ANDREA FAGIOLINI
Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
Scientific Rationale
According to the scientific literature, there are relevant differences related to sex and gender in schizophrenia.
The incidence of schizophrenia appears to be higher among men compared to women, with a ratio of 1.4:1.
Men also tend to experience the onset of schizophrenia 3-4 years earlier than women, and different
susceptibilities are observed at different life stages. Among individuals with schizophrenia, males have a
greater risk of prominent negative symptoms, while females display more affective symptoms such as
depression, impulsivity, emotional instability, sexual misconduct, and sexual delusions.
In terms of cognitive dysfunction, female patients tend to perform better on measures of executive function,
verbal memory, and information processing speed compared to male patients.
On the other hand, male patients generally outperform females in terms of visual memory and attention.
However, it is important to note that:
1. Sex differences in schizophrenia are recognized in clinical practice, but they are still poorly understood
phenomena.
2. Differences in the efficacy and safety of therapies for schizophrenia in relation to sex and gender are
not well-known, which can impact the appropriateness of treatment.
3. The specific pharmacodynamics and pharmacokinetics differences between sexes are not known, but
there are currently no established gender-specific dosing recommendations. This lack of knowledge
poses a significant risk of either overmedicating or undermedicating individuals.
4. The impact of female hormonal phases on schizophrenia treatment is not clear, and its effect on the
predictability of treatment outcomes is unknown. Additionally, societal prejudices against individuals
with mental illness may have a more significant impact on female patients with schizophrenia.
Given the complexity of these factors, it is important for healthcare professionals and researchers to further
investigate and understand the sex and gender differences in schizophrenia. This will aid in the development
of tailored treatment approaches that consider the unique needs of each individual, taking into account both
biological and psychosocial factors. How can we identify specific treatments or solutions for these
individuals ?
Faculty
Sofia Brissos Lisbon Psychiatric Hospital Centre, Lisbon, Portugal
Davide Cafiero Helaglobe, Florence, Italy
Laura Castro Women's Brain Project, Zurigo, Switzerland
Bernardo Dell'Osso University of Milan, Italy
Luca Fabris Italian Center for the Studies on Gender Health and Medicine, Padova, Italy
Andrea Fagiolini Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
Tiziana Vavalà AOU Città della Salute e della Scienza, Turin, Italy