Sex Differences in Clinical and Functional Outcomes among Patients Treated in an Early Intervention Service for Psychotic Disorders: An Observational Study

Dama, Manish; Veru, Franz; Schmitz, N.; Shah, Jai; Iyer, Srividya N.; Joober, Ridha; Malla, Ashok

doi:10.1177/0706743719854069

Cited by 18 publications

(20 citation statements)

References 51 publications

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“…Compared with 41% of the men, 61% of the women with schizophrenia showed a period of recovery at some point during the 20-year period. Dama et al 7 suggested that some men may need more than 2 years of EIS to achieve good clinical outcomes and effectively improve their overall functioning. We suggest that patients receiving EIS beyond 3 years may continue to experience further improvements in negative symptoms and functioning, resulting in increased rates of recovery.…”

Section: Discussionmentioning

confidence: 99%

“…A study carried out in Hong Kong with young people suffering from an FEP 6 found notable sex differences in functional outcomes, specifically in terms of higher levels of functioning in women (i.e., higher proportion of fulltime employment) within the initial 3 years of Early Intervention Services (EIS). However, in a recent observational study, Dama et al 7 , found that sex differences in outcomes among patients treated over 2 years in an EIS for psychosis in Canada could be largely affected by the disparity of other factors that exist between the two sexes (i.e., childhood and early adolescent premorbid adjustment, and age at onset of psychosis). In the Danish OPUS trial, designed for 2-, 5-, and 10-year follow-ups, it was found that almost 30% of all FEP patients improved their outcomes between 5-year and 10-year follow-ups, indicating that improvement is still possible late in illness course 8,9 .…”

Section: Introductionmentioning

confidence: 99%

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Understanding sex differences in long-term outcomes after a first episode of psychosis

et al. 2020

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While sex differences in schizophrenia have long been reported and discussed, long-term sex differences in outcomes among first episode of psychosis (FEP) patients in terms of the efficacy of Early Intervention Services (EIS) has been an under-explored area. A total of 209 FEP patients (95 females and 114 males) were reassessed after a time window ranging from 8 to 16 years after their first contact with an EIS program (PAFIP) that we will call the 10-year PAFIP cohort. Multiple clinical, cognitive, functioning, premorbid, and sociodemographic variables were explored at 1-year, 3-year and 10-year follow-ups. At first contact, females were older at illness onset, had higher premorbid adjustment and IQ, and were more frequently employed, living independently, and accompanied by a partner and/or children. Existence of a schizophrenia diagnosis, and cannabis and alcohol consumption were more probable among men. During the first 3 years, women showed a significantly better response to minimal antipsychotic dosages and higher rates of recovery than men (50% vs. 30.8%). Ten years later, more females continued living independently and had partners, while schizophrenia diagnoses and cannabis consumption continued to be more frequent among men. Females also presented a lower severity of negative symptoms; however, functionality and recovery differences did not show significant differences (46.7% vs. 34.4%). Between the 3- and 10-year follow-up sessions, an increase in dosage of antipsychotics was observed. These results suggest that the better outcomes seen among women during the first 3 years (while they were treated in an EIS) were in the presence of more favourable premorbid and baseline characteristics. After an average period of 10 years, with the only difference being in negative symptoms course, outcomes for women approximated those of men, drawing particular attention to the increase in dosage of antipsychotic medication once FEP patients were discharged from the EIS program towards community-based services. These findings help to pose the question of whether it is advisable to target sexes and lengthen EIS interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Understanding sex differences in long-term outcomes after a first episode of psychosis

et al. 2020

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“…Robust sex disparities are recognized in schizophrenia incidence, age of onset, risk factors, symptomatology, and disease course [ 1 ▪▪ ]. Men experience more severe negative and cognitive symptoms and perform worse on social functioning, whereas affective symptoms, self-harm, and suicide attempts are more frequent among women [ 1 ▪▪ , 2 , 3 ]. This different presentation can cause diagnostic delay in women [ 1 ▪▪ ].…”

Section: Introductionmentioning

confidence: 99%

Estrogens in schizophrenia: progress, current challenges and opportunities

Brand

Boer

Sommer

2021

Current Opinion in Psychiatry

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Purpose of review Schizophrenia is a heterogeneous psychiatric disorder with a different, but not necessarily milder clinical presentation in women as compared to men. These sex differences have largely been attributed to the protective role of estrogens. This article reviews the current state of estrogen research in schizophrenia. Recent findings Estrogens regulate important pathophysiological pathways in schizophrenia, including dopamine activity, mitochondrial function, and the stress system. Estrogen deficiency is common in both sexes and is associated with increases in psychotic symptoms. Hyperprolactinemia causes secondary estrogen deficiency and can be a reaction to stress, or secondary to prolactin-raising antipsychotics. Therefore, prolactin-sparing antipsychotics should be preferred especially in premenopausal women, who are more prone to hyperprolactinemia. Premenopausal women furthermore require lower doses of antipsychotics than men, since estrogens raise the availability and efficacy of antipsychotics. Summary The past years have established the importance of estrogens in the pathophysiology of schizophrenia and have shown its relevance to clinical practice through its influence on antipsychotic drug efficacy. Future research should focus on the neurobiological and clinical effect of contraceptives in premenopausal women with schizophrenia. Furthermore, the potential of estrogen-like augmentation with raloxifene and phytoestrogens in schizophrenia should be established in the coming years.

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“…Data on the duration of untreated psychosis in men and women are contradictory. In some studies, this duration in men has been shown to be significantly higher (Cohen et al, 2000; Dama et al, 2019; Pu et al, 2019), while it does not differ in others (Choi et al, 2009; Hui et al, 2014; Segarra et al, 2012). The age of the first hospitalization and the duration of untreated psychosis depends not only on the age of onset but also additionally on an environmental factor, such as the diagnosis age, social support of the patient, socio‐cultural and socio‐economic factors, knowledge about the disease, differences in health systems and state support (Häfner, 2019; Hui et al, 2014).…”

Section: Discussionmentioning

confidence: 95%

“…A study by Pang, concentrating on symptoms remission after 3 months, 6 months and 1 year showed that women have a better course of the disease (Pang et al, 2016). Dama et al (2019) showed that women were more likely to achieve remission of symptoms than men after 2 years of treatment. Our study did not show explicit sex differences, only for the G subscale in PANSS and DSM‐5, where the difference in scores before and after treatment differed by 3 and 1, respectively.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in social functioning of patients with schizophrenia depending on the age of onset and severity of the disease

Zorkina

Morozova

Abramova

et al. 2020

Early Intervention Psych

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Aim Schizophrenia manifests differently in women and men. This disease starts at a young age, leads to disability at working age. The aim of our work was to study sex differences, association between social factors and different parameters of the clinical picture and the course of the disease. Methods This study was performed using population of Russian patients (men: 345, women: 310). Patients were examined using DSM‐V, Bush‐Francis catatonia rating scale (BFCRS), Positive and Negative Syndrome Scale (PANSS), 4‐Items Negative Symptoms Assessment (NSA‐4) and Frontal Assessment Battery (FAB). Results Sex differences were mainly shown through negative symptoms, which were more severe in male patients. Men were shown to experience a decrease in social functioning and earlier age of onset. A positive family history further influenced negative symptoms and age of onset. When comparing scores before and after inpatient treatment (4 weeks), sex differences were not so pronounced. Female patients and patients with high levels of education, no conflictual relationship with family and active labour activity showed a later age of onset of the prodromal events and manifestation age. The decrease in the number of social contacts correlated with lower age of disability. The association between social factors and the severity of psychotic symptoms was shown across DSM‐V, PANSS, NSA‐4 and FAB, but not for BFCRS. Social factors were associated with negative symptoms of schizophrenia, but not with positive. Conclusion For successful treatment of patients with schizophrenia, the discussed factors must be considered and schizophrenia treatment methods should be primarily aimed at improving social functioning.

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Sex Differences in Clinical and Functional Outcomes among Patients Treated in an Early Intervention Service for Psychotic Disorders: An Observational Study

Abstract: Les diffé rences entre les sexes dans les ré sultats cliniques et fonctionnels de patients traité s dans un service d'intervention pré coce pour troubles psychotiques : une é tude par observation

Cited by 18 publications

References 51 publications

Understanding sex differences in long-term outcomes after a first episode of psychosis

Understanding sex differences in long-term outcomes after a first episode of psychosis

Estrogens in schizophrenia: progress, current challenges and opportunities

Sex differences in social functioning of patients with schizophrenia depending on the age of onset and severity of the disease

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