Sex differences in schizophrenia relevant to clinical care

ABSTRACT

Introduction: Most medical diagnoses present somewhat differently in men and women, more so at specific periods of life. Treatment effects may also differ. This is true for schizophrenia, where premorbid effects are experienced earlier in life in boys than in girls, and where symptoms and outcomes differ.

Areas covered: This review does not cover all the differences that have been reported between men and women but, instead, focuses on the ones that carry important implications for clinical care: effective antipsychotic doses, medication side effects, symptom fluctuation due to hormonal levels, comorbidities, and women’s requirements for prenatal, obstetric, postpartum, and parenting support.

Expert opinion: Of consequence to schizophrenia, sex-biased genes, epigenetic modifications, and sex steroids all impact the structure and function of the brain. Furthermore, life experiences and social roles exert major sex-specific influences. The co-morbidities that accompany schizophrenia also affect men and women to different degrees. This review offers several examples of sex-specific intervention and concludes that gold standard treatment must look beyond symptoms and address all the physiologic, psychologic, and social role needs of men and women suffering from this psychiatric disorder.

KEYWORDS:

• Schizophrenia
• sex/gender differences
• genes
• hormones
• treatment

Article highlights

• Most illnesses present somewhat differently in men and women

• This is due sex-biased genes, epigenetic modifications, and different sets of exposures during life, either those elicited by genes or those imposed because of tradition

• Males are more vulnerable than females to adversity in utero, are exposed to more obstetric complications and have more difficulties than girls prior to the expression of schizophrenia

• An early onset of psychosis in males disadvantages them further with respect to schooling, employment, friendships, intimate relationships

• Symptoms of schizophrenia differ to some extent between men and women

• Treatment strategies need to take sex/gender into account

• Women’s symptoms are affected by hormonal changes throughout life

• Clinical care needs to target reproductive issues such as sex, contraception, abortion, adoption, prenatal care, pregnancy and postpartum care, menopausal care

• Clinicians need to devote time and focus on parenting issues in schizophrenia

• Schizophrenia is associated with a variety of comorbidities that increase mortality in this population. Some comorbidities are more associated with women, some with men

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.