GENDER DIFFERENCES IN ONSET OF ILLNESS, TREATMENT RESPONSE, COURSE, AND BIOLOGIC INDEXES IN FIRST-EPISODE SCHIZOPHRENIC-PATIENTS

Objective: Gender differences in onset of illness, response to treatme nt, course, and biologic measures have been consistently reported in p atients with chronic schizophrenia. Patients with first-episode schizo phrenia were examined to determine whether gender differences also occ ur in these patients. Method: Fifty-four neuroleptic-naive schizophren ic patients (29 men and 25 women) were studied beginning in an initial stage of the first hospitalization for psychosis while undergoing tre atment with a standardized medication regimen. Before antipsychotic dr ug treatment and during 1 year of follow-up each patient was rated on the Schedule for Affective Disorders and Schizophrenia-Change Version (psychosis and disorganization items), Scale for the Assessment of Neg ative Symptoms, Clinical Global Impression, modified Simpson Tardive D yskinesia Scale, and Simpson-Angus Rating Scale for extrapyramidal sid e effects. Methylphenidate challenge testing was done at study entry. Plasma neuroleptic, homovanillic acid (HVA), and prolactin levels were determined weekly for the first 6 weeks. Results: The female schizoph renic patients had a later onset and better treatment response than th e men. Plasma HVA levels at baseline and week 1 and changes in prolact in levels from baseline to weeks 1 through 6 were greater among the wo men. Conclusions: Gender differences in onset and degree of treatment response in first-episode schizophrenic patients are similar to those of chronic patients and are apparent at early stages of the illness. T he greater pharmacologic responsivity of the female patients, as indic ated by the neuroendocrine results, is consistent with the gender diff erence in degree of symptom improvement with medication.