Sex differences in diagnostic stability in first episode psychosis after 1-year follow-up

TL;DR

This study found that sex influences diagnostic stability in first episode psychosis after one year, with women more likely to switch from non-affective to affective psychosis.

Contribution

The study identifies sex as a novel predictor of diagnosis switch in first episode psychosis after 1-year follow-up.

Findings

Sex was the only variable predicting diagnosis switch after 1-year follow-up in first episode psychosis.

Women showed significant differences in diagnosis at 1-year follow-up compared to men.

Baseline characteristics did not differ significantly between completers and non-completers.

Abstract

Diagnostic stability is a controversial issue in first episode psychosis (FEP) due to heterogenous symptoms and unclear affective symptoms. Differencing affective and non-affective psychoses is important as treatment strategies are different. Initial affective symptomatology has low specificity for predicting the subsequent diagnosis of affective psychosis. Sex has proven to be relevant for clinical and functional outcomes but it remains unclear how sex may contribute to diagnosis switch of FEP.

To determine the role of sex in diagnostic stability in a sample of FEP after 1-year follow-up.

Diagnoses of FEP patients from Hospital del Mar of Barcelona were assessed at baseline and 1 year after. Univariate analyses was perfomed for all diagnoses and dichotomic variable (affective/non-affective). Logistic regression model was perfomed to know which variables predict diagnosis switch.

256 patients were enrolled. No differences were found at baseline between completers and non-completers (Table 1). No significant differences between men and women at baseline diagnosis were found, neither all diagnoses (p=0.274) nor the dichotomic variable affective/non-affective (p=0.829) (Table 2AB). Significant differences were found at 1-year follow-up between men and women, for all diagnoses (p=0.043) and the dichotomic variable (p=0.039). Sex was the only variable that predicted diagnosis switch (Figure 1), PANSS, CDSS, YMRS, GAF and cannabis did not.
Table 1.Baseline characteristics of participantsCompleters
(n=188)Non-completers
(n=68)pWomen (n, %)71 (37.8)30 (44.1)0.111Age (M, IQR)24 (20-28)22 (20-28)0.899Cannabis use (M, IQR)5.5 (0-18)7 (0-21)0.231DUP (M, IQR)45 (12.5-130)36 (11.25-115.75)0.213PANSS (m, sd)44.55 (10.17)40.93 (10.42)0.761CDSS (M, IQR)2 (0-7)3 (0-5.5)0.199YMRS (m, sd)19 (9.64)17.6 (9.15)0.845GAF (M, IQR)30 (25-50)30 (25-35)0.114
TABLE 2A and 2B.Diagnosis comparison (n, %)Baseline1-year follow-up

Men
Women
Total
Men
Women
Total
Psychosis NOS
69 (59)39 (54.9)108 (57.4)28 (23.9)10 (14.1)38 (20.2)Schizophreniform disorder
22 (18.8)16 (22.5)38 (20.2)14 (129 (12.7)23 (12.2)Induced psychosis
4 (3.4)0 (0)4 (2.1)15 (12.8)4 (5.6)19 (10.1)Affective psychosis
17 (14.5)9 (12.7)26 (13.8)24 (20.5)25 (35.2)49 (26.1)Schizophrenia
0 (0)0 (0)1 (0.4)30 (25.6)14 (19.7)44 (23.4)Brief psychotic disorder
5 (4.3)7 (9.9)12 (6.4)6 (5.1)8 (11.3)14 (7.4)
Baseline1-year follow-up

Men
Women
Total
Men
Women
Total
Affective psychosis
17 (14.5)9 (12.7)26 (13.8)24 (20.5)25 (35.2)49 (26.1)Non-affective psychosis
100 (85.5)62 (87.3)162 (86.2)93 (79.5)46 (64.8)139 (73.9)

Baseline characteristics of participants

Diagnosis comparison (n, %)

Image:

Sex has proven to be the main predictor of switching initial diagnosis of FEP.

None Declared

Figures