Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study

Abstract

Background The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. Methods Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. Results There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. Discussion Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

The effect of first- and second-generation antipsychotics on brain morphology in schizophrenia: A systematic review of longitudinal magnetic resonance studies with a randomized allocation to treatment arms

“…The literature includes a large number of naturalistic studies and overall it suggests that there is some brain volume loss over time both in medicated and in unmedicated patients with schizophrenia (Ahmed et al, 2015; Andreasen et al, 2013; Baaré et al, 2001; Boonstra et al, 2011; Chaves et al, 2015; Gur et al, 1998; Ho et al, 2003b; Hu et al, 2020; Kraguljac et al, 2019; Kubota et al, 2015; Li et al, 2019; Lin et al, 2019; Lyall et al, 2021; Narr et al, 2005, Van Haren et al, 2011; Veijola et al, 2014; Vita et al, 2012; Xiao et al, 2018). An important problem in the interpretation of findings is that a significant number of patients with schizophrenia are complete or partially treatment resistance already since the first episode (Demjaha et al, 2017), while the natural history of the disease is highly heterogeneous (Ciompi, 1980; Dragioti et al, 2017; Fountoulakis et al, 2019, 2021a,b). Duration of untreated psychosis seems to have an adverse impact also (Correll et al, 2018; Howes et al, 2021).…”

“…It is important to note that the findings seem to be present already during the first episode of schizophrenia (Goff et al, 2018; Lawrie et al, 1999; Mcintosh et al, 2011; Vita et al, 2006) and also before illness onset, during the prodromal phase of the illness (Koutsouleris et al, 2012, 2018; Pantelis et al, 2005). The prevailing conclusion of the so far available data is that brain loss in schizophrenia is related to a combination of (early) neurodevelopmental processes as well as illness progression (Fountoulakis et al, 2020, 2021a,c; Goff et al, 2018; Haijma et al, 2013; Ho et al, 2007, 2011; Lieberman et al, 2001; Mcintosh et al, 2011; Olabi et al, 2011; Vita and De Peri, 2007; Van Haren et al, 2007, 2011; Veijola et al, 2014).…”

Gender differences in cognitive improvements after two months of atypical antipsychotic treatment in first episode schizophrenia

“…Gender is one of the most important heterogeneity factors in schizophrenia ( 1 ). Over the past few decades, numerous studies have explored difference between male and female patients in several aspects of the disease.…”