Female patients with schizophrenia, more often than men, are able to enter into and maintain social roles. For instance, at first occurrence of illness, roughly one-third of women are married, compared to less than one-fifth of men. Comparable figures for the general population show that three-fourths of women and over one-half of men are married. With respect to parenting roles, approximately half of all women with schizophrenia have children.

However, because blunted affect and paranoid thinking can severely impair maternal competence, women with schizophrenia are frequently unable to rear their children. About one-third lose custody of their children to family members, ex-partners, foster care, or to adoption.

Single motherhood adds to the stresses of mothers with schizophrenia, and this is usually exacerbated by partner violence, poverty, and substance abuse.

Treatment response
Women appear to require lower doses of antipsychotic drugs than do men to achieve equal improvement.

This may be due to the attainment of higher blood levels (partly accounted for by women smoking less than men), to the fact that women are generally more compliant with prescribed medications, and to their greater fat stores, which extend the half-life of lipophilic drugs. It may also result from estrogen action at receptor target sites, such as brain dopamine receptors. Women’s relatively superior response appears to be lost after menopause.

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»  » Clinical implications - Schizophrenia and Gender

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MARY V. SEEMAN
Mary V. Seeman, MDCM, FRCPC, FACP, is Professor and Tapscott Chair of Schizophrenia Studies at the University of Toronto and Centre for Addiction and Mental Health,Toronto, Ontario, Canada.

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REFERENCES

1. Aleman, A., Kahn, R. S., & Selten, J. P. (2003). Sex differences in the risk of schizophrenia: Evidence from meta-analysis. Archives of General Psychiatry, 60, 565–571.
2. Angermeyer, M. C., Kuhn, L., & Goldstein, J. M. (1990). Gender and the course of schizophrenia: Differences in treated outcomes. Schizophrenia Bulletin, 16, 293–307.
3. Cho, J. J., Iannucci, F. A., Fraile, M., Franco, J., Alesius, T. N., & Stefano, G. B. (2003). The role of the estrogen in neuroprotection: Implications for neurodegenerative diseases. Neuroendocrinology Letters, 24, 141–147.
4. Goldstein, J. M., Seidmann, L. J., O’Brien, L. M., Horton, N. J., Kennedy, D. N., Makris, H., et al. (2002). Impact of normal sexual dimorphisms on sex differences in structural brain abnormalities in schizophrenia assessed by magnetic resonance imaging. Archives of General Psychiatry, 15, 154–164.

Full References  »