Lindamer L A, Lohr J B, Harris M J, McAdams L A, Jeste D V
Department of Psychiatry, University of California, San Diego, San Diego VA Medical Center, 92161, USA.
J Clin Psychiatry. 1999 Jan;60(1):61-7; quiz 68-9. doi: 10.4088/jcp.v60n0114.
Gender differences in the clinical presentation of young patients with schizophrenia have been well-documented, yet few studies have investigated gender-related clinical differences in older patients. Furthermore, the symptoms of late-onset schizophrenia have been described, but the interaction between gender and age at onset has not been examined.
In an older (46-85 years of age) outpatient sample, we assessed clinical characteristics of women and men with early-onset schizophrenia (N = 90) and late-onset schizophrenia (N = 34). Subjects did not differ with respect to age, education, ethnicity, severity of depression, daily neuroleptic dosage, subtype of schizophrenia, total score on the Mini-Mental State Examination, or severity of overall psychopathology. Diagnosis was made using the Structured Clinical Interview for the DSM-III-R or DSM-IV.
A significantly greater proportion of women had late-onset schizophrenia (41% vs. 20%), and women overall had more severe positive psychotic symptoms. Although there was no overall gender difference in severity of negative psychotic symptoms, women with late onset had significantly less severe negative symptoms than men with early onset, men with late onset, and women with early onset. Furthermore, age at onset of schizophrenia was inversely correlated with severity of negative symptoms for women, but not for men. These results indicate that women overall may develop more severe positive symptoms than men, and that when women develop schizophrenia after age 45, they may suffer less severe negative symptoms than men or than women with earlier onset. Our results suggest that some of the clinical differences between late-onset and early-onset schizophrenia may relate to gender effects, and that there may be inherent differences in the clinical presentation of schizophrenia that are related to gender and gender by age at onset interactions.
These differences may reflect the influence of sex hormones and menopause on the clinical presentation of schizophrenia or the possible existence of an "estrogen-related" form of schizophrenia in women with late-onset schizophrenia.
年轻精神分裂症患者临床表现中的性别差异已有充分记录，但很少有研究调查老年患者中与性别相关的临床差异。此外，迟发性精神分裂症的症状已有描述，但性别与发病年龄之间的相互作用尚未得到研究。
在一个年龄较大（46 - 85岁）的门诊样本中，我们评估了早发性精神分裂症（N = 90）和迟发性精神分裂症（N = 34）的女性和男性的临床特征。受试者在年龄、教育程度、种族、抑郁严重程度、每日抗精神病药物剂量、精神分裂症亚型、简易精神状态检查表总分或总体精神病理学严重程度方面没有差异。使用针对DSM - III - R或DSM - IV的结构化临床访谈进行诊断。
患有迟发性精神分裂症的女性比例显著更高（分别为41%和20%），并且女性总体上有更严重的阳性精神病性症状。虽然阴性精神病性症状的严重程度在总体上没有性别差异，但迟发性女性的阴性症状明显不如早发性男性、迟发性男性和早发性女性严重。此外，精神分裂症的发病年龄与女性阴性症状的严重程度呈负相关，但与男性无关。这些结果表明，女性总体上可能比男性发展出更严重的阳性症状，并且当女性在45岁以后患上精神分裂症时，她们可能比男性或早发性女性遭受的阴性症状较轻。我们的结果表明，迟发性和早发性精神分裂症之间的一些临床差异可能与性别效应有关，并且精神分裂症的临床表现可能存在与性别以及性别与发病年龄相互作用相关的内在差异。
这些差异可能反映了性激素和更年期对精神分裂症临床表现的影响，或者在迟发性精神分裂症女性中可能存在一种“雌激素相关”形式的精神分裂症。
