Moriarty P J, Lieber D, Bennett A, White L, Parrella M, Harvey P D, Davis K L
Mt Sinai School of Medicine, New York, NY 10029, USA.
Schizophr Bull. 2001;27(1):103-13. doi: 10.1093/oxfordjournals.schbul.a006850.
Gender effects have been reported quite consistently in schizophrenia, with male patients having an earlier age of onset, poorer functional outcome, greater negative symptoms and cognitive impairment, and less severe positive symptoms. Because age of onset, cognitive impairments, and negative symptoms are all correlated with poorer functional status, it is not clear if previously reported gender differences in symptoms are just recapturing gender differences in functional outcome. In this study, 205 geriatric patients with lifelong poor-outcome schizophrenia (43% male) were examined for the severity of schizophrenic symptoms, cognitive impairments, and specific deficits in adaptive skills, as well as for demographic differences such as age at first psychiatric admission, premorbid education, and current treatment status. Previously reported gender differences were replicated in these patients with a uniformly poor functional outcome, with male patients having more severe negative symptoms and an earlier age of first psychiatric admission. No differences in cognitive functioning or specific functional deficits were found, however. These findings suggest that negative symptom severity is greater in male patients regardless of functional outcome and that the association of cognitive deficits with gender may be found only in patients with better functional outcome. The study of gender-related differences in brain structure or function and their interaction with overall course of illness might help understand these differences in symptom presentation.
在精神分裂症中，性别效应的报道较为一致，男性患者发病年龄更早，功能预后较差，阴性症状和认知障碍更严重，阳性症状则没那么严重。由于发病年龄、认知障碍和阴性症状均与较差的功能状态相关，所以之前报道的症状方面的性别差异是否只是反映了功能预后的性别差异尚不清楚。在本研究中，对205例功能预后一直较差的老年精神分裂症患者（43%为男性）进行了检查，评估了精神分裂症症状的严重程度、认知障碍、适应性技能的特定缺陷，以及诸如首次精神科入院年龄、病前教育程度和当前治疗状况等人口统计学差异。在这些功能预后均较差的患者中，之前报道的性别差异得到了重复，男性患者的阴性症状更严重，首次精神科入院年龄更早。然而，未发现认知功能或特定功能缺陷存在差异。这些发现表明，无论功能预后如何，男性患者的阴性症状严重程度更高，而且认知缺陷与性别的关联可能仅在功能预后较好的患者中存在。对大脑结构或功能中与性别相关的差异及其与疾病总体病程的相互作用进行研究，可能有助于理解这些症状表现上的差异。
