Am J Psychiatry 1997; 154:475-482
Copyright © 1997 by American Psychiatric Association
Age at onset and gender of schizophrenic patients in relation to neuroleptic resistance
HY Meltzer, J Rabinowitz, MA Lee, PA Cola, R Ranjan, RL Findling and PA Thompson
Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, USA. herbert.meltzer@mcmail.vanderbilt.edu
OBJECTIVE: The age at onset of schizophrenia for males has usually but not
always been reported to be less than that for females. Early onset has also
been associated with poor response to neuroleptic treatment and worse
long-term outcome. The authors compared age at onset in
neuroleptic-resistant and -responsive schizophrenic patients to determine
whether the gender difference in age at onset is related to response to
neuroleptic treatment. METHOD: The subjects were 322 patients with
schizophrenia or schizoaffective disorder who were consecutively admitted
to a university hospital-based research program. RESULTS: Analysis of
variance showed significant relationship between age at onset and both
gender and longterm responsivity to neuroleptic drugs. The mean ages at
onset in the neuroleptic-responsive men (mean = 21.2 years, SD = 6.1, N =
75), neuroleptic-resistant men (mean = 19.4 years, SD = 4.7, N = 119), and
neuroleptic-resistant women (mean = 20.1 years, SD = 6.3, N = 77) were
fairly similar, whereas that of the neuroleptic-responsive women (mean =
24.2 years, SD = 8.7, N = 51) was significantly greater than for all other
groups. A simple effects model indicated that male and female
neuroleptic-resistant patients did not differ significantly in mean age at
onset, whereas male and female neuroleptic-responsive patients did. The
effect of gender and neuroleptic responsivity on age at onset was related
to schizophrenic subtype. CONCLUSIONS: These results confirm previous data
indicating neuroleptic resistance is associated with early onset. The
finding that the difference in age at onset between males and females is
smaller in neuroleptic-resistant patients than in neuroleptic-responsive
patients suggests that neuroleptic-resistant patients differ premorbidly as
well as after onset of illness.
