Schizophrenia in women is widely misunderstood and misdiagnosed

Mental illness such as depression and anxiety has long been considered the stepchild of medical care, but it has become increasingly visible and better understood. This is not the case for schizophrenia, especially in women.

Part of the problem is that schizophrenia, a serious mental illness characterized by hallucinations, delusions and faulty thinking, was previously thought to be rare. Official figures put the figure at about five per cent. But new research published this summer by the nonprofit Research Triangle Institute shows that number is a significant underestimate. Currently, approximately 1.6% of U.S. women are believed to have lifetime schizophrenia. For men, who often face the disease, the figure is only slightly higher at 2%.

Schizophrenia deserves more attention, especially in women, said Deanna Kelly, a psychiatrist and researcher at the University of Maryland’s Maryland Psychiatric Research Center. She said decades of inadequate research meant the differences between women and men with the disease were not well understood, which could lead to poor care.

Katy Thakkar, a psychologist at Michigan State University who has recently studied some of the gaps, said there are still many questions about women with the disease. For example, the first episode of schizophrenia tends to occur in men’s teenage years, while in women it occurs three to five years later; some women succumb first, around menopause.

Doctors have long believed that women with schizophrenia fare better than men, but that’s not necessarily the case.While Finns are less likely to commit suicide, a study of Finnish people published in the journal nature The study found that women were slightly more likely to be hospitalized within 10 years of diagnosis.

Get the right diagnosis

The difference was there from the start: Women with schizophrenia were more likely to be misdiagnosed.

It’s something Analisa Chase knows all too well. The 31-year-old autistic therapist from Tacoma, Washington, suffers from schizoaffective disorder, a psychosis that periodically combines with depression.

Until the age of 15, Chase was a happy, normal teenager, swimming on the high school team and singing in the choir. Then the disease struck suddenly, like a switch flipping on, Chase recalled. Although about 80 percent of the risk for schizophrenia is thought to be genetic, Chase had no known family history.

Voices began to tell her that she was Jesus’ chosen prophet and urged her to be more pure to fulfill this role. Chase began wearing white clothes and avoiding food and drink. As she walked around the house at night, she saw dark spirits climbing the stairs and her own face in the mirror changed.

Chase tried not to allow herself to have such delusions, but after a few weeks, her mother, Patricia Stewart, began to feel alarmed, especially when Chase refused to take a sip of water. Stewart took her daughter to the hospital, where the two were incorrectly diagnosed with bipolar disorder 1 (also known as manic depression) and prescribed lithium, which is not effective against psychosis.

Chase said, I’ve had this title for a long time. It took her 10 years, multiple psychotic episodes and multiple hospitalizations to get a proper diagnosis.

Diagnosing women is often hampered by the fact that people with delusions do not admit that they are. “You can’t go to your doctor and say, ‘I have this problem because my vision is impaired,'” said Abigail Donovan, director of clinical services for the Psychiatric Program at Massachusetts General Hospital. It takes people around to say something is wrong.

Stewart played the role as Chase. But Donovan said men may attract more attention from family members or teachers because they tend to experience more negative symptoms, such as apathy and withdrawal, in addition to delusions and hallucinations.

Early diagnosis is crucial because all data show that the longer it takes to get good treatment, the worse the prognosis. People who receive early care recover faster and stay healthy longer, Kelly said.

In recent years, this recognition has prompted several states to fund first-episode clinics that specialize in early intervention. (Donovans-Massachusetts General Hospital was one of the original models.) A review published in August found that such early, comprehensive treatment was most effective at reducing symptoms and improving quality of life.

The role of female hormones

Women are also vulnerable because estrogen has long been known to have protective effects, which is part of the reason why the prevalence is slightly lower in women than in men.

After puberty, when the brain is bathed in hormones, at-risk women form relationships and thrive in school during their teenage years. That provided important support when they died years later, said John Krystal, chairman of the department of psychiatry at Yale School of Medicine. Also, boys become ill before this critical socialization period, which may be a possible reason why men with the disorder become isolated from society and end up living on the streets.

But when protective hormones are withdrawn during menopause, some people who avoid psychosis early on develop it later. The first onset of schizophrenia after the age of 40 is uncommon, but the proportion of women with schizophrenia may be as high as 15%, twice the rate of men who develop schizophrenia after age 40.

We don’t know why this happens or what treatments or interventions are best for this age group. The extent of the information vacuum was surprising, Thakar said. It’s not even clear whether hormones are the only factor behind the midlife peak, as women also experience significant stress during this time, including having adult children, caring for aging parents, and/or sometimes divorce, a known genetic predisposition Crowds are triggers, she said.

There are currently no unique treatment guidelines for women diagnosed in midlife, though they may respond differently to medications than younger patients, and menopausal hormone therapy may be helpful, Thakar said. She and colleagues are currently recruiting women to participate in a study to begin answering some of these questions.

Late onset of the disease also requires unique psychological treatments. How do we help the children of middle-aged women maintain close, loving relationships with parents who may do or say meaningless things? How do we help families stay whole and connected? Donovan asked.

Correct medication is key to women’s success

Even women who are diagnosed at a more typical, younger age can experience unique problems. One of these involves environmental factors that contribute to psychosis. Kelly noted that girls are physically abused in childhood, and her research shows that this abuse can lead to more psychotic symptoms than in women who were not abused and even in abused men.

Scientists are also concerned about the impact of marijuana use on schizophrenia rates among teenage girls living in states that have legalized marijuana; this could further narrow the gender gap in schizophrenia rates.

Marijuana use during adolescence is known to increase the likelihood of psychotic symptoms, Krystal said.A study in lancet Research published in March found that marijuana use was one of the factors that best predicted relapse in patients.

When it comes to treatment, many common antipsychotic drugs cause more serious side effects in women than men, including high blood pressure and heart rhythm problems. Some people also develop a particularly unpleasant side effect of hyperprolactinemia, the production of milk by the breasts, causing some women to stop taking the medication.

Kelly found that women’s problems could be significantly reduced by adding the antipsychotic drug aripiprazole. The findings highlight the need for additional gender-specific treatment research, she said.

There are also differences in access to the most effective schizophrenia drug, clozapine.

Experts say the drug is underprescribed to everyone, especially women. According to the agency, only 27% of women took the drug within 5 years of diagnosis. nature Research shows that the proportion of men is 31%.

Kelly said psychiatrists are hesitant to prescribe clozapine, at least in part, because of the strict safety requirements imposed by the U.S. Food and Drug Administration, known as Risk Evaluation and Mitigation Strategies (REMS).

The FDA requires REMS because clozapine can cause a drop in certain white blood cells, which can lead to serious infection and even death. If a patient takes this drug, the doctor who prescribes the drug must perform frequent weekly blood tests for the first six months.

Kelly hopes to reduce the frequency of blood monitoring, especially after the first year when the risk drops significantly. This spring, she testified with Chase on the matter before a congressional committee.

risk of death by suicide [for patients with uncontrolled schizophrenia] Kelly maintains that the risk of death is hundreds to thousands of times higher with low white blood cell counts.

Stewart, who was involved in Chase’s care, said that although Chase saw numerous psychiatrists after she was properly diagnosed, no one gave her clozapine. Instead, Chase struggled with episodic symptoms and bothersome side effects for years while taking seven medications in a row.

Stewart eventually discovered clozapine in an online social media group. When she suggested it to Chase’s doctors, all of them said no.

For me, as her mother and advocate, getting Analyssa on the right medication was very difficult. How can someone with this disease hope to defend themselves? Stewart said. Finally, four years ago, after another severe psychotic episode and a month of hospitalization, Chase started taking clozapine.

Chase said I still see things and hear voices sometimes, but now I’m able to separate reality from unreality so I don’t have to participate.

Since starting medication, Chase has become stable enough to live independently, graduate from college, find a part-time job, and be in a healthy relationship. Stewart smiled and said that despite the challenges, she performed extremely well.

Kelly said schizophrenia was considered a disease that locked you away and prevented you from functioning in society. Getting the right diagnosis and treatment can flip this trajectory on its head. Women live, work, and prosper among us. Some people don’t quite get back to the way they were before,” but with the right help, they can live meaningful and fulfilling lives.


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