RESEARCH WEEKLY: Toward Better Care for Women with Schizophrenia By Shanti Silver (March 8, 2023) Today is International Women’s Day: a global day that encourages action to create a world free from gender bias and discrimination. In honor of this day, this week’s Research Weekly features a recent article from The Lancet that explores differences in the clinical needs and outcomes of men and women with schizophrenia spectrum disorders. Key differences include differences in diagnoses, the stage of life when people begin to experience symptoms, medication prescription rates and the impact of medication. Gender differences in receiving an accurate diagnosis for schizophrenia spectrum disorders Women with schizophrenia may be less likely to receive a diagnosis of schizophrenia than men with the same symptoms. For example, the authors describe a study where psychiatrists were given information about a patient who had symptoms that could be diagnosed as schizophrenia. Half of the psychiatrists were given information about a male patient, and the other half were given information about a female patient. The descriptions of the patients were identical, except for different pronouns (“he” vs “she”). Despite the identical descriptions, the male patient was more likely to be diagnosed with schizophrenia than the female patient. Women with schizophrenia have also been shown to be more likely to show atypical schizophrenia symptoms such as affective symptoms (i.e., symptoms relating to mood) and changes in an ability to focus compared with men. Women with schizophrenia have also been shown to be less likely than men to have negative symptoms (e.g., difficulty with speaking or an inability to feel pleasure). According to the authors, these differences may contribute to women with psychosis being more likely to receive diagnoses such as borderline personality disorder, anxiety, PTSD or depression. This gender bias in diagnosis can lead to longer durations of untreated psychosis for women. The authors describe a study that found the average duration of untreated psychosis for men was approximately 2½ years, while the average duration of untreated psychosis for women was approximately 6½ years. Because duration of untreated psychosis is associated with a range of negative outcomes, this disparity could have profound impacts on the wellbeing of women with schizophrenia. Gender differences in the stage of life when symptoms begin Women with schizophrenia typically begin to show symptoms of schizophrenia later in life than men. For example, in one study, while men were most likely to experience the beginning of symptoms during adolescence and young adulthood (15-25 years old), women were most likely to experience the beginning of their symptoms either during adolescence and adulthood (15-30 years old) or during menopause (45-49 years old). The increase in schizophrenia symptoms that occurs during menopause is thought to be caused by the rapid decrease in the hormone estrogen that women experience during this time. The later age of onset has profound implications for the treatment of women with schizophrenia. For example, the authors note that many interventions for early psychosis are targeted toward younger adults, which may disproportionately impact women with schizophrenia who develop the illness later in life. The authors additionally note that many clinical studies on treatments for schizophrenia spectrum disorders do not include people who are older than 45. This, along with the longstanding underrepresentation of women in clinical studies, may lead to treatments for schizophrenia being less evidence-based for women than men. Gender differences in medication prescriptions and the impact of medication The authors additionally describe several studies that indicate differences in the impact of antipsychotic medications between men and women. These studies suggest that when women and men receive similar dosages of antipsychotic medication, the medications may stay in the body at a higher concentration and be more effective for women. Despite these differences, the authors note that most guidelines for antipsychotic medications do not have recommendations that are specific to women, which may lead to the overmedication of women with schizophrenia spectrum disorders. There are also differences in patterns of medication prescription among men and women that may impact women with schizophrenia. For example, one study found that women with treatment-resistant schizophrenia spectrum disorders were offered clozapine less often than men. Several studies have also found women are less likely to be prescribed long-acting injectable antipsychotics, even though women are not more adherent to oral antipsychotic medications than men. Toward better care for women with schizophrenia spectrum disorders This paper highlights the underrepresentation of women with schizophrenia in clinical trials, a delay in receiving accurate diagnoses, overmedication and lower prescription rates for clozapine and long-acting injectables as some factors that may negatively impact women with schizophrenia. Importantly, providing the best care for women with schizophrenia spectrum disorders begins with identifying the disorder as early and accurately as possible, according to the authors. We hope you will join us in honoring the experiences of the millions of women who live with severe mental illness on this International Women’s Day. If you would like to learn more about the experiences of women with severe mental illness, we encourage you to read the Office of Research and Public Affair’s 2022 report, “LISTEN TO US: The Unique Experience of Women with Severe Mental Illness.” References Brand, B. A., et al. (April 2022). Towards better care for women with schizophrenia-spectrum disorders. The Lancet Psychiatry. Shanti Silver is a research assistant at Treatment Advocacy Center. View as Webpage To receive Research Weekly directly in your email inbox on a weekly basis, click here. Questions? Contact us at [email protected] Research Weekly is a summary published as a public service of Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications. Treatment Advocacy Center does not solicit or accept funds from pharmaceutical companies. 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