Gender differences in schizophrenia

Katy Thakkar, Ph.D.Gender Matters in Biomedicine Forum

February 26, 2016

Salomon et al (2012) Lancet, 380: 61680-8.

Schizophrenia

Chronic and severe brain disorder

Affects approximately 21 million individuals worldwide

Associated with highest disability weight

Positive symptomsHallucinations

DelusionsThought disorder

Negative symptomsLack of pleasure

Flat affectLow motivation

Aleman et al. (2003) Archives of General Psychiatry, 60: 565-571.

Gender differences in risk

Greater disease risk in men

Male excessFemale excess

~1.4 incidence risk ratio for men versus women

Cannot rule out differences in help-seeking behavior

Not observed in developing countries

Possible differences in disease severity

that lead schizophrenia to go

unrecognized in women

Häfner et al. (1993) Psychological Medicine, 23: 925-940.Stevens (2002) American Journal of Psychiatry, 159: 713-719.

Gender differences in age of onset

Most robust gender difference is age of onset

Onset of schizophrenia is ~3-4 years later in women, not

accounted for by help-seeking

behavior

Post-menopausal

peak in women

Suggests relationship between the disorder and

changes taking place during adolescence

Sex differences in presentation

Men have more severe negative symptoms

Gur et al. (1996) Schizophrenia Research, 21: 1-12.

Stevens (2002) American Journal of Psychiatry, 159: 713-719. (Review)Kulkarni et al (2012) Current Opinion in Psychiatry, 25: 89-95. (Review)

Protective effect of estrogen?

Reduced disease risk, later illness onset and post-menopausal peak attributed to protective effects of

estrogen

Protective effect of estrogen

Estrogen has effects on D2, NMDA and GABA receptors in rats

Estrogen therapy shows positive effects in both men and women

Schizophrenia symptoms, but not depressive symptoms, are associated with estrogen levels and vary over the menstrual cycle in women