Converging lines of research indicate significant sex differences in schizophrenia. Females have a more benign course, typified by later age of onset, better premorbid adjustment, more affective symptoms, fewer cognitive deficits, better neuroleptic response, shorter hospital stay, fewer relapses, lower risk for suicide, lower family Expressed Emotion (EE) and better social and work adjustment. Nevertheless, evidence of sex differences tends to be underemphasized and hypotheses concerning sex differences have rarely been investigated in a systematic, prospective study.
AIMS : This study will assess: (1) sex-related variation in the clinical symptom pattern of schizophrenia; (2) sex differences in premorbid factors and precipitants of onset; (3) sex-related parameters of posthospital recovery and relationship to family environment factors; (4) prominence of sex-related differences at early and later phases of the illness; and (5) the relative influence of neurocognitive, neuroanatomic and family environment factors in prediction of two-year recovery/relapse rates for first- admission, and more chronic, males and females. METHODS: Study 1. From a pool of approximately 1100 annual inpatient admissions, a sample of approximately 700 consecutive admission psychotic patients will be identified over a 30-month period and given a standard (SCID) interview. Patients who meet broad-band (New Haven) criteria for schizophrenia will be cross-classified on more narrow-band (RDC and DSM-III) criteria and the sex ratio will be compared across diagnostic systems to determine the extent of differential exclusion by sex. Study 2. 300 (150 early- and 150 later-phase) patients who meet DSM-III criteria for schizophrenia spectrum disorders will be assessed on premorbid, neurocognitive, neuroanatomic (VBR), and family environment measures to identify sex-related parameters of psychopathology. Study 3. The same 300 patients will be studied longitudinally in order to determine sex differences in neurocognitive, neuroanatomic and family environment factors and their relative importance in predicting recover/relapse and functioning for males and females over the two-year post-admission phase. SIGNIFICANCE: This study will contribute to (1) general knowledge and practice in the diagnosis and classification of schizophrenia; (2) understanding of the pathogenesis and course of illness; (3) increased accuracy of prognosis and selection of treatment strategies for males and females.
| Hien, D; Haas, G; Cook, H (1998) Gender differences in premorbid social adjustment and intimacy motivation in schizophrenia. J Clin Psychol 54:35-48 |
| Sweeney, J A; Haas, G L; Li, S (1992) Neuropsychological and eye movement abnormalities in first-episode and chronic schizophrenia. Schizophr Bull 18:283-93 |
