Sex matters: Differences in prodromes, clinical and neuropsychological features in individuals with a first episode mania or psychosis

Abstract

Early psychosis; Prodromes; Sex differences

Psicosis temprana; Pródromos; Diferencias de sexo

Psicosi primerenca; Pròdroms; Diferències de sexe

Objective This study was aimed at identifying sex differences in patients presenting a first episode mania (FEM) or psychosis (FEP) to help shaping early treatment strategies focused on sex differences. Methods Patients with a FEM or FEP underwent a clinical, neuropsychological (neurocognitive functions and emotional intelligence) and functional assessment. Performance on those variables was compared between groups through general linear model, with sex and group (FEM vs FEP) as main effects and group by sex interactions. Results The total sample included 113 patients: FEM = 72 (45.83 % females) and FEP = 41 (46.34 % females). There were significant main effects for group (not for sex) for most of the clinical features (depressive, negative and positive symptoms) and psychosocial functioning (χ2 = 8.815, p = 0.003). As for neuropsychological performance, there were significant main effects for sex and group. Females performed better than males in verbal memory (χ2 = 9.038, p = 0.003) and obtained a higher emotional intelligence quotient (χ2 = 13.20, p < 0.001). On the contrary, males obtained better results in working memory (χ2 = 7.627, p = 0.006). FEP patients significantly underperformed FEM patients in most cognitive domains. There were significant group by sex interactions for few neuropsychological variables, namely processing speed (χ2 = 4.559, p = 0.033) and verbal fluency (χ2 = 8.913, p = 0.003). Limitations Differences between sexes were evaluated, but the influence of gender was not considered. Retrospective evaluation of prodromes and substance use. No healthy control group comparator. Conclusion The main finding is the presence of significant sex effect and group by sex interaction on specific neurocognitive cognition and emotional intelligence measures. Tailored sex-based early treatment strategies might be implemented.

This work was supported by The Secretaria d’ Universitats i Recerca del Departament d'Economia i Coneixement (2021 SGR 01128; 2017-SGR-1271); the CIBER -Consorcio Centro de Investigación Biomédica en Red (CIBERSAM), Instituto de Salud Carlos III; the Centres de Recerca de Catalunya-CERCA Programme; the Spanish Ministry of Science, Innovation (CPII16/00018 to EPC, CD20/00177 to SA, PI24/00671 to SA, PI12/0091 to EV, PI15/00283 to EV, PI18/00805 to EV, PI21/00787 to EV, PI24/00432 to EV and AMA, PI18/01001 to IP, PI20/00344 to CT, PI24/00407 to CT) integrated into the Plan Nacional de I + D + I and co-financed by the ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the “Pla estrategic de Recerca i Innovació en Salut 2016–2020” (SLT006/17/00357 to EV); the La Marató-TV3 Foundation grants 202234–30 (to EV) and 202234–32 (to SA); the Biomedicine international training research programme for excellent clinician-scientists-BITRECS project (Marie-Curie grant No 754550 and “La Caixa” Foundation LCF/PR/GN18/50310006 to NV). SA has been supported by Sara Borrell doctoral programme (CD20/00177) and M-AES mobility fellowship (MV22/00002), from the Instituto de Salud Carlos III (ISCIII), and co-funded by European Social Fund “Investing in your future”. MFF received the support of “Contratos predoctorales de formación en investigación en salud” (PFIS22) (FI22/00185) from the Instituto de Salud Carlos III (ISCIII). NEF-O thanks the support of the European Union Horizon 2020 research and innovation program (EU.3.1.3. Treating and managing disease: Grant No 945151), and DAAD (Deutscher Akademischer Austauschdienst) (ID-57681229 - Ref. No. 91629413).