Schizophrenia clinical symptom differences in women vs. men with and without a history of childhood physical abuse.

BACKGROUND: Childhood abuse has been implicated as an environmental factor that increases the risk for developing schizophrenia. A recent large population-based case-control study found that abuse may be a risk factor for schizophrenia in women, but not men. Given the sex differences in onset and clinical course of schizophrenia, we hypothesized that childhood abuse may cause phenotypic differences in the disorder between men and women. METHODS: We examined the prevalence of childhood physical abuse in a cohort of men and women with schizophrenia and schizoaffective disorder. Specifically, we examined differences in positive, negative, cognitive and depressive symptoms in men and women who reported a history of childhood physical abuse. We recruited 100 subjects for a single visit and assessed a history of childhood physical abuse using the childhood trauma questionnaire (CTQ) and clinical symptoms and cognition using the brief psychiatric rating scale (BPRS), the calgary depression scale (CDS) and the repeatable battery of the assessment of neuropsychological status (RBANS) for cognition. RESULTS: Ninety-two subjects completed the full CTQ with abuse classified as definitely present, definitely absent or borderline. Twelve subjects who reported borderline abuse scores were excluded. Of the 80 subjects whose data was analyzed, 10 of 24 (41.6 %) women and 11 of 56 (19.6 %) men reported a history of childhood physical abuse (χ(2) = 4.21, df = 1, p = 0.04). Women who reported such trauma had significantly more psychotic (sex by abuse interaction; F = 4.03, df = 1.76, p = 0.048) and depressive (F = 4.23, df = 1.76, p = 0.04) symptoms compared to women who did not have a trauma history and men, regardless of trauma history. There were no differences in negative or cognitive symptoms. CONCLUSIONS: Women with schizophrenia and schizoaffective disorder may represent a distinct phenotype or subgroup with distinct etiologies and may require different, individually tailored treatments.

The risk of suicide after clozapine discontinuation: Cause for concern.

BACKGROUND: Clozapine is a second-generation antipsychotic that has been shown to reduce suicidal ideation and suicidal behaviors in patients with schizophrenia. However, it is underutilized because of its serious side effects. METHODS: We describe 3 patients with a history of suicide ideation and attempts who were successfully treated and maintained in the community without suicidal tendencies while taking clozapine. All 3 patients, men in their 20s, discontinued clozapine because of side effects and subsequently committed suicide. We also review the literature on clozapine's effects on suicidality. RESULTS: In these 3 cases, suicide followed abrupt discontinuation of clozapine or transition to another antipsychotic. CONCLUSIONS: This case series is the first of its kind to document the risk of suicide when clozapine is discontinued. The decision to discontinue clozapine should be made carefully, especially because clozapine is considered the treatment of last resort for patients with treatment-resistant schizophrenia and suicidal ideation. We stress the importance of minimizing the risk of abrupt clozapine discontinuation and recommend further evaluation of suicide ideation and attempts when clozapine is discontinued.