSP] scales). All psychiatric diagnoses were made according to International Classification of Diseases, Tenth Revision criteria. Data were collected from September 2006 through September 2009. RESULTS A total of 868 patients (488 men and 380 women) were included in the assessment. At baseline, the women were significantly older than the men (42.1 ± 12.8 vs 34.8 ± 11.1 years, respectively; P < .0001). The women were also significantly more frequently diagnosed with schizoaffective disorder (P = .0048). There was no difference between men and women in the proportion of patients hospitalized in the retrospective and prospective period (including length of stay). At 24 months, the men were taking fewer antidepressants and benzodiazepines than the women (controlled for baseline values). In men and women, a significant decrease in the CGI-S score (P < .001) and a significant increase in the GAF and PSP scores (P < .001) from baseline were observed. The improvements in CGI-S and PSP scores were similar in both groups (no significant difference between male and female patients). The improvement (increase) in the mean GAF score was significantly higher in women than in men (P = .0317). CONCLUSIONS The treatment with risperidone long-acting injection was associated with clinically significant improvement in both male and female patients with schizophrenia with comparable severity of illness. There were no significant differences in most outcome measures. Gender differences, especially concerning treatment response to individual antipsychotics and their different forms, should be more intensively studied.
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Affiliation(s)
- Eva Ceskova
- Central European Institute of Technology, Masaryk University, and Masaryk University and Faculty Hospital, Brno, Czech Republic
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Homocysteine and cognition in first-episode psychosis patients. Eur Arch Psychiatry Clin Neurosci 2012; 262:557-64. [PMID: 22382435 DOI: 10.1007/s00406-012-0302-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 02/14/2012] [Indexed: 12/23/2022]
Abstract
In the last years, there has been growing evidence linking elevated homocysteine levels with cognitive dysfunction in several neurological and neuropsychiatric diseases. The aim of the present study was to investigate the potential relationship between elevated homocysteine levels and cognitive deficits in first-episode psychosis patients. Plasma levels and cognitive performance of 139 patients and 99 healthy volunteers were compared. Patients were classified as elevated homocysteine (>90 percentile for controls) and normal and compared on 22 cognitive outcome measures grouped into cognitive domains known to be impaired in schizophrenia. Patients had a statistically significant increase in plasmatic homocysteine levels. In addition, they presented with significantly increased cognitive deficits. However, no relationship between homocysteine levels and cognitive impairment was detected. These results suggest the need for further studies to clarify the role of homocysteine in the etiology and prognosis of psychosis.
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Gender differences in service use in a sample of people with schizophrenia and other psychoses. SCHIZOPHRENIA RESEARCH AND TREATMENT 2012; 2012:365452. [PMID: 22966434 PMCID: PMC3420527 DOI: 10.1155/2012/365452] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/28/2012] [Indexed: 11/18/2022]
Abstract
Objective. The main objective is to analyze the use of mental health services in a sample of people with schizophrenia and other psychoses according to gender. Method. The sample of this observational and retrospective study (n = 7483) consisted of all the persons who visited any mental health service of the Parc Sanitari Sant Joan de Déu from 2001 to 2007 with a diagnosis of schizophrenia and other psychoses. The main measures analyzed regarding gender were the frequency of patients for each diagnosis, their risk of being admitted into hospital, and the number and length of hospitalizations for the subsample of inpatient people during the study period. Results. Men are more frequent in the total sample (58.1%). For diagnosis of schizoaffective or delusional disorder, women have a higher frequency than men. Women with diagnosis of schizophrenia have a lower risk of being admitted to the hospital (RR = 0.84, 95% CI (0.72, 0.97)). We found a higher risk of longer stays for men with schizophrenia of the disorganized type (RR = 0.49, 95% CI (0.30, 0.81)), undifferentiated (RR = 0.41, 95% CI (0.27, 0.61)), or delusional disorder (RR = 0.65, 95% CI (0.49, 0.87)). Conclusion. Gender of patients is a relevant variable in mental health service use by patients with schizophrenia and other psychoses.
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Falkai P, Möller HJ. Neurobiology of schizophrenia: from outcome to pathophysiological insights. Eur Arch Psychiatry Clin Neurosci 2012; 262:93-4. [PMID: 22271345 PMCID: PMC3297739 DOI: 10.1007/s00406-012-0294-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- P. Falkai
- Department of Psychiatry and Psychotherapy, University of Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - H. -J. Möller
- Department of Psychiatry, Ludwigs-Maximililans-University Munich, Nussbaumstr. 7, 80336 Munich, Germany
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