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Gender Differences in Never-Medicated First-Episode Schizophrenia and Medicated Chronic Schizophrenia Patients

Xiang Yang Zhang, MD, PhD; Da Chun Chen, MD; Mei Hong Xiu, PhD; Fu De Yang, MD; Colin N. Haile, MD, PhD; Therese A. Kosten, PhD; and Thomas R. Kosten, MD

Published: July 15, 2012

Article Abstract

Background: Schizophrenia shows gender differences in patients’ clinical presentation, neurocognitive impairment, course, and treatment outcome. The aims of this study were to compare gender differences in clinical features and cognitive functioning in first-episode and chronic schizophrenia among Han Chinese inpatients.

Method: We compared gender differences in 262 unmedicated first-episode schizophrenia and 960 chronic schizophrenia inpatients (diagnosed according to DSM-IV) to 804 matched healthy controls on sociodemographic characteristics, smoking behavior, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients were also rated on the Positive and Negative Syndrome Scale. The study was conducted from December 2006 to May 2008.

Results: Schizophrenia first occurred in both first-episode and chronic schizophrenia patients at a significantly earlier age in male than female patients (P < .05 and P < .001, respectively). The paranoid subtype of schizophrenia was more common in female patients only in chronic schizophrenia, not first-episode patients. Further, cigarette smoking was more common in male than female patients from both patient groups, and, among men, more chronic schizophrenia patients than controls smoked, while among women, fewer chronic schizophrenia patients than controls smoked. Female chronic schizophrenia patients had more severe positive and general psychopathological symptoms, whereas male patients had more severe negative symptoms. By contrast, first-episode schizophrenia patients showed no gender differences in symptoms and severity. Both first-episode and chronic schizophrenia patients performed worse than controls on most of the cognitive tasks. RBANS attention, delayed memory, and immediate memory were less impaired in female than male chronic schizophrenia patients, and first-episode schizophrenia patients showed no gender differences.

Conclusions: Chronic schizophrenia patients have notable gender differences in the age at onset, smoking, symptom severity, and cognitive function favoring women, but first-episode schizophrenia patients show few gender differences.

J Clin Psychiatry 2012;73(7):1025-1033

Submitted: September 27, 2011; accepted February 16, 2012(doi:10.4088/JCP.11m07422).

Corresponding author: Xiang Yang Zhang, MD, PhD, VA Medical Center, Research Bldg 109, Room 130, 2002 Holcombe Blvd, Houston, Texas, 77030 (

Volume: 73

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