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Gender differences in schizophrenia
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Gender differences in schizophrenia G.L. Haas*, J.A. Sweeney, D.A. Hien, D. Goldman, Department of Psychiaty, University of Pittsbqh,
M. Deck
PA 15213, U.S.A.
Background: Gender differences in schizophrenia span a broad range of clinical parameters, including age of onset, premorbid history, intermorbid social and occupational adjustment, and course of illness characteristics. The cumulative clinical data suggest a more benign form of disorder among females, accompanied by fewer core deficit features and less neurocognitive impairment. Little, however, is yet known regarding the etiology or associated pathophysiology of such gender-related heterogeneity of the disorder. The purpose of this prospective study is to assess the nature of sex differences in symptomatology, neurocognitive and neuroanatomic features of schizophrenia, with a focus on differences across the early (first episode) versus later (5 years or longer ill) stages of illness. A second objective is to examine the relationship of sex-related clinical features to: 1) possible etiologic features including obstetric/perinatal complications and family history variables, 2) neuropsychologic and neurophysiologic (SPEM) deficits, and 3) neuroanatomic (VBR) features. Methods: A series of consecutive-admission, first-episode (N = 63), and later-course-of-illness (N = 93) inpatients with DSM-III-R schizophrenia, schizoaffective and schizophreniform disorders were assessed on sociodemographic, clinical (BPRS, GAS, SAPS and SANS), neurocognitive, and neuroanatomic (VBR) measures. Results: The first-episode group showed no sex differences in clinical symptoms or neurocognitive features, although there were differences in onset-of-illness characteristics, showing earlier age of onset of psychotic symptoms (p < 0.04) and age of first medication (p < 0.02), in males. Sex differences in symptomatology and neurocognition were restricted to the later-course-of illness patients, with males showing greater deficit on cognitive measures of verbal recognition and recall memory (p < 0.02), verbal fluency (p < 0.04), and the digit symbol test, a measure of verbal encoding and psychomotor speed (p < 0.01). Evidence of more severe negative symptomatology in males was shown on the SANS measures of affective flattening (p < 0.05) and alogia (p < 0.07). Interestingly, these longer-ill males also showed greater left, than right, cerebral ventricular area (p < 0.05). Conclusions: Results suggest that a more severe syndrome, characterized by negative symptoms and core deficit features, is more prominent among males and is more evident during the later phase of the illness. One implication of these findings may be that males may show a more progressive, deteriorating course of illness associated with greater dominant hemisphere abnormalities.
Thought disorder in the siblings of schizophrenic patients J.K. Hall, M.F. Pogue-Geile,*
A.H. Garrett, J.J. Brunke
Department of Psychology, Universiv of Pittsburgh Pittsburgh, PA 15260, USA.
Since thought disorder is a common and important feature of clinical schizophrenia, mildly disordered thinking may also be present in genetically susceptible, but non-schizophrenic relatives of schizophrenic patients. The identification of such unexpressed genotypes would be an important contribution to genetic segregation and linkage studies. Therefore, in this study we sought to use measures of thought disorder to identify a liability for schizophrenia in the biological siblings of schizophrenic patients. Subjects were 40 RDC schizophrenic outpatients, 40 of their biological siblings, 40 never-psychiatrically-ill control probands, and 40 of their biological siblings. The well control probands were matched with the patient siblings on age, sex, race and education. Two different ratings of thought disorder were made from responses to the Proverbs Test: concrete thinking (a measure of negative thought disorder) and bizarre-idiosyncratic thinking (a measure of positive thought disorder). Both measures of thought disorder were rated reliably (rs > 0.70) and blind to group membership. The results showed that: 1) replicating previous findings, schizophrenic patients were significantly more thought disordered than controls on both measures (ps < 0.001). 2) Interestingly, schizophrenic patients and their siblings did not differ significantly on either measure of thought disorder (ps > 0.14). 3) Overall, patient siblings were significantly more thought disordered than matched controls on both measures (ps c 0.01). 4) Perhaps most importantly, even those siblings of schizophrenic patients without psychiatric diagnoses them-
Gender differences in schizophrenia G.L. Haas*, J.A. Sweeney, D.A. Hien, D. Goldman, Department of Psychiaty, University of Pittsbqh,
M. Deck
PA 15213, U.S.A.
Background: Gender differences in schizophrenia span a broad range of clinical parameters, including age of onset, premorbid history, intermorbid social and occupational adjustment, and course of illness characteristics. The cumulative clinical data suggest a more benign form of disorder among females, accompanied by fewer core deficit features and less neurocognitive impairment. Little, however, is yet known regarding the etiology or associated pathophysiology of such gender-related heterogeneity of the disorder. The purpose of this prospective study is to assess the nature of sex differences in symptomatology, neurocognitive and neuroanatomic features of schizophrenia, with a focus on differences across the early (first episode) versus later (5 years or longer ill) stages of illness. A second objective is to examine the relationship of sex-related clinical features to: 1) possible etiologic features including obstetric/perinatal complications and family history variables, 2) neuropsychologic and neurophysiologic (SPEM) deficits, and 3) neuroanatomic (VBR) features. Methods: A series of consecutive-admission, first-episode (N = 63), and later-course-of-illness (N = 93) inpatients with DSM-III-R schizophrenia, schizoaffective and schizophreniform disorders were assessed on sociodemographic, clinical (BPRS, GAS, SAPS and SANS), neurocognitive, and neuroanatomic (VBR) measures. Results: The first-episode group showed no sex differences in clinical symptoms or neurocognitive features, although there were differences in onset-of-illness characteristics, showing earlier age of onset of psychotic symptoms (p < 0.04) and age of first medication (p < 0.02), in males. Sex differences in symptomatology and neurocognition were restricted to the later-course-of illness patients, with males showing greater deficit on cognitive measures of verbal recognition and recall memory (p < 0.02), verbal fluency (p < 0.04), and the digit symbol test, a measure of verbal encoding and psychomotor speed (p < 0.01). Evidence of more severe negative symptomatology in males was shown on the SANS measures of affective flattening (p < 0.05) and alogia (p < 0.07). Interestingly, these longer-ill males also showed greater left, than right, cerebral ventricular area (p < 0.05). Conclusions: Results suggest that a more severe syndrome, characterized by negative symptoms and core deficit features, is more prominent among males and is more evident during the later phase of the illness. One implication of these findings may be that males may show a more progressive, deteriorating course of illness associated with greater dominant hemisphere abnormalities.
Thought disorder in the siblings of schizophrenic patients J.K. Hall, M.F. Pogue-Geile,*
A.H. Garrett, J.J. Brunke
Department of Psychology, Universiv of Pittsburgh Pittsburgh, PA 15260, USA.
Since thought disorder is a common and important feature of clinical schizophrenia, mildly disordered thinking may also be present in genetically susceptible, but non-schizophrenic relatives of schizophrenic patients. The identification of such unexpressed genotypes would be an important contribution to genetic segregation and linkage studies. Therefore, in this study we sought to use measures of thought disorder to identify a liability for schizophrenia in the biological siblings of schizophrenic patients. Subjects were 40 RDC schizophrenic outpatients, 40 of their biological siblings, 40 never-psychiatrically-ill control probands, and 40 of their biological siblings. The well control probands were matched with the patient siblings on age, sex, race and education. Two different ratings of thought disorder were made from responses to the Proverbs Test: concrete thinking (a measure of negative thought disorder) and bizarre-idiosyncratic thinking (a measure of positive thought disorder). Both measures of thought disorder were rated reliably (rs > 0.70) and blind to group membership. The results showed that: 1) replicating previous findings, schizophrenic patients were significantly more thought disordered than controls on both measures (ps < 0.001). 2) Interestingly, schizophrenic patients and their siblings did not differ significantly on either measure of thought disorder (ps > 0.14). 3) Overall, patient siblings were significantly more thought disordered than matched controls on both measures (ps c 0.01). 4) Perhaps most importantly, even those siblings of schizophrenic patients without psychiatric diagnoses them-