Gender differences in the prediction of 5‐year outcome in first episode psychosis

Mattsson, Maria; Flyckt, Lena; Edman, Gunnar; Nyman, Håkan; Cullberg, Johan; Forsell, Yvonne

doi:10.1002/mpr.228

Cited by 14 publications

(7 citation statements)

References 40 publications

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“…While gender has been associated with other outcome measures after FEP [34,37,38], there was no indication of influence on the late hospitalization for psychosis outcome in the current study. This illustrates the multidimensional character of outcome after FEP, and how different outcome measures may have very different dependencies on premorbid and other risk factors.…”

Section: Discussioncontrasting

confidence: 72%

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Early predictors for late hospitalizations up to 14 years after first episode psychosis

Strålin

Skott

Cullberg

2020

Soc Psychiatry Psychiatr Epidemiol

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Purpose New hospitalizations after first episode psychosis (FEP) may be viewed as an indicator of instability in a psychotic disorder. In the current study we wanted to analyse long term risk for psychosis hospitalizations after FEP. We also wanted to analyse predictors for late hospitalizations, with focus on early antipsychotic medication. Methods First episode psychosis cases were recruited to the Swedish Parachute project in 1996–1997. The program offered highly available and continuous psychosocial support and a cautious use of antipsychotic medication for 5 years from inclusion. Longitudinal data from population registers on psychiatric hospitalizations up to 14 years after inclusion were analysed. One hundred and sixty-one cases were included of the original 175 in the project. Associations with possible early predictive factors from the original project data were analysed with COX regression. Results A majority of the cases (67%) had hospitalizations in the first year after inclusion in the study. The cohort then diverged into a group (46%) with new hospitalizations for psychosis after the first year, most of them multiple times, and another group (54%) without new hospitalizations for psychosis, many without any late antipsychotic medication. Forty-two percentage of the cases had antipsychotic medication by month 12, and it was significantly associated with later psychosis hospitalizations (HR = 2.5, p value < 0.001). Conclusions The study demonstrates that a large part of FEP cases have a good outcome as measured by absence of new hospitalizations for psychosis, and that many cases may terminate antipsychotic medication within a year of FEP onset without later relapses needing hospitalizations.

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Section: Discussioncontrasting

confidence: 72%

“…Demographic data for the cohort have previously been described [20,34]. 55% of the cases were males.…”

Section: Description Of the Cohortmentioning

confidence: 99%

Early predictors for late hospitalizations up to 14 years after first episode psychosis

Strålin

Skott

Cullberg

2020

Soc Psychiatry Psychiatr Epidemiol

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“…They concluded that the association of cognitive deficits with sex may be found only in patients with better functional outcome. Mattsson et al (2007) showed the Global Assessment of Functioning (GAF; American Psychiatric Association, 1987) scores (current score and the highest score in the year before admission) to be valid 5-year outcome predictors for male patients but not for female patients. A low educational level was the primary predictor of the unfavorable outcome in women but not in men.…”

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confidence: 99%

Cognition and Global Assessment of Functioning in Male and Female Outpatients With Schizophrenia Spectrum Disorders

Karilampi

Helldin²,

Archer³

2011

Journal of Nervous &Amp; Mental Disease

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The relationship between the symptom and function subscales of the Global Assessment of Functioning (GAF) and neurocognitive test performance was studied in 195 outpatients with schizophrenia, schizoaffective disorder, or delusional disorder who were assigned to functional groups based on their sex. A composite cognition score was created based on z-scores. Stepwise multiple regression analysis was used to assess the predictive value of GAF Symptom and GAF Function on composite cognition and to check for the effect of the individual cognitive tests against the GAF subscales. Better composite cognition scores were predicted by higher function levels in male patients and by lower symptom levels in female patients. There was also a sex-specific difference in neurocognitive components, indicating that executive functioning may have a greater impact on the symptom and function profiles of male schizophrenia spectrum patients than on that of female patients. The results suggest that endophenotypes in schizophrenia may be sex-specific.

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“…Although, sex differences have been extensively described in first-episode psychosis (FEP), mixed results have been found in neurocognitive performance. For example, research has found that females demonstrate better premorbid adjustment (14,(23)(24)(25) and neurocognitive performance (14,23) than their male counterparts. Conversely, higher severity of negative symptoms and higher rates of substance use were more frequent in males (23).…”

Section: Introductionmentioning

confidence: 99%

Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: differences between males and females

Serra-Navarro

Amoretti²,

Verdolini³

et al. 2022

Front. Psychiatry

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BackgroundDeficits in psychosocial functioning are present in the early stages of psychosis. Several factors, such as premorbid adjustment, neurocognitive performance, and cognitive reserve (CR), potentially influence functionality. Sex differences are observed in individuals with psychosis in multiple domains. Nonetheless, few studies have explored the predictive factors of poor functioning according to sex in first-episode psychosis (FEP). This study aimed to explore sex differences, examine changes, and identify predictors of functioning according to sex after onset.Materials and methodsThe initial sample comprised 588 individuals. However, only adults with non-affective FEP (n = 247, 161 males and 86 females) and healthy controls (n = 224, 142 males and 82 females) were included. A comprehensive assessment including functional, neuropsychological, and clinical scales was performed at baseline and at 2-year follow-up. A linear regression model was used to determine the predictors of functioning at 2-year follow-up.ResultsFEP improved their functionality at follow-up (67.4% of both males and females). In males, longer duration of untreated psychosis (β = 0.328, p = 0.003) and worse premorbid adjustment (β = 0.256, p = 0.023) were associated with impaired functioning at 2-year follow-up, while in females processing speed (β = 0.403, p = 0.003), executive function (β = 0.299, p = 0.020) and CR (β = −0.307, p = 0.012) were significantly associated with functioning.ConclusionOur data indicate that predictors of functioning at 2-year follow-up in the FEP group differ according to sex. Therefore, treatment and preventative efforts may be adjusted taking sex into account. Males may benefit from functional remediation at early stages. Conversely, in females, early interventions centered on CR enhancement and cognitive rehabilitation may be recommended.

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Gender differences in the prediction of 5‐year outcome in first episode psychosis

Abstract: This study revealed that the predictors for poor outcome differ between male and female patients with FEP.

Cited by 14 publications

References 40 publications

Early predictors for late hospitalizations up to 14 years after first episode psychosis

Early predictors for late hospitalizations up to 14 years after first episode psychosis

Cognition and Global Assessment of Functioning in Male and Female Outpatients With Schizophrenia Spectrum Disorders

Influence of clinical and neurocognitive factors in psychosocial functioning after a first episode non-affective psychosis: differences between males and females

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