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Schizophrenia is classified to be a severe psychiatric disorder that affects individuals’ social life and personal. The origin of the word itself Schizophrenia— meaning “split mind” in Greek—first appeared in 1908 by the Swiss psychiatrist Eugen Bleuler (Barnet, 2018). This disorder presents itself in three types of symptoms which can be psychotic symptoms, negative symptoms, and cognitive impairment. Psychotic symptoms can present delusions and hallucinations which is the inability to connect with reality. Other symptoms related to this order are, negative symptoms decreased motivation, impaired speech, social withdrawal, and cognitive impairment which is the lack of performance that controls a variety of cognitive functions. ( Owen, Sawa, & Mortensen, 2016). The psychotic symptoms tend to be more frequent and more long-term than the other symptoms. By late adolescence, or even in early adulthood many have experienced their first episode that is followed by a prodromal phase. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), schizophrenia presents itself with the state of psychosis, psychoses features can be associated with schizophrenia but have different types of psychoses associated with bipolar disorder that include psychotic episodes including major depressive disorder also including psychotic episodes ( Owen et al., 2016). Each individual’s diagnosis varies taking into consideration the number of times episodes have been encountered also if there has been any sign of substance abuse and if there were any indications of depression or mania. With some evidence of the progression of the disorder during the early stages in the left hemisphere and the superior temporal structures more than any other part of the cortex ( Vita, Barlati, Peri, Desde, & Sacchetti, 2016). As the disorder progresses into more severe stages with the degree of progression with the frequency occurrence of episodes and including antipsychotics that are prescribed.

This literature review scrutinizes the research that includes treatment in sex differences of schizophrenia itself including symptoms, and treatments. My focus is on the symptoms and treatment plan that impaired individuals with schizophrenia according to a treatment plan that follows according to their sex and the severity of their disorder.

Hallucinations and Delusions

In schizophrenia, there are different levels of severity of the disorder, but a common symptom is the appearance of hallucinations which differ from person to person. Also, different types of hallucinations can be experienced by the five senses. Auditory hallucinations are the most common type within individuals (Smith, 2019). During an auditory hallucination, the person may hear voices, it could be several voices at once which can sound like whispers, or a different person trying to mummer. The voices can often tell the affected person to do commands, and the internal voices can sound unhappy with them (Smith, 2019). During visual hallucinations, individuals experience the presence of objects, figures, people, patterns, and lights that are not physically there. Others have reported being able to see and get in contact with their deceased loved ones. Losing perception is also included (Smith 2019). Also, when experiencing olfactory hallucinations often can cause some trouble without being able to smell many individuals fear for mealtime from the fear being experienced, many of them refrain from eating because they fear their food has been poisoned. (Smith, 2019) Next, in a tactile hallucination individuals experience the feeling of ants crawling which in reality is not happening. Delusions are characterized by DSM 5 “by having a false belief based on incorrect interference about external reality that is firmly sustained despite what almost everyone else believes and despite what makes up incontrovertible and obvious proof or evidence to the contrary (Imperfect Cognitions, 2013)”. During persecutory delusions, the person concludes that harm is coming their way either by an individual group despite the reality that is not happening. In erotomanic delusions, the person comes to the delusion that an individual, or more likely to be a celebrity has fallen in love with them. In somatic delusions, a person can believe they have an illness, or that something is affecting their body by an undiagnosed and rare condition that is not present or detected. When a grandiose delusion is present, a person believes that they have superior abilities or qualities despite not having valid proof (Smith, 2019).

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Sex Differences in Schizophrenia

Men have a greater probability than women to be diagnosed with schizophrenia, the ratio 4:1 male to female between the ages of 18 and 25 which is 4 years earlier than females (Gogos, Ney, Seymour, Rheenen, & Felmingham, 2019). Because of the lack of ovarian hormones being produced during menopause, women experience a peak of the disease. Research shows that men with schizophrenia have shown higher brain changes in morphological abnormalities and the amount of white matter than women. Reports show that women experience more negative symptoms in a more critical matter than men (Gogos et al., 2019). Both women and men experience the same amount of major depressive symptoms. During the progression of the disease and the severity of each present stage, men are least affected by the prescribed antipsychotic medication and have been hospitalized more often than women. Men also have a higher rate of being hospitalized which comes with substance abuse or medication men increase social isolation than women and many more men experience social withdrawal. Women have been shown to have better rates of remission and higher rates of recovery than men (Gogos et al., 2019). In studies that were conducted on the brains of males and females, MRI and postmortem studies show that men with schizophrenia show to having larger lateral and third ventricles, and anterior temporal horns than women; and also shows that men have smaller medial temporal volumes, hippocampus and amygdala, Herschel’s gyrus, superior temporal gyrus, and overall smaller frontal and temporal lobe volumes (Kathryn, Richard, & Jill, 2010).

Sex Differences in the Treatment of Schizophrenia

Treatment In Schizophrenia

The ultimate goal in treatment for schizophrenia is to seize the relapse of the frequency of episodes, and symptoms and integrate the person back into their daily routines. Most people with this disorder rarely go back to how their life was before the disorder. There are two types of treatment plans nonpharmacological and pharmacological for long-term outcomes. When going with a nonpharmacological option it is advised to include psychotherapy sessions as well. According to the American Psychiatric Association, antipsychotics except for clozapine (SGAs) are the best medication treatment for schizophrenia. SGAs are the best option for medication over antipsychotics (FGAs) because individuals experience fewer extrapyramidal symptoms ( Patel, Cherian, Gohil, & Atkinson, 2014). Sex differences in essential when wanting a more effective gender-specific pharmacological treatment which can help to predict the proper dose of medication is necessary, control the side effects of the medication, and compliance. Female patients have been shown to have surpassed their treatment plan with 50% higher of being hospitalized ( Patel et al., 2014). Thus, male patients tend to have a higher tolerance to antipsychotics which often requires males to be prescribed a much higher dose than females the reason for the higher dose is the correlation between liver enzymatic clearance. Also, males have higher levels of unhealthy habits such as cigarette smoking, drinking alcohol, and high caffeinated drinks which create a higher rate of enzymes to build up in the liver. For women with high hormone levels cause them to have more side effects such as hyperprolactinemia, hypotension, increased weight gain, and autoimmune complications ( Li, Ma, Wang, Yang, & Wang,2016). Research of sex factors in gender differences involves hormones more specifically gonadal hormones, for example, estrogen in women. A new finding of oxytocin is an important hormone for reproductive function which is beneficial for a therapeutic target for schizophrenia patients ( Li et al., 2016).


Limitations of Existing Research

Research on differences in sex differences demonstrated that women have shown to have better outcomes even when schizophrenia remains present longer in women at a later age ( Urizar, Fond, Urzua, & Boyer, 2018). Most of the studies have shown a greater increase in social adjustment for females compared to males, and they also have better premorbid functioning than males (Thara & Kamath, 2015). Studies have shown that there is no relationship between gender differences in the incidence and prevalence of schizophrenia. Thus, the majority of research states females reported having better clinical outcomes than males in the short-term, where in contrast gender differences tend to disappear over longer periods ( Thara & Kamath, 2015). During the early phase of schizophrenia, gender differences are more present in the prodromal phase and early presentation of psychosis a treatment plan is provided ( Talonen, Vaananen, & Kaltiala-Heino, 2017). Psychotherapy was administered to both men and women to help reduce the frequency of negative symptoms, but only women found this type of therapy to be helpful with their symptoms ( Savil, Orfanos, Bentall, Reininghaus, Wykes, & Priebe, 2017). Future research should have a control group with a specific treatment for each man and woman for each group for example adolescents, early adulthood, or late adulthood. Taking into consideration the sample size and patients taking nonpharmacological and pharmacological treatments. However, each treatment plan comes with different types of medication or extra psychotherapy to be included to fully follow the treatment plan. Having the right knowledge of the severity of schizophrenia can help an individual, not relapse and have better management skills in taking their medication without the substance abuse of their antipsychotics. Also, future research should include outpatient treatment plans and their outcomes to inpatient treatment plans.

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