ABSTRACT
Acute psychosis is diagnosed by clearly defined operational criteria embedded into international classification systems. Many studies have tried to determine the role of gender in psychosis but mainly in terms of epidemiology and course of illness, most often schizophrenia. There are however also important gender-specific differences in clinical symptoms of acute psychosis. No guidelines or treatment recommendations suggest gender as an important factor in the choice of antipsychotic treatment, which is true for all treatment modalities (antipsychotic, dose, duration). We will review shortly available literature and present some of our own research data on gender differences in clinical presentations of acute psychosis. When the diagnosis of an illness depends almost entirely on symptoms and their presentations as in the case of acute psychosis, important gender specific differences might challenge the diagnostic process as well as treatment choice and course of psychosis. Our as well as other data confirm that acute psychosis manifest itself differently in males and females. To define further the impact of observed differences we need further research into gender specific clinical and not just epidemiological variables.
Subject(s)
Antipsychotic Agents/therapeutic use , Psychotic Disorders/drug therapy , Acute Disease , Adult , Affect/drug effects , Amisulpride , Antipsychotic Agents/adverse effects , Benzodiazepines/therapeutic use , Brain/drug effects , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Hospitalization , Humans , Internal-External Control , Male , Olanzapine , Psychiatric Status Rating Scales , Psychotic Disorders/classification , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Sex Factors , Sulpiride/analogs & derivatives , Sulpiride/therapeutic use , Thinking/drug effectsSubject(s)
Hospitals, Psychiatric/organization & administration , Intensive Care Units , Mental Health Services/organization & administration , Catchment Area, Health , Hospitalization , Humans , Mental Disorders/epidemiology , Mental Disorders/rehabilitation , Prospective Studies , Slovenia/epidemiologyABSTRACT
PURPOSE: Many factors influencing compliance in schizophrenia have been reported in the literature. Our aim was to assess predictors of noncompliance in male patients with first-episode schizophrenia, schizophreniform and schizoaffective disorder in a naturalistic setting. SUBJECTS AND METHODS: Fifty-six male patients, discharged from hospital, were included in a 1-year follow-up study. Psychopathological symptoms were assessed with positive and negative syndrome scale at admission and discharge, while extrapyramidal side effects were recorded weekly during hospitalisation using the Simpson-Angus and Barnes akathisia scales. Socio-demographic and some other variables were also recorded. RESULTS: Thirty patients (53.6%) dropped out of treatment in the first year and 21 of them relapsed. With the Cox survival analysis three predictors of noncompliance were found: diagnosis of schizophrenia versus the other two diagnoses, positive symptoms at admission, and lack of insight at discharge. Discussion. In spite of a specific methodology and selection of only first-episode male patients, the results are in accordance with the findings of other authors. This confirms the universality of noncompliance in psychotic patients. CONCLUSIONS: First-episode patients have a high dropout rate. However, in compliant patients, the relapse rate was low, and therefore special attention and compliance-promoting interventions in first-episode patients are needed.
