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International Journal of Methods in Psychiatric Research logoLink to International Journal of Methods in Psychiatric Research
. 2008 Jan 10;16(4):208–218. doi: 10.1002/mpr.228

Gender differences in the prediction of 5‐year outcome in first episode psychosis

Maria Mattsson 1,3,✉, Lena Flyckt 1, Gunnar Edman 1, Håkan Nyman 2, Johan Cullberg 1, Yvonne Forsell 3
PMCID: PMC6878358  PMID: 18188834

Abstract

Objective: To examine gender differences in prediction of long‐term outcome in first episode psychosis (FEP).

Method: Eighty‐one male and 72 female FEP patients were compared regarding the sensitivity and specificity of the Predictive Rating Scale (PRS). The contributions of pre‐admission clinical and socio‐demographic characteristics to a poor 5‐year outcome were analysed for males and females separately. Gender differences in the relations between predictors and outcome were examined using the equality of correlation comparing correlation coefficients.

Results: The sensitivity of the PRS was significantly better for males than for females. The following items: ‘the highest Global Assessment of Functioning (GAF) the year before first admission ≤70’ and ‘GAF at first admission ≤30’ explained most of the variance of a poor 5‐year outcome for males, whereas for females the corresponding items were ‘the highest educational level is compulsory school’, ‘living with parents’ and ‘contact with friends ≤2–3 times/month’. When the PRS was adapted assigning a weight of two to the item ‘the highest educational level is compulsory school’ for females, the sensitivity increased.

Conclusion: This study revealed that the predictors for poor outcome differ between male and female patients with FEP. Copyright © 2008 John Wiley & Sons, Ltd.

Keywords: gender differences, psychosis, outcome

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REFERENCES

  1. Alanen YO, Lehtinen K, Rakkolainen V, Aaltonen J. Need‐adapted treatment of new schizophrenic patients: experiences and results of the Turku Project. Acta Psychiatr Scand 1991; 83: 363–72. [DOI] [PubMed] [Google Scholar]
  2. Amminger GP, Edwards J, Brewer WJ, Harrigan S, McGorry PD. Duration of untreated psychosis and cognitive deterioration in first‐episode schizophrenia. Schizophr Res 2002; 54: 223–30. [DOI] [PubMed] [Google Scholar]
  3. Amminger GP, Schlogelhofer M, Lehner T, Looser Ott S, Friedrich MH, Aschauer HN. Premorbid performance IQ deficit in schizophrenia. Acta Psychiatr Scand 2000; 102: 414–22. [DOI] [PubMed] [Google Scholar]
  4. Bleuler M. The long‐term course of the schizophrenic psychoses. Psychol Med 1974; 4: 244–54. [DOI] [PubMed] [Google Scholar]
  5. Carbone S, Harrigan S, McGorry PD, Curry C, Elkins K. Duration of untreated psychosis and 12‐month outcome in first‐episode psychosis: the impact of treatment approach. Acta Psychiatr Scand 1999; 100: 96–104. [DOI] [PubMed] [Google Scholar]
  6. Carlsson R, Nyman H, Ganse G, Cullberg J. Neuropsychological functions predict 1‐ and 3‐year outcome in first‐episode psychosis. Acta Psychiatr Scand 2006; 113: 102–11. [DOI] [PubMed] [Google Scholar]
  7. Ciompi L. The natural history of schizophrenia in the long term. Br J Psychiatry 1980; 136: 413–20. [DOI] [PubMed] [Google Scholar]
  8. Cullberg J, Levander S, Holmqvist R, Mattsson M, Wieselgren IM. One‐year outcome in first episode psychosis patients in the Swedish Parachute project. Acta Psychiatr Scand 2002; 106: 276–85. [DOI] [PubMed] [Google Scholar]
  9. Drake RJ, Haley CJ, Akhtar S, Lewis SW. Causes and consequences of duration of untreated psychosis in schizophrenia. Br J Psychiatry 2000; 177: 511–5. [DOI] [PubMed] [Google Scholar]
  10. Egeland J, Rund BR, Sundet K, Landro NI, Asbjornsen A, Lund A, et al. Attention profile in schizophrenia compared with depression: differential effects of processing speed, selective attention and vigilance. Acta Psychiatr Scand 2003; 108: 276–84. [DOI] [PubMed] [Google Scholar]
  11. Flyckt L, Mattsson M, Edman G, Carlsson R, Cullberg J. Predicting 5‐year outcome in first‐episode psychosis: construction of a prognostic rating scale. J Clin Psychiatry 2006; 67: 916–24. [DOI] [PubMed] [Google Scholar]
  12. Foerster A, Lewis S, Owen M, Murray R. Pre‐morbid adjustment and personality in psychosis. Effects of sex and diagnosis. Br J Psychiatry 1991; 158: 171–6. [DOI] [PubMed] [Google Scholar]
  13. Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the ‘right stuff’? Schizophr Bull 2000; 26: 119–36. [DOI] [PubMed] [Google Scholar]
  14. Hafner H. Gender differences in schizophrenia. Psychoneuroendocrinology 2003; 28(Suppl 2): 17–54. [DOI] [PubMed] [Google Scholar]
  15. Harding CM, Brooks GW, Ashikaga T, Strauss JS, Breier A. The Vermont longitudinal study of persons with severe mental illness, II: Long‐term outcome of subjects who retrospectively met DSM‐III criteria for schizophrenia. Am J Psychiatry 1987; 144: 727–35. [DOI] [PubMed] [Google Scholar]
  16. Harrigan SM, McGorry PD, Krstev H. Does treatment delay in first‐episode psychosis really matter? Psychol Med 2003; 33: 97–110. [DOI] [PubMed] [Google Scholar]
  17. Harris MG, Henry LP, Harrigan SM, Purcell R, Schwartz OS, Farrelly SE, et al. The relationship between duration of untreated psychosis and outcome: an eight‐year prospective study. Schizophr Res 2005; 79: 85–93. [DOI] [PubMed] [Google Scholar]
  18. Huber G, Gross G, Schuttler R, Linz M. Longitudinal studies of schizophrenic patients. Schizophr Bull 1980; 6: 592–605. [DOI] [PubMed] [Google Scholar]
  19. Iverson GL, Woodward TS, Green P. Base rates of WAIS‐R VIQ‐PIQ differences in 1593 psychiatric inpatients. J Clin Psychol 2001; 57: 1579–87. [DOI] [PubMed] [Google Scholar]
  20. Kaplan E, Bartfai A. WAIS‐R som neuropsykologiskt instrument: manual. Hägersten: Psykologiförlaget, 1994. [Google Scholar]
  21. Larsen TK, Moe LC, Vibe‐Hansen L, Johannessen JO. Premorbid functioning versus duration of untreated psychosis in 1 year outcome in first‐episode psychosis. Schizophr Res 2000; 45: 1–9. [DOI] [PubMed] [Google Scholar]
  22. Lindamer LA, Bailey A, Hawthorne W, Folsom DP, Gilmer TP, Garcia P, et al. Gender differences in characteristics and service use of public mental health patients with schizophrenia. Psychiatr Serv 2003; 54: 1407–9. [DOI] [PubMed] [Google Scholar]
  23. Malla AK, Norman RM, Manchanda R, Ahmed MR, Scholten D, Harricharan R, et al. One year outcome in first episode psychosis: influence of DUP and other predictors. Schizophr Res 2002; 54: 231–42. [DOI] [PubMed] [Google Scholar]
  24. Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T. Association between duration of untreated psychosis and outcome in cohorts of first‐episode patients: a systematic review. Arch Gen Psychiatry 2005; 62: 975–83. [DOI] [PubMed] [Google Scholar]
  25. McGorry P, Krstev H, Harrigan S. Early detection and treatment delay: implications for outcome in early psychosis. Curr Opin Psychiatry 2000; 13: 37–43. [Google Scholar]
  26. Norman RM, Lewis SW, Marshall M. Duration of untreated psychosis and its relationship to clinical outcome. Br J Psychiatry 2005; 48(Suppl): S19–23. [DOI] [PubMed] [Google Scholar]
  27. Perkins DO, Gu H, Boteva K, Lieberman JA. Relationship between duration of untreated psychosis and outcome in first‐episode schizophrenia: a critical review and meta‐analysis. Am J Psychiatry 2005; 162: 1785–804. [DOI] [PubMed] [Google Scholar]
  28. Phillips L. Case history data and prognosis in schizophrenia. J Nerv Ment Dis 1953; 117: 515–25. [DOI] [PubMed] [Google Scholar]
  29. Preston NJ, Orr KG, Date R, Nolan L, Castle DJ. Gender differences in premorbid adjustment of patients with first episode psychosis. Schizophr Res 2002; 55: 285–90. [DOI] [PubMed] [Google Scholar]
  30. Rahm C, Cullberg J. Diagnostic stability over three years in a total group of first–episode psychosis patients. Nord J Psychiatry 2007; 61(3): 189–93. [DOI] [PubMed] [Google Scholar]
  31. Salokangas RK, Honkonen T, Saarinen S. Women have later onset than men in schizophrenia – but only in its paranoid form. Results of the DSP project. Eur Psychiatry 2003; 18: 274–81. [DOI] [PubMed] [Google Scholar]
  32. Spitzer M. Clinical aspects and practical applications of DSM‐III. Psychiatr Prax 1987; 14: 212–7. [PubMed] [Google Scholar]
  33. Stephens JH, Richard P, McHugh PR. Long‐term follow‐up of patients hospitalized for schizophrenia, 1913 to 1940. J Nerv Ment Dis 1997; 185: 715–21. [DOI] [PubMed] [Google Scholar]
  34. Strauss JS, Carpenter WT Jr. The prediction of outcome in schizophrenia. II. Relationships between predictor and outcome variables: a report from the WHO international pilot study of schizophrenia. Arch Gen Psychiatry 1974; 31: 37–42. [DOI] [PubMed] [Google Scholar]
  35. Tsuang MT, Woolson RF, Fleming JA. Long‐term outcome of major psychoses. I. Schizophrenia and affective disorders compared with psychiatrically symptom‐free surgical conditions. Arch Gen Psychiatry 1979; 36: 1295–301. [DOI] [PubMed] [Google Scholar]
  36. Usall J, Ochoa S, Araya S, Marquez M. Gender differences and outcome in schizophrenia: a 2‐year follow‐up study in a large community sample. Eur Psychiatry 2003; 18: 282–4. [DOI] [PubMed] [Google Scholar]
  37. Vaillant GE. Prospective prediction of schizophrenic remission. Arch Gen Psychiatry 1964; 11: 509–18. [DOI] [PubMed] [Google Scholar]
  38. Wechsler D, Bartfai A. WAIS‐RS: Wechsler Adult Intelligence Scale‐revised: manual. Vol 2. Hägersten: Psykologiförlaget, 1994. [Google Scholar]
  39. Verdoux H, Liraud F, Assens F, Abalan F, van Os J. Social and clinical consequences of cognitive deficits in early psychosis: a two‐year follow‐up study of first‐admitted patients. Schizophr Res 2002; 56: 149–59. [DOI] [PubMed] [Google Scholar]

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