The neurodevelopmental basis of sex differences in schizophrenia

Abstract

The neurodevelopmental basis of sex differences in schizophrenia 1 Male schizophrenics tend to manifest a severe form of the disease, characterized by early onset, poor pre-morbid adjustment, 'typical' and 'negative' symptoms, and poor outcome; they are more likely than their female counterparts to have a history of pre-or peri-natal complications, and to exhibit structural brain abnormalities.The most plausible explanation for these differences is that more male than female schizophrenics have a form of disease due to neurodevelopmental anomaly.This hypothesis also accounts for the excess of males in strictly defined schizophrenic cohorts, and in those who present before 30 years of age.In contrast, many later-onset females diagnosed 'schizophrenic' have more in common, aetiologically, with affective psychosis than schizophrenia.Thus, much of the contemporary confusion about schizophrenia results from the conflation of two separate disorders, one commonest in young males and the other in older females.There have been many reports in the literature of differences in the characteristic of schizophrenia in males and females.The explanatory hypotheses proposed have mainly been in terms of the different social roles of men and women, though some authors have suggested that antidopaminergic properties of oestrogens may be 'protective' in females.This editorial argues that a neurodevelopmental perspective has greater explanatory power for the male-female differences in schizophrenia.