The influence of gender on the classification of psychotic disorders — a multidiagnostic approach

Abstract

A multidiagnostic approach was used prospectively to classify a sample of 176 psychotic patients. An excess of males was found with only one out of 11 systems of schizophrenia, the World Health Organization "flexible" system of schizophrenia, with an excess of females noted in 2 of 5 systems of schizoaffective disorder, the Kasanin schizoaffective system and the Feighner schizoaffective depressed category. Correlation matrices of the diagnostic categories were generated for men and women and multidimensional scaling was used to plot the distribution of diagnostic categories. In the male sample, patients appeared to cluster according to affective symptoms and the mood-congruence of psychotic symptoms. Four clusters were apparent, but were less evident in the female sample. This gender difference was given partial support by quantitative measures of concordance. It is suggested that women manifested a greater admixture of symptoms, especially mixed affective and psychotic symptoms, than men.

Competing Definitions of Schizophrenia: What Can Be Learned From Polydiagnostic Studies?

“…13 Definitions excluding affective symptoms were demonstrated to form a cluster with a higher kappa than the cluster formed by the definitions that permit them. 37 In a sample of chronic psychotic patients, the elimination of the OPCRIT item 52, ''cooccurrence ofpsychotic andaffective symptoms,'' increased the agreement of the sz spectrum disorders. 38 Among all studies of the present review comparing diagnostic concordance kappas (N = 34), values above 0.80 were found exclusively in those that included chronic psychotic patients but not in first-onset psychotic patients and mixed groups of patients (Fisher exact test: P < .005).…”

Where Are the Women in First-Episode Studies of Schizophrenia?

“…Hence, it seems unlikely that we found an excess of males with schizophrenia simply because our diagnostic approach was overly narrow. Other recent investigations that have examined either the incidence of schizophrenia (Cooper et al 1987; NiNullain et al 1987) or the diagnosis of schizophrenia generally (Copolov et al 1990) as a function of diagnostic breadth have also failed to find that narrowing the criteria necessarily leads to an excess of males. In their eight-center incidence study, Sartorius and colleagues (1986) also did not find such an effect.…”

Development of a Computerized Psychiatric Diagnostic Interview for Use by Mental Health and Primary Care Clinicians

“…Questions asked during the intake interview have been found to vary with a variety of factors including interviewer expertise, 1 and patient race 2 and gender. 3,4 The clinician's theoretical orientation (e.g., psychodynamic vs. biologic) may influence the choice of questions asked. Time pressures may shorten interview s and elim inate lines of questioning that otherwise may have been pursued.…”