A comparative profile analysis of neuropsychological function in men and women with schizotypal personality disorder☆
Introduction
Studies of gender differences in schizophrenia indicate a less severe form of the disorder in females, who tend to exhibit later age of disease onset, better premorbid history, more positive and fewer negative symptoms, fewer structural brain abnormalities and a better response to neuroleptic medications (e.g., Tamminga, 1997; Goldstein and Levine, 2000). Some studies addressing neuropsychological performance in schizophrenia suggest that women exhibit less severe cognitive deficits than men (Seidman et al., 1997, Goldstein et al., 1998), although not all studies are consistent with this observation (e.g., Lewine et al., 1996; Albus et al., 1997). The putative sex differences in cognitive function have been variously explained as a function of the normal sexual dimorphism of the brain or the modulating effects of estrogen on dopamine systems (Lindamer et al., 1997, Goldstein et al., 2002).
Schizotypal personality disorder (SPD) is characterized by oddities in appearance, perception and behavior that appear to represent a milder variant of schizophrenia (Kety et al., 1975). We previously studied a wide range of cognitive functions in a small group of men who met full diagnostic criteria for SPD, and found significant deficits on measures of verbal learning and abstraction (Voglmaier et al., 1997). This profile was similar to that found in patients with schizophrenia, albeit less severe, and we suggested it might reflect similar involvement of frontal and left temporal brain areas. Because our previous sample was limited to men, it was unclear if this profile was representative of cognitive function in women with SPD.
Gender differences in clinical, biological and cognitive profiles have not been studied in clinically defined SPD. Some studies have identified cognitive deficits in mixed groups of male and female SPD subjects (e.g., Cadenhead et al., 1999). Others have shown gender differences in cognitive function associated with schizotypal symptoms in healthy college students (e.g., Lubow et al., 2001, Lubow and De la Casa, 2002, Gruzelier, 1994), although the relationship of these symptoms to clinically defined SPD and schizophrenia remains unclear. The purpose of the current study was to compare the cognitive profiles of men and women with DSM-IV-defined SPD. We hypothesized: (1) that females with SPD would be impaired relative to female controls, and (2) that sex differences in SPD would be similar to those in schizophrenic subjects, in that females with SPD would have less severe cognitive deficits than males.
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Subjects
Subjects were 26 right-handed women and 31 right-handed men who met DSM-IV criteria for SPD; the groups were compared to 24 right-handed female and 23 right-handed male control subjects, respectively, who were comparable on age, ethnicity and parental socioeconomic status. Recruitment and diagnostic procedures have been described elsewhere (Voglmaier et al., 1997). Briefly, SPD subjects met full clinical diagnostic criteria based on structured clinical interview. They had no lifetime history of
Results
The z-score profile of neuropsychological functioning is presented in Fig. 1. Female and male SPDs are contrasted relative to their respective comparison groups, which are set to zero (±1 S.D.). The MANOVA revealed a significant main effect for Cognitive Domain [F(6,37)=44.74, p<0.001], a nonsignificant trend for Group [F(1,42)=8.94, p=0.072), and a significant Group×Domain interaction [F(21,242)=2.16, p<0.01], indicating different profile shapes for male and female SPD groups. Among males,
Discussion
To our knowledge, this is the first study to compare the neuropsychological profiles of clinically defined SPD in women and men. As hypothesized, the results indicate that female SPD subjects show a mild, general reduction in neuropsychological performance compared to female comparison subjects. The profile in female SPD also indicates less severe cognitive impairment than in male SPD subjects, consistent with previous studies of gender differences in schizophrenia. The female SPD profile
Acknowledgements
The authors wish to thank Anita Madan, Richard Rhoads, Jonathan Sutton and EngKeat Teh for assistance with this study.
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Supported by the Medical Research Service of the Department of Veterans Affairs (RWM), NIMH 1-R01-MH52807 (RWM), NIMH RO1 40,779 (RWM), NIMH KO2-MH-0110 (MES), NIMH MH-R29 50747 (MES), Peter Livingston Research Fellowship (MMV) and Research and Education Fund Fellowship (MMV) from the Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center.