Sex and schizophrenia: a review of gender differences

Abstract

Gender differences in schizophrenia have been noted since conceptualisation of the illness. Female onset is typically later, with a second peak post-menopause. Whilst incidence is higher in men, prevalence does not differ. Research has explored possible biopsychosocial causes of these differences. Evidence for genetic and neurodevelopmental factors is weak but support has garnered for the "estrogen hypothesis," which emphasises the possible neuroprotective effect of estrogen in women. Differences have also been attributed to a differing psychological vulnerability between men and women based on symptomatology: "negative" symptoms are more common in men, whilst "positive" symptoms differ in content between the genders. Social factors might also play a role: whilst women experience more sexual assault, socioeconomic disadvantage and provide more care for dependents, men experience less familial engagement and more environmental hostility. The relevance of gender differences in schizophrenia has meaning beyond academic interest, since they can affect treatment: recent research has, for instance, begun to explore the efficacy of estrogen therapy. The aetiology of gender differences in schizophrenia is only partially understood and more research is needed to elucidate the causal roles of Biopsychosocial factors: understanding these will ultimately improve the treatment of all who suffer from this serious mental illness.

Clinical high risk for psychosis: gender differences in symptoms and social functioning

“…Research has demonstrated gender-specific differences in terms of symptoms, course and outcome for a range of psychiatric disorders. [2][3][4][5][6] Environmental factors may also impact differently on male and female behaviour, 7 and the time-points at which environmental factors exert their influence differ between men and women. 8 As pointed out by Walder et al, 9 improved delineation of gender differences during the prodrome of psychosis may offer important value in terms of (i) elucidating theoretical models, including a dimensional perspective of psychosisproneness; (ii) understanding the neurobiological underpinnings of psychosis; and (iii) constructing algorithms for risk prediction.…”

“…1 The main gender differences reported in schizophrenia are more pronounced negative symptoms and a higher propensity to comorbid substance abuse, poorer social functioning and earlier age at onset in men, and more affective symptoms in women. 6,[10][11][12][13] To our knowledge, only three published studies have explicitly addressed the issue of gender differences in HR subjects using state-of-the-art instruments. 9,14,15 Willhite et al investigated gender differences in positive, negative and disorganized symptoms, and in social support and functioning, in 68 HR subjects (male, n = 49; female, n = 19; average age on inclusion 17 years).…”

Uncovering complex disease subtypes by integrating clinical data and imputed transcriptome from genome-wide association studies: Applications in psychiatry and cardiovascular medicine

“…While 26% of patients were males in subgroup 1, all patients were males in the remaining two subgroups. It is worth noting that gender differences in schizophrenia is well-established 33,34,35 , so imbalance in the male/female proportion across the subgroups are not entirely surprising. Compared with the remaining two subgroups, the first derived subgroup showed a trend towards high proportion of positive family history of mental illness and paranoid schizophrenia.…”

Mechanisms Underlying Auditory Hallucinations—Understanding Perception without Stimulus

“…The link between trauma, particularly early childhood and sexual abuse, and the later development of AVH appears to be a solid one [14,56,57]. Failure of inhibition may generate intrusive thoughts, which are increased in schizophrenia, despite also occurring in other mental illnesses and even in healthy individuals.…”