Elsevier

Schizophrenia Research

Volume 104, Issues 1–3, September 2008, Pages 237-245
Schizophrenia Research

Gender differences in symptoms, functioning and social support in patients at ultra-high risk for developing a psychotic disorder

https://doi.org/10.1016/j.schres.2008.05.019Get rights and content

Abstract

Gender differences have been widely observed in the clinical presentation, psychosocial functioning and course of illness in first-episode and chronic patients suffering from schizophrenia. However, little is known about gender differences in the psychosis prodrome. This study investigated gender differences in symptoms, functioning and social support in individuals at ultra-high-risk for developing a psychotic disorder. Sixty-eight ultra-high-risk patients were assessed at baseline, and twenty-seven returned for follow-up assessments approximately 6 and 12 months later. Clinical symptoms and functioning were assessed by clinical interview; social support was measured using a self-report questionnaire. There were no gender differences in demographic variables, symptoms or functioning at baseline. Males were found to have significantly higher levels of negative symptoms and marginally lower levels of functioning when baseline and follow-up time points were considered collectively. Additionally, females reported higher levels of social support at baseline. Differences in negative symptoms were found to mediate differences in functioning between male and female patients. This study suggests that gender based differences in symptom presentation and functional outcome may predate conversion to psychosis. Follow-up studies should examine the relationship between symptoms, functioning and social support in this population.

Introduction

Studies have consistently shown there are gender differences in age of onset, severity of negative symptoms, long-term functioning and social support for patients with schizophrenia (Angermeyer et al., 1990, Bardenstein and McGlashan, 1990, DeLisi et al., 1989, Goldstein and Link, 1988, Grossman et al., 2006, Hambrecht et al., 1992, Lindamer et al., 2003, Shtasel et al., 1992, Usall et al., 2003). Some of these differences have also been observed in individuals with schizotypal personality disorder and other schizophrenia spectrum disorders (Dickey et al., 2005, Gurrera et al., 2005). However, it is not currently known if gender differences in clinical presentation and functioning are present prior to the development of psychosis.

To date, only one study (Amminger et al., 2006) has examined gender differences in adolescents who are at ultra-high-risk (UHR) for an imminent onset of psychosis. This study found that female sex was a significant predictor of conversion to affective psychosis 2-years after ascertainment. In addition, a second study (Nordentoft et al., 2006) found that, among young adults with a diagnosis of schizotypal disorder, males had a four-fold risk for conversion to schizophrenia 1-year after enrollment when compared to females. However, the findings of this study may not be directly comparable to a UHR population since diagnosis of schizotypal disorder allows for transient symptoms at the fully psychotic level. To our knowledge, no research to date has examined whether early clinical presentation or functioning differs between UHR males and females.

The current study focused on the clinical presentation of male and female patients who are UHR for developing a psychotic disorder. The primary goal was to determine if consistent relationships between gender, age at referral, psychosocial functioning, social support, and negative symptoms that are observed across phases of psychotic illness are also present in UHR youth. Second, we wanted to determine whether differences in negative symptoms are related to differences in later functioning and course of illness in UHR youth.

Section snippets

Subjects

All research was conducted at the Staglin Music Festival Center for the Assessment and Prevention of Prodromal States (CAPPS) at the University of California, Los Angeles. UHR participants were recruited primarily by clinical referral from local mental health providers, school psychologists or counselors, and by self-referral in response to advertisements or the CAPPS website. Potential subjects were screened over the phone and told that the program was recruiting individuals who had

Demographic variables

Demographic and attrition data can be found in Table 1. There were no significant differences between male and female participants on any demographic factors at baseline. There was also no significant difference in drop-out rates between male and female participants enrolled in this study.

Information on baseline medications can be found in Table 2. There were no differences in the number of males and females taking psychiatric medications at baseline, or in the average number of medications

Discussion

Within the sample of UHR patients, males appeared to have more severe negative symptoms and lower functioning than females, when data from all three time points was examined. The absence of differences between males and females at baseline suggests that differences in negative symptoms and functioning in UHR patients may be subtle but remain stable over time. Although the sample size was very small, incorporating data from follow-up time points decreased measurement error, thus providing a more

Role of funding source

This research was supported by NIMH grants MH65079, MH066286, and 5-T32-MH14584, and by a gift from the Staglin Music Festival for Mental Health.

Contributors

Ms. Willhite formulated the hypothese, conducted all analyses and wrote the manuscript. Drs. Niendam, Bearden and O'Brien assisted in organizing the database and editing the manuscript as did Ms. Zinberg. Dr. Cannon was instrumental in organizing the study and allowing Ms. Willhite to have access to the data. Dr. Cannon also assisted in the statistical analyses and helped to edit the manuscript.

Conflict of interest

None of the authors received any funding from sources that would provide a conflict of interest with regard to this research.

Acknowledgement

The authors would like to thank Malin McKinley, Adrienne Gallet and Maria Garcia for all of their hard work and significant contributions toward the study.

References (37)

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    Regarding psychopathology, our findings were in line with a previous study of our own group that reported no gender differences in psychopathology, neither in ARMS nor in FEP patients, when corrected for multiple testing [26]. Furthermore, Willhite et al. [27] also found no significant gender differences in ratings of any of the symptoms of the Scale of Prodromal Symptoms (SOPS) in high-risk patients. A possible explanation may be that gender differences in the symptoms are so small that they can only be reliably detected in studies with very high statistical power (i.e. in very large datasets or in meta-analyses).

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