Evidence that better outcome of psychosis in women is reversed with increasing age of onset: a population-based 5-year follow-up study.
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.
Köhler
Sebastian
S
Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, SEARCH, Maastricht University Medical Centre, Maastricht, The Netherlands. s.koehler@np.unimaas.nl
van der Werf
Margriet
M
Hart
Brian
B
Morrison
Gary
G
McCreadie
Robin
R
Kirkpatrick
Brian
B
Verkaaik
Mike
M
Krabbendam
Lydia
L
Verhey
Frans
F
van Os
Jim
J
Allardyce
Judith
J
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