Sex differences in symptom severity, cognition and psychosocial functioning among individuals with at-risk mental state for psychosis

Sex difference in alexithymia and cognitive impairment in chronic schizophrenia: a large sample study based on Chinese Han population

Sex differences in schizophrenia have been noted across domains such as alexithymia and cognitive function; however, how they interact remains unclear. This study aimed to explore sex differences in the relationship between alexithymia and cognitive function in patients with chronic schizophrenia. A total of 695 patients (464 males and 231 females) who met the DSM-IV diagnostic criteria for schizophrenia were recruited in this cross-sectional study. Demographic and clinical data were collected using self-reported questionnaires. We assessed alexithymia using the Toronto Alexithymia Scale (TAS-20), cognitive function using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and psychiatric symptoms using the Positive and Negative Syndrome Scale (PANSS). Male schizophrenic patients have to read 56.7% of the alexithymia rate, and higher scores on the RBANS visuospatial/constructional, language and total score than female patients (all P < 0.05).Alexithymia patients had lower language than non-alexithymia patients(P = 0.001). In addition, there were significant differences of the correlation scores for men and women in immediate memory and delayed memory (P < 0.001). Our results indicate that there are sex differences in the prevalence comorbid alexithymia symptoms, as well as their association with cognitive function, in patients with schizophrenia. However, a cross-sectional design could not establish definitive causative associations between sex and alexithymia or cognitive function.

Effects of comorbid alexithymia on cognitive impairment in chronic schizophrenia: a large-sample study on the Han Chinese population

Background

Alexithymia and cognitive dysfunction are common in patients with schizophrenia. However, only a few studies have investigated the cognitive performance of patients with schizophrenia and comorbid alexithymia. This study aimed to investigate the relationship between alexithymia and neurocognitive impairment in patients with schizophrenia.

Methods

A total of 695 patients who met the DSM-IV diagnostic criteria for schizophrenia were included in this cross-sectional study (male/female = 464/231). Demographic and clinical data were collected using self-reported questionnaires. The severity of alexithymia was assessed using the Toronto Alexithymia Scale (TAS-20), cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) tool, and the severity of psychiatric symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS).

Results

The prevalence of comorbid alexithymia in patients with chronic schizophrenia was 31.40%, with a male preponderance. Patients with alexithymia had higher PANSS negative symptom subscale scores and PANSS total scores than those without alexithymia (p < 0.05 for all). In addition, patients with alexithymia had more severe deficits in immediate memory, delayed memory, and language and lower RBANS scores than those without alexithymia. Stepwise multivariate regression analysis showed that alexithymia was a risk factor for language deficits and indicated low total RBANS scores in patients with schizophrenia.

Conclusion

This study suggests that patients with chronic schizophrenia with alexithymia have poorer cognitive function than those without alexithymia. Some demographic characteristics and alexithymia are risk factors for cognitive dysfunction in patients with chronic schizophrenia.

Neonatal phencyclidine as a model of sex-biased schizophrenia symptomatology in adolescent mice

Sex-biased differences in schizophrenia are evident in several features of the disease, including symptomatology and response to pharmacological treatments. As a neurodevelopmental disorder, these differences might originate early in life and emerge later during adolescence. Considering that the disruption of the glutamatergic system during development is known to contribute to schizophrenia, we hypothesized that the neonatal phencyclidine model could induce sex-dependent behavioral and neurochemical changes associated with this disorder during adolescence. C57BL/6 mice received either saline or phencyclidine (5, 10, or 20 mg/kg) on postnatal days (PN) 7, 9, and 11. Behavioral assessment occurred in late adolescence (PN48-50), when mice were submitted to the open field, social interaction, and prepulse inhibition tests. Either olanzapine or saline was administered before each test. The NMDAR obligatory GluN1 subunit and the postsynaptic density protein 95 (PSD-95) were evaluated in the frontal cortex and hippocampus at early (PN30) and late (PN50) adolescence. Neonatal phencyclidine evoked dose-dependent deficits in all analyzed behaviors and males were more susceptible. Males also had reduced GluN1 expression in the frontal cortex at PN30. There were late-emergent effects at PN50. Cortical GluN1 was increased in both sexes, while phencyclidine increased cortical and decreased hippocampal PSD-95 in females. Olanzapine failed to mitigate most phencyclidine-evoked alterations. In some instances, this antipsychotic aggravated the deficits or potentiated subthreshold effects. These results lend support to the use of neonatal phencyclidine as a sex-biased neurodevelopmental preclinical model of schizophrenia. Olanzapine null effects and deleterious outcomes suggest that its use during adolescence should be further evaluated.

Meta-analysis of gender differences in transition prevalence among individuals at clinical high risk of psychosis

Gender differences have been found in several areas of individuals at clinical-high risk for psychosis(CHR). Therefore the risk of transition to psychosis may differ between male and female CHR, but previous work has not systematically reviewed and analyzed gender differences in conversion rates.We performed a meta-analysis according to PRISMA guidelines including all studies that assessed CHR with reliable instruments and provided data on the transition from male CHR and female CHR to psychosis to understand the conversion rate conversion in male and female CHR. Seventy-nine article were identified.A total of 1250 out of 5770 in the male CHR individuals, and 832 out of 4468 in the female CHR individuals translated to psychotic disorders. Transition prevalence were 19.4%(95%CI:14.2-25.8%)at 1 year, 20.6% at 2 year (95%CI:17.1-24.8%),24.3% at 3 years (95%CI:21.5-27.4%),26.3% at 4 years or older (95%CI:20.9-32.5%) and 22.3% at all (95%CI:20.0-24.8%) in male CHR and 17.7% (95%CI:12.6-24.4%) at 1 years, 17.5% (95%CI:14.2-21.4%) at 2 year, 19.9%(95%CI:17.3-0.228%) at 3 years,and 0.267 (95%CI:22.1-31.9%) at 4 years or older follow-up,20.4% at all (95%CI:18.1-22.9%) in female CHR. There were differences between the two groups in the overall conversion, the 2-year, and the 3-year follow up transition prevalence, which were higher in men CHR than in female CHR. Future research characterizing male versus female CHR is needed with the expectation that interventions will be developed that are tailored to the respective gender, further reducing the rate of conversion to CHR.

Gender differences in screening self-reported psychotic symptoms in a first help-seeking population

Gender differences in the frequency and severity of psychotic symptoms have been widely reported. However, in the screening process for the detection of early psychosis, gender differences were largely overlooked in China. This study investigated gender differences in self-reported psychotic symptoms in a clinical population who initially visited a mental health service. In total, 1931 consecutive new patients were included in the current analysis, with a mean age of 25.3 years, including 852 (44.1%) men and 1079 (55.9%) women, of whom 388 (20.1%) had psychotic disorders and 1543 (79.9%) had non-psychotic disorders. Psychotic symptoms were assessed using the PRIME Screen-Revised (PS-R) questionnaire. The cohort was grouped according to gender, age (adolescents ≤ 21 years, adults > 21 years), and clinical diagnosis. Within the full sample, gender differences in psychotic symptoms were not significant, except that females appeared to have more severe symptoms of disorganized communication than males. However, gender differences began to appear at subgroup levels, after stratification by age and diagnosis. Female adolescents reported more severe psychotic symptoms than male adolescents, especially in the symptom of perceptual abnormalities, which refer to hallucinations. Different patterns and predictors were found to significantly discriminate between psychotic and non-psychotic disorders among age and gender groups. Our study highlights gender differences in the severity, frequency, and pattern of self-reported psychotic symptoms when screening in a first help-seeking population. Therefore, gender differences should be considered during psychotic symptoms screening.