Centre for Women's Mental Health, School of Community Based Medicine, University of Manchester, Oxford Road, Manchester, UK.
Int Rev Psychiatry. 2010;22(5):417-28. doi: 10.3109/09540261.2010.515205.
Evidence suggests sex differences in schizophrenia reflect differences in both neurodevelopmental processes and social effects on disease risk and course. Male:female incidence approximates 1.4:1 but at older onset women predominate. Prevalence differences appear smaller. Men have poorer premorbid adjustment and present with worse negative and less depressive symptoms than women, which may explain their worse medium term outcome according to a range of measures. Substance abuse is a predominantly male activity in this group, as elsewhere. Findings of sex differences in brain morphology are inconsistent but occur in areas that normally show sexual dimorphism, implying that the same factors are important drivers of sex differences in both normal neurodevelopmental processes and those associated with schizophrenia. There are sex differences in antipsychotic responses but sex-specific endocrine effects on illness and response to antipsychotics are potentially complex. Oestrogen's role as an adjunctive medication is not yet clear due to methodological differences between the few randomized controlled trials. Services that are sensitive to differences in gender can better meet their patients' specific needs and potentially improve outcome.
有证据表明，精神分裂症中的性别差异反映了神经发育过程以及社会因素对疾病风险和病程的影响存在差异。男性与女性的发病率接近 1.4:1，但女性的发病年龄较大。患病率的差异似乎较小。男性在发病前的适应能力较差，表现出比女性更严重的阴性症状和较少的抑郁症状，这可能解释了他们在一系列指标上的中期预后较差。与其他地方一样，该群体中的物质滥用主要是男性行为。脑形态学方面的性别差异研究结果并不一致，但出现在通常具有性别二态性的区域，这意味着在正常的神经发育过程以及与精神分裂症相关的过程中，相同的因素是导致性别差异的重要驱动因素。抗精神病药物反应存在性别差异，但疾病和抗精神病药物反应的特定内分泌效应可能很复杂。由于少数随机对照试验之间存在方法学差异，因此雌激素作为辅助药物的作用尚不清楚。对性别差异敏感的服务可以更好地满足患者的特定需求，并有可能改善预后。
