Gender and First Episode Psychosis

Background There have been many studies investigating the impact of gender on psychosis but few studies have examined the impact of gender on first episode psychosis (FEP). Although recent studies suggest that at psychosis onset gender appears to affect age of the incidence peak, symptoms presentation and social functioning, these findings are not entirely consistent and it is not known whether and how these gender differences impact on the first years after psychosis onset. Other gender differences include childhood trauma, and adulthood domestic abuse, which are common among psychotic patients, with women being more likely to have been exposed to sexual abuse and physical abuse during their childhood, and adulthood. These may therefore impact on psychopathology, age of onset and needs for care differently in men and women with FEP. The in depth study of gender differences in needs for care of FEP patients may thus highlight important deficiencies in treatment provision, especially in those countries where there is a lack of gender-sensitive services. Aims This PhD Thesis aims to: 1) explore gender differences in psychopathology, needs for care and insight in a large cohort of FEP patients over 5 years; 2) provide a comprehensive summary of the findings on gender and childhood abuse in people with psychosis; 3) assess the impact of gender and traumatic experiences (physical and sexual abuse) on psychopathology, age of psychosis onset and needs for care in a large cohort of FEP patients. Methods For the aim 1 analyses were conducted within the framework of the PICOS study (Psychosis Incident Cohort Outcome Study). A total of 185 FEP patients have been followed-up for five years after psychosis onset and gender differences have been explored for psychopathology (PANSS), needs for care (CAN) and insight (SAI-E). For the aim 2 a narrative review was conducted. Papers concerning the impact of gender and childhood trauma in people with psychosis (to July 2018) were identified using a comprehensive search of PubMed, Web-of-Science, Scopus and Cochrane databases and analysing reference list of relevant papers. For the aim 3 a total of 444 FEP patients have been recruited within the context of the GET UP trial (Genetics, Endophenotypes, Treatment: Understanding early Psychosis). Symptomatology has been assessed using the PANSS scale, needs for care with the CAN scale and childhood abuse with the CECA-Q scale. Results Regarding aim 1, male patients with FEP showed more negative symptoms than females over time, whereas female patients showed higher levels of depressive symptoms than males throughout the study period. In addition, female patients presented more functioning unmet needs for care than males but higher levels of insight into illness than males. Concerning aim 2, we found that women with psychosis and childhood abuse tend to report more positive and mood symptoms, more suicide attempts and an earlier age of onset compared to men. Conversely, men with psychosis and childhood abuse tend to show more negative symptoms, substance abuse and a poorer cognitive performance compared to women. As for aim 3, childhood abuse was associated with higher levels of negative symptoms in both men and women, with a reduced the age of onset in women only and little increase in needs for care in both men and women. Conclusions This Thesis contributes to the literature on gender differences in psychosis. It may be useful in identifying the different factors that can influence treatment in the first years after psychosis onset. It may also help clinicians to select the best treatment options for men and women with FEP, especially for those who experienced childhood trauma.