To determine the relative duration of the prepsychotic prodrome and the period of untreated psychosis in women and men with schizophrenia.
Method
From a larger study population, we selected 27 women and 34 men treated at 1 facility. To determine the time of first behavioural change and the time of first psychotic symptoms, we administered the Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). Subjects' mothers were interviewed using the same instrument. Time of first treatment was determined by hospital record.
Results
The first sign of behavioural disturbance occurred at approximately the same age in women and men. The prepsychotic prodrome was almost twice as long for women as for men. The duration of untreated psychosis did not differ between the 2 sexes. Substance abuse did not influence the observed difference between men and women in the duration of the prepsychotic phase. The interval between first behavioural sign and first treatment was, on average, 6 years for men and 9 years for women.
Conclusion
As-yet-unknown factors speed up the progression from nonspecific symptoms to psychosis in men or delay it in women.
AndiaAMZisookS. Gender differences in schizophrenia: A literature review. Ann Clin Psychiatry1991;3:333–40.
2.
DeLisiL. The significance of age of onset for schizophrenia. Schizophr Bull1992;18:209–315.
3.
FaraoneSVChenWJGoldsteinJMTsuangMT. Gender differences in age at onset of schizophrenia. Br J Psychiatry1994; 164:625–9.
4.
BehlCSkutellaTLezoualc'hFPostAWilmannMNewtonCJHolsboerF. Neuroprotection against oxidative stress by estrogens: Structure-activity relationship. Mol Pharmacology1997;51:535–41.
5.
DiPaoloT. Modulation of brain dopamine transmission by sex steroids. Rev Neurosci1994;5:27–42.
6.
FinkGSumnerBEHRosieRGraceOQuinnJP. Estrogen control of central neurotransmission: Effect on mood, mental state, and memory. Cell Mol Neurobiol1996;16:325–44.
7.
MillerDBAliSFO'CallaghanJPLawsSC. The impact of gender and estrogen on striatal dopaminergic neurotoxicity. Ann N Y Acad Sci1998;844:153–65.
HäfnerHMaurerKLöfflerWRiecher-RösslerA. The influence of age and sex on the onset and early course of schizophrenia. Br J Psychiatry1993;162:80–6.
12.
HäfnerHFatkenheuerBNowotnyBvan der HeidenW. New perspectives in the epidemiology of schizophrenia. Psychopathology1995;28:26–40.
13.
HäfnerHan der HeidenW. Epidemiology of schizophrenia. Can J Psychiatry1997;42:139–51.
14.
HäfnerHan der HeidenWBehrensSGattazWFHambrechtM, Löffler W, and others. Causes and consequences of the gender difference in age at onset of schizophrenia. Schizophr Bull1998;24:99–113.
15.
HambrechtMMaurerKHäfnerH. Evidence for a gender bias in epidemiological studies of schizophrenia. Schizophr Res1992;8:223–31.
16.
HäfnerHMaurerKLöfflerWFätkenheuerBan der HeidenW, Riecher-Rossler A, and others. The epidemiology of early schizophrenia: Influence of age and gender on onset and early course. Br J Psychiatry1993;164(Suppl 23):29–38.
17.
WelhamJLPembertonMRMcGrathJJ. Incorporating lag effects in register-based age-of-onset distributions in schizophrenia. Schizophr Res1996;20:125–32.
18.
FolgenovicZFolgenovic-SmalcV. Schizophrenia in Croatia: Age of onset differences between males and females. Schizophr Res1994;4:83–91.
19.
AlbusMMaierW. Lack of gender differences in age at onset in familial schizophrenia. Schizophr Res1995;18:51–7.
20.
AldaMAhrensBLitWDvorakovaMLabelleAZvolskyPJonesB. Age of onset in familial and sporadic schizophrenia. Acta Psychiatr Scand1996;93:447–50.
21.
GorwoodPLeboyerMJayMPayanCFeingoldJ. Gender and age at onset in schizophrenia: Impact of family history. Am J Psychiatry1995;152:208–12.
22.
BeiserMEricksonDFlemingJAEIaconoWG. Establishing the onset of psychotic illness. Am J Psychiatry1993;150:1349–54.
23.
SalokangasRKR. First-contact rate for schizophrenia in community psychiatric care. Eur Arch Psychiatry Clin Neurosci1993;242:337–46.
24.
LarsenTKMcGlashanTHMoeLC. First-episode schizophrenia: 1. Early course parameters. Schizophr Bull1996;22:241–56.
25.
CohenRZSeemanMVGotowiecAKopalaL. Earlier puberty as a predictor of later onset of schizophrenia in women. Am J Psychiatry1999;16:1059–64.
26.
FirstMBWilliamsJBWSpitzerRL. DTREE for Windows: The DSM IV expert computer program. N Y: Multi Health Systems Inc; 1997.
27.
HäfnerHRiecher-RösslerAHambrechtMMaurerKMeissnerS, Schmidtke A, and others. IRAOS: An instrument for the assessment of onset and early course of schizophrenia. Schizophr Res1992;6:209–23.
28.
MaurerKHäfnerH. Methodological aspects of onset assessement in schizophrenia. Schizophr Res1995;15:265–76.
29.
HambrechtMHäfnerH. Sensitivity and specificity of relatives' reports on the early course of schizophrenia. Psychopathology1997;30:12–9.
30.
HambrechtMHäfnerH. Substance abuse and the onset of schizophrenia. Biol Psychiatry1996;40:1155–63.
31.
LinszenDDingemansOLeniorM. Cannabis use and the course of schizophrenic disorders. Arch Gen Psychiatry1994;51:273–9.
32.
DavidsonMReichenbergARabinowitzJWeiserMKaplanZMarkM. Behavioural and intellectual markers for schizophrenia in apparently healthy male adolescents. Am J Psychiatry1999; 156:1328–35.
33.
ParnasJ. From predisposition to psychosis: Progression of symptoms in schizophrenia. Acta Psychiatr Scand1999;99(Suppl 395):20–9.
34.
McGorryPDEdwardsJ. The feasibility and effectiveness of early intervention in psychotic disorders: The Australian experience. International Clin Psychopharm1998;13 (Suppl 1):47S–52S.
35.
BirchwoodMToddPJacksonC. Early intervention in psychosis. Br J Psychiatry1998;172(Suppl 33):53–9.
36.
McGlashanTHJohannessenJO. Early detection and intervention with schizophrenia: Rationale. Schizophr Bull1996;22:201–22.
37.
WyattRJ. Early intervention for schizophrenia: Can the course of illness be altered?Biol Psychiatry1995;38:1–3.
