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

Willhite, Rachael; Niendam, Tara A.; Bearden, Carrie E.; Zinberg, Jamie; O’Brien, Mary P.; Cannon, Tyrone D.

doi:10.1016/j.schres.2008.05.019

Cited by 86 publications

(72 citation statements)

References 35 publications

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“…Another smaller, recent CHR study also demonstrated more negative symptoms among high-risk males than females (Corcoran et al, 2011). These findings replicate and extend earlier retrospective findings from smaller high-risk and prodromal studies (Willhite et al, 2008). …”

Section: Introductionsupporting

confidence: 89%

Sexual dimorphisms and prediction of conversion in the NAPLS psychosis prodrome

Walder

Holtzman

Addington

et al. 2013

Schizophrenia Research

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Sex differences in age at onset, symptomatology, clinical course (see Walker, Walder, Lewine and Loewy, 2002) and functional impairment (Thorup et al., 2007) are well documented in psychosis. The general pattern of findings is that males manifest an earlier onset, more severe symptoms and poorer prognosis than females. Limited studies examining individuals at clinical high-risk (CHR) suggest a similar pattern of sexual dimorphism (Holtzman et al., in review; Corcoran et al., 2011). As part of the North American Prodrome Longitudinal Study (NAPLS), the current study prospectively examined sexual dimorphisms differences in relationships among CHR symptoms, childhood (premorbid) academic and social functioning, baseline social and role functioning, and conversion to psychosis. Subjects included 276 (113F/163M) CHR NAPLS participants (ages 12–36.8 years). All measures/criteria were assessed at baseline except conversion status, assessed at 6-month intervals up to 30 months. Results show sex differences in baseline social and role functioning (though not in early childhood adjustment) that predate psychosis onset, with sexually dimorphic patterns in relation to prodromal symptoms. Among male (but not female) CHRs, baseline social functioning and positive prodromal symptoms predicted conversion. These findings help elucidate early course of vulnerability for, and maximally sensitive and specific etiological and prediction models of, psychosis conversion. Findings highlight the importance of considering sexually differentiated predictors of longitudinal course and outcome, in the context of emerging risk profiles. This may optimize efforts at early identification and individually tailored preventive interventions targeting different neurobiological markers/systems and/or cognitive-behavioral approaches. We speculate a contemporary, multidimensional model of psychosis risk that posits a role of sexually dimorphic, genetically linked influences that converge with a modulating role of gonadal hormones (see Walder et al., 2012) across a temporally sensitive neurodevelopmental trajectory towards conferring risk.

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Section: Introductionsupporting

confidence: 89%

Sexual dimorphisms and prediction of conversion in the NAPLS psychosis prodrome

Walder

Holtzman

Addington

et al. 2013

Schizophrenia Research

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“…However, despite comparatively better social and role function, the females were still at appreciable risk for psychosis, as two of the twelve (17%) developed psychosis. Of note, a general pattern of superior functioning in females has been described across early stages of schizophrenia – in other CHR cohorts 12–13 and among first episode psychosis patients 14 .…”

Section: Discussionmentioning

confidence: 80%

The Subjective Experience of Youths at Clinically High Risk of Psychosis: A Qualitative Study

Ben‐David¹,

Birnbaum²,

Eilenberg³

et al. 2014

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Objective Understanding the experience of individuals across stages of schizophrenia is important for development of services to promote recovery. As yet, little is known about the experience of individuals who exhibit prodromal symptoms of schizophrenia. Methods Audiotaped interviews were conducted with 27 participants at clinical high risk (CHR) for psychosis (15 males; 12 females; mean age 21; ethnically diverse). Phenomenological qualitative research techniques of coding, consensus, and comparison were used. Results Emergent themes differed by gender. Themes for males were feeling abnormal or “broken”; focus on going “crazy”; fantasy and escapism; and alienation and despair, with a desire for relationships. Themes for females were psychotic illness in family members; personal trauma; struggle with intimate relationships; and career and personal development. Conclusions The finding of relative social engagement and future-orientation of females identified as at risk for psychosis is novel, and has implications for outreach and treatment.

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“…Several investigations support the fact that there are gender differences in age of onset, severity of symptoms and long-term functioning in schizophrenia, with different patterns of prodromal symptoms beginning before the disorder onset [29,30]. As Lewine [31] has already indicated, several aspects of schizophrenia, such as the onset, may be best pursued from a biological (sex difference) perspective, whereas a sociocultural perspective, including gender differences, may be better to understand different aspects, such as neuropsychological functioning.…”

Section: Schizophreniamentioning

confidence: 96%