Time for a Gender Sensitive Approach to Treatment?
Although the lifetime incidence of schizophrenia is roughly similar in men and women it remains the case that men seem to have a worse general outlook than women. More men than women are diagnosed with schizophrenia between the ages of 15 to 25 and they tend to show higher levels of social withdrawal, self-neglect and substance misuse. Men with schizophrenia also rate their life satisfaction lower than women.
Women tend to experience less severe symptoms and their stay in hospital tends to be of shorter duration. Men tend to experience higher levels of deficit symptoms such as low motivation and they appear to have greater difficulty with decision making and planning. Mortality in women from unrelated incidents such as suicide is also much lower.
The question is, why does schizophrenia seem to hit men the hardest? Various reasons for these gender differences have been put forward. Men, for example, are more prone to head trauma and there is an increased risk of exposure to birth injuries in males. Men might come to the attention of the medical profession earlier because of the nature of their behavior during a psychotic episode. It has also been suggested that in women there is the possibility of initial misdiagnosis as bipolar disorder or depression. Biologically there seem to be differences in the structure of the male brain. Imaging studies have shown that an area of the brain know as the inferior parietal lobule (IPR) acts as a neural crossroads. Schizophrenic males have up to a 16% smaller IPR than healthy males. This whole area of the brain may, in some way, be miswired in schizophrenia.
On average, schizophrenia tends to affect women around three or four years later than men. Some attention has been given to the protective function of the female hormone estrogen as several studies have pointed out that it seems to have antipsychotic effects. It has been suggested that estrogen may both delay the onset and reduce the severity of schizophrenia in women.
Delayed onset of symptoms may be a critical factor in terms how well the individual is able to adapt to the disease. For example, we know that in the normal course of development girls mature much earlier than boys and develop symptoms of schizophrenia much later. This provides a more solid foundation of normal development and perhaps something of a reference point for women that men lack. In one study by the Central Institute for Mental Health in Germany, it was noted that women have a much stronger tendency towards social conformity and therapy compliance.
Despite a long-standing interest by clinicians regarding gender differences in schizophrenia the main approach to treatment remains antipsychotic medication. To date, prescription guidelines do not differentiate between men and women even though it is known that the dynamics of drug interaction vary between the sexes. Isn’t it time for a more gender sensitive approach to treatment?
Hafner, H. "Gender differences in schizophrenia". Psychoneuroendocrinology. vol 28 pp. 17-54 (2003) www.sciencedirect.com
Riecher-Rössler, Anita. Medscape. 2004. 9 Jun 2008 <http://www.medscape.com/viewarticle/473295>.