Sex differences in schizophrenia

Mental health experts believe that certain life events may be responsible for the triggers of schizophrenia in people with a genetic risk.[1][2] Twin studies have shown that it is partially hereditary, with a concordance rate of 40% in monozygotic twins, and a risk increase to 6.5% in people with an affected first degree relative.[3] Schizophrenia is 1.4 times more common in men than women.[3] The age of onset is typically late adolescence or early adulthood.[1] In women, it tends to begin later in life[3][4] and in a milder form compared to men. Childhood-onset of schizophrenia is very rare and usually happens after the age 5.[5] It can often be very difficult to differentiate from other developmental problems a child could possibly have.

Symptoms with regard to gender differences

In schizophrenia different genders often exhibit different symptoms. It was suggested that men become more passive, apathetic, and socially withdrawn from society, while women become more impulsive, outgoing, and domineering (Ellison and Hamilton). This has been known to be called role reversal because each gender shows features opposite to their stereotyped gender role.[6] More recent studies do not support this idea.[7] As well as male like behavior in females, they also tend to develop paranoid symptoms. Men, on the other hand, seem to have religious delusions and delusions of grandeur (Berner et al. 1979).

Tobacco usage

Smoking is more prevalent in people with schizophrenia (80%) than in the general population (20%).[8] However, schizophrenia is only seen as a risk factor for smoking in men, with social factors associated with mental illness contributing to increased rate of smoking in both genders.[9]

Cognitive performance and phenotype

There are differences within respect to cognitive function between male and female schizophrenic individuals. Male patients have been found to have a significant negative association between cognitive variables and the PANSS (negative symptom scale) scores. Significant decrease in immediate memory and delayed memory, language and total RBANS scores have been seen in schizophrenic patients for both genders. Males were found to have lower immediate memory, delayed memory and total RBANS scores than females, although this gender difference was also seen in the healthy control group. In female patients there were positive correlations between the positive symptom scale and immediate memory, visuospatial, and total score. Attention and language indices were negatively associated with the symptom scales. Lower education, higher negative symptoms, older age and male gender were associated with cognitive impairments in schizophrenia.[10]

Age onset within gender differences

The first hospital admission in schizophrenic patients tends to be at a younger age in males than in females, regardless of age of onset.[11] The first manifestations of schizophrenia is thought to occur at the same age in both males and females, but the time that elapses between onset and first admission to a hospital is considerably shorter in males than in females. Gender differences in age at the first hospital admission are typically due to a more acute onset in females.[12]

Social outlook

Individuals suffering from schizophrenia tend to have a different outlook on social situations, particularly in regard to eye contact and their perception of others eye contact. They have a much harder time perceiving and interpreting social cues which can make socially adaptation difficult. Schizophrenics have been found to have deficits in processing self-referential social information that may be particularly relevant to schizophrenic symptoms.[13] They often misinterpret benign, irrelevant, social cues/signals as being threatening and self-relevant which may be in result to being paranoid and having delusions which may ultimately cause a withdrawal from social interaction.[14] This abnormalities in eye contact perception were significantly associated with severe negative symptoms, poorer neurocognition, and having lower emotional intelligence.[15]

Schizophrenic's eye contact perceptions are less dichotomous than in healthy individuals. They tend to be uncertain when determining the self-referential nature of eye contact, which at times is responsible for activating biases when social signals are ambiguous. It has been found that the biases and the observed uncertainty in the gaze perception directly reflect the failures to be able to recruit critical important brain regions in things involving theory of mind in schizophrenia.[15] A possible way to help resolve this issue is to use neurobiological interventions to improve social cognition problems. The effects of neurology treatment in schizophrenia patients supports this theory. Conducting neurobiological transmissions to patients with schizophrenia has shown that the modulation of eye-contact perception by fearful emotion can be greatly reduced in schizophrenic patients.[13]

Brain shrinkage

Dr Nancy Andreasen documented progressive brain volume reductions in her patients. Andreasen took MRI brain scans of 211 schizophrenia patients. The cause of the reduction is not known, it could be the progression of schizophrenia or the current medical treatment. Certain antipsychotics have also been demonstrated to progressively reduce brain volume.[16]

References

  1. 1 2 Van Os, J.; Kapur, S. (2009). "Schizophrenia". The Lancet. 374 (9690): 635–645. doi:10.1016/S0140-6736(09)60995-8. PMID 19700006.
  2. ↑ Selten, J. P.; Cantor-Graae, E.; Kahn, R. S. (2007). "Migration and schizophrenia". Current Opinion in Psychiatry. 20 (2): 111–115. doi:10.1097/YCO.0b013e328017f68e. PMID 17278906.
  3. 1 2 3 Picchioni, M. M.; Murray, R. M. (2007). "Schizophrenia". BMJ. 335 (7610): 91–95. doi:10.1136/bmj.39227.616447.BE. PMC 1914490Freely accessible. PMID 17626963.
  4. ↑ Cullen KR, Kumra S, Regan J et al.. Atypical Antipsychotics for Treatment of Schizophrenia Spectrum Disorders. Psychiatric Times. 2008;25(3).
  5. ↑ Kumra S, Shaw M, Merka P, Nakayama E, Augustin R. Childhood-onset schizophrenia: research update. Canadian Journal of Psychiatry. 2001;46(10):923–30. PMID 11816313.
  6. ↑ Ecker, J.; Levine, J.; Zigler, E. (1973). "Impaired Sex-Role Identification in Schizophrenia Expressed in the Comprehension of Humor Stimuli". The Journal of Psychology. 83 (1st Half): 67–77. doi:10.1080/00223980.1973.9915592. PMID 4688199.
  7. ↑ Angermeyer, M. C.; Grottker, D. (1990). "Do schizophrenic psychoses lead to a reversal of sex-specific role behavior? Results of an explorative study". Psychiatrische Praxis. 17 (2): 85–90. PMID 2343069.
  8. ↑ Keltner, N. L.; Grant, J. S. (2006). "Smoke, Smoke, Smoke That Cigarette". Perspectives in Psychiatric Care. 42 (4): 256–261. doi:10.1111/j.1744-6163.2006.00085.x. PMID 17107571.
  9. ↑ Johnson, J.; Ratner, P.; Malchy, L.; Okoli, C.; Procyshyn, R.; Bottorff, J.; Groening, M.; Schultz, A.; Osborne, M. (2010). "Gender-specific profiles of tobacco use among non-institutionalized people with serious mental illness". BMC Psychiatry. 10: 101. doi:10.1186/1471-244X-10-101. PMC 3002315Freely accessible. PMID 21118563.
  10. ↑ Han, M.; Huang, X. F.; Chen, D. C.; Xiu, M. H.; Hui, L.; Liu, H.; Kosten, T. R.; Zhang, X. Y. (2012). "Gender differences in cognitive function of patients with chronic schizophrenia". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 39 (2): 358–363. doi:10.1016/j.pnpbp.2012.07.010. PMID 22820676.
  11. ↑ Häfner, H.; Riecher, A.; Maurer, K.; Löffler, W.; Munk-Jørgensen, P.; Strömgren, E. (2009). "How does gender influence age at first hospitalization for schizophrenia? A transnational case register study". Psychological Medicine. 19 (4): 903–918. doi:10.1017/S0033291700005626. PMID 2594886.
  12. ↑ Angermeyer, M. C.; Kühn, L. (1988). "Gender differences in age at onset of schizophrenia. An overview". European archives of psychiatry and neurological sciences. 237 (6): 351–364. doi:10.1007/BF00380979. PMID 3053193.
  13. 1 2 Harvey, P. O.; Lee, J.; Horan, W. P.; Ochsner, K.; Green, M. F. (2011). "Do patients with schizophrenia benefit from a self-referential memory bias?". Schizophrenia Research. 127 (1–3): 171–177. doi:10.1016/j.schres.2010.11.011. PMC 3050992Freely accessible. PMID 21147520.
  14. ↑ Sullivan, R. J.; Allen, J. S. (1999). "Social deficits associated with schizophrenia defined in terms of interpersonal - Machiavellianism". Acta Psychiatrica Scandinavica. 99 (2): 148–154. doi:10.1111/j.1600-0447.1999.tb07213.x. PMID 10082191.
  15. 1 2 Stahl, S. M.; Buckley, P. F. (2007). "Negative symptoms of schizophrenia: A problem that will not go away". Acta Psychiatrica Scandinavica. 115 (1): 4–11. doi:10.1111/j.1600-0447.2006.00947.x. PMID 17201860.
  16. ↑ Long-term Antipsychotic Treatment and Brain Volumes February 07, 2011
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