title: Evidence that better outcome of psychosis in women is reversed with increasing age of onset: a population-based 5-year follow-up study.
abstract: BACKGROUND
  Female gender and later onset of psychosis are both associated with better outcome. However whether their effects are independent, is not known.
  
  
  METHODS
  In 379 incident cases of psychoses, from an epidemiologically defined catchment area, admixture analysis was employed to generate age of onset classes. Five year course and outcome measured across clinical and social domains were used as dependent variables in regression analyses, to estimate associations of outcomes with gender, age of onset and gender by age of onset interaction.
  
  
  RESULTS
  Three age of onset classes were identified: early (14-41 years), late (42-64 years) and very late onset psychosis (65-94 years). Overall, women had better outcomes, including milder delusions, fewer negative symptoms, less deterioration from baseline functioning, fewer hospital readmissions and shorter psychotic episodes. Later age of onset was also associated with better outcome, although in the very late onset class the results were mixed. There was a statistically significant gender by age of onset interaction (in the ratio scale) within this sample with men displaying poorer outcome in the early/late onset class, whereas women tended to have a worse outcome in the very late onset class.
  
  
  CONCLUSIONS
  The favourable outcome in women becomes reversed in old age, suggesting gender-age-related differences in the distribution of aetiological factors for psychosis.
authors.affiliation: Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, SEARCH, Maastricht University Medical Centre, Maastricht, The Netherlands. s.koehler@np.unimaas.nl
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
authors.forename: Margriet
authors.initials: M
authors.lastname: van der Werf
authors.forename: Brian
authors.initials: B
authors.lastname: Hart
authors.forename: Gary
authors.initials: G
authors.lastname: Morrison
authors.forename: Robin
authors.initials: R
authors.lastname: McCreadie
authors.forename: Brian
authors.initials: B
authors.lastname: Kirkpatrick
authors.forename: Mike
authors.initials: M
authors.lastname: Verkaaik
authors.forename: Lydia
authors.initials: L
authors.lastname: Krabbendam
authors.forename: Frans
authors.initials: F
authors.lastname: Verhey
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
authors.forename: Judith
authors.initials: J
authors.lastname: Allardyce
mesh_terms: D017668:Age of Onset; D018672:Community Health Planning; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000503:physiopathology; D012565:Schizophrenic Psychology; D055906:Seveso Accidental Release; D012727:Sex Characteristics; D016896:Treatment Outcome