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.