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

Abstract

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.