First-episode psychosis hits men hard

Men with first-episode psychosis have more severe symptoms than women and are less likely to achieve recovery, say Danish researchers.

In addition, Anne Thorup, from the University of Copenhagen, and colleagues note: "Significantly more males than females died during the follow-up period, and in this study suicide was seven times as frequent among the males, indicating that males have poorer health status and problems getting the right help."

They write in European Psychiatry: "In a clinical perspective, we need to differentiate between males and females, when medical treatment doses are prescribed and when treatment is planned, since males and females have completely different symptom patterns, problems and needs."

The team examined data on 578 patients with first-episode psychosis in the schizophrenia spectrum from the Danish OPUS trial, in which individuals were randomly assigned to receive intensive early intervention or standard treatment.

Men had significantly higher baseline scores than women on the Scale for Assessment of Negative Symptoms, and the domain of bizarre behavior and delusions worsened in men versus women over the 5-year follow up.

Although women were significantly more likely to attempt suicide during follow up, men were significantly more likely to die, at 14% versus 1%, and more likely to commit suicide, at 2.0% versus 0.4%. Conversely, women were more likely than men to meet the researchers' criteria for recovery, with the difference being significant at 2 and 5 years of follow up.

Men generally did worse than women on most measures during follow up. They were less likely to be in a job or education, more likely to live alone, and had more bed days. Men were more likely than women to be prescribed antipsychotic medication, but were less likely to adhere to it.

More men than women had a second diagnosis of substance abuse at 5 years, at 56% versus 16%, which the team suggests may contribute to their poor treatment compliance.

"Their substance abuse may reduce the effectiveness of the treatment, and thus, the treatment planning should include measures to treat the substance abuse to enhance the overall outcome, say Thorup et al.

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