Gender differences in poor outcome patients with lifelong schizophrenia

Gender effects have been reported quite consistently in schizophrenia, with male patients having an earlier age of onset, poorer functional outcome, g reater negative symptoms and cognitive impairment, and less severe positive symptoms. Because age of onset, cognitive impairments, and negative sympto ms are all correlated,vith poorer functional status, it is not clear if pre viously reported gender differences in symptoms are just recapturing gender differences in functional outcome. In this study, 205 geriatric patients w ith lifelong poor-outcome schizophrenia (43% male) were examined for the se verity of schizophrenic symptoms, cognitive impairments, and specific defic its 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 pat ients with a uniformly poor functional outcome, with male patients having m ore severe negative symptoms and an earlier age of first psychiatric admiss ion. No differences in cognitive functioning or specific functional deficit s were found, however. These findings suggest that negative symptom severit y is greater in male patients regardless of functional outcome and that the association of cognitive deficits with gender may be found only in patient s with better functional outcome. The study of gender-related differences i n brain structure or function and their interaction with overall course of illness might help understand these differences in symptom presentation.