Sex differences in schizophrenia, bipolar disorder, and post‐traumatic stress disorder: Are gonadal hormones the link?

Abstract

In this review, we describe the sex differences in prevalence, onset, symptom profiles, and disease outcome that are evident in schizophrenia, bipolar disorder, and posttraumatic stress disorder. Women with schizophrenia tend to exhibit less disease impairment than men. By contrast, women with post-traumatic stress disorder are more affected than men. The most likely candidates to explain these sex differences are gonadal hormones. This review details the clinical evidence that oestradiol and progesterone are dysregulated in these psychiatric disorders. Notably, existing data on oestradiol, and to a lesser extent, progesterone, suggest that low levels of these hormones may increase the risk of disease development and worsen symptom severity. We argue that future studies require a more inclusive, considered analysis of gonadal steroid hormones and the intricacies of the interactions between them, with methodological rigour applied, to enhance our understanding of the roles of steroid hormones in psychiatric disorders.

No basal or drug‐induced sex differences in striatal dopaminergic levels: a cluster and meta‐analysis of rat microdialysis studies

“…In recent years, increasing attention is rightfully paid to identify biological sex differences associated with neurological and psychiatric disorders (Smith and Dahodwala, 2014;Gogos, et al, 2019;Goldstein, et al, 2019;Manwani and McCullough, 2019). Thereby, the spatiotemporal scale of consideration and context are critical.…”

X-linked diseases: susceptible females

“…Sex differences in human disease are usually attributed to sex specific life experiences, and sex hormones that influence the function of susceptible genes throughout the genome. [1][2][3][4][5] Such factors do account for some dissimilarities. However, a major cause of sex-determined expression of disease has to do with differences in how males and females transcribe their gene-rich human X chromosomes, which is often underappreciated as a cause of sex differences in disease.…”

The assessment of psychopathological symptoms and the course of schizophrenia depending on gender, duration of the disease, somatic comorbidity and suicide attempts

“…Schizophrenia occurs equally often in men and women, but the course of the disease varies greatly depending on the gender (Saha et al, 2005;Charlson et al, 2018). The differences, confirmed in many scientific studies, include the earlier onset of the disease in men (McGrath et al, 2004;Galderisi et al, 2012;Sun et al, 2016;Gogos et al, 2019), which is usually at least a few years ahead of the onset of the disease in wom en, as well as the greater propensity to addiction and generally worse longterm prognosis in men (Koster et al, 2008;Zhang et al, 2012). Studies on the differences in the psychopathological picture are not fully consist ent, which raises the need for further research.…”