Gender-related clinical differences in older patients with schizophrenia

Background: Gender differences in the clinical presentation of young patien ts with schizophrenia have been well-documented. yet few studies have inves tigated gender-related clinical differences in older patients. Furthermore, the symptoms of late-onset schizophrenia have been described, but the inte raction between gender and age at onset has not been examined. Method: In an older (46-85 years of age) outpatient sample, we assessed cli nical characteristics of women and men with early-onset schizophrenia (N = 90) and late-onset schizophrenia (N = 34). Subjects did not differ with res pect to age, education, ethnicity, severity of depression, daily neurolepti c dosage, subtype of schizophrenia, total score on the Mini-Mental State Ex amination, or severity of overall psychopathology. Diagnosis was made using the Structured Clinical Interview for the DSM-III-R or DSM-IV. Results: A significantly greater proportion of women had late-onset schizop hrenia (41% vs. 20%), and women overall had more severe positive psychotic symptoms, Although there was no overall gender difference in severity of ne gative psychotic symptoms, women with late onset had significantly less sev ere negative symptoms than men with early onset, men with late onset, and w omen with early onset. Furthermore, age at onset of schizophrenia was inver sely correlated with severity of negative symptoms for women. but not for m en. These results indicate that women overall may develop more severe posit ive symptoms than men, and that when women develop schizophrenia after age 45, they may suffer less severe negative symptoms than men or than women wi th earlier onset. Our results suggest that some of the clinical differences between late-onset and early-onset schizophrenia may relate to gender effe cts, and that there may be inherent differences in the clinical presentatio n of schizophrenia that are related to gender and gender by age at onset in teractions. Conclusion: These differences may reflect the influence of sex hormones and menopause on the clinical presentation of schizophrenia or the possible ex istence of an "estrogen-related" form of schizophrenia in women with late-o nset schizophrenia.