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Am J Psychiatry 1995; 152:698-703
Copyright © 1995 by American Psychiatric Association
Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients
S Szymanski, JA Lieberman, JM Alvir, D Mayerhoff, A Loebel, S Geisler, M Chakos, A Koreen, D Jody and J Kane
Hillside Hospital, Glen Oaks, NY 11004, USA.
OBJECTIVE: Gender differences in onset of illness, response to treatment,
course, and biologic measures have been consistently reported in patients
with chronic schizophrenia. Patients with first- episode schizophrenia were
examined to determine whether gender differences also occur in these
patients. METHOD: Fifty-four neuroleptic-naive schizophrenic patients (29
men and 25 women) were studied beginning in an initial stage of the first
hospitalization for psychosis while undergoing treatment with a
standardized medication regimen. Before antipsychotic drug treatment and
during 1 year of follow-up each patient was rated on the Schedule for
Affective Disorders and Schizophrenia--Change Version (psychosis and
disorganization items), Scale for the Assessment of Negative Symptoms,
Clinical Global Impression, modified Simpson Tardive Dyskinesia Scale, and
Simpson-Angus Rating Scale for extrapyramidal side effects. Methylphenidate
challenge testing was done at study entry. Plasma neuroleptic, homovanillic
acid (HVA), and prolactin levels were determined weekly for the first 6
weeks. RESULTS: The female schizophrenic patients had a later onset and
better treatment response than the men. Plasma HVA levels at baseline and
week 1 and changes in prolactin levels from baseline to weeks 1 through 6
were greater among the women. CONCLUSIONS: Gender differences in onset and
degree of treatment response in first-episode schizophrenic patients are
similar to those of chronic patients and are apparent at early stages of
the illness. The greater pharmacologic responsivity of the female patients,
as indicated by the neuroendocrine results, is consistent with the gender
difference in degree of symptom improvement with medication.
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