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. 2025 Jan 15:369:449-461.
doi: 10.1016/j.jad.2024.10.002. Epub 2024 Oct 3.

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

Roberto Palacios-Garran  1 , Silvia Amoretti  2 , Maria Serra-Navarro  3 , Carla Torrent  3 , Marina Garriga  3 , Natalia E Fares-Otero  3 , Maria Sagué-Vilavella  3 , Santiago Madero  4 , M Florencia Forte  3 , Laura Montejo  3 , Pilar Salgado-Pineda  5 , Irene Montoro  6 , Vanessa Sánchez-Gistau  6 , Edith Pomarol-Clotet  5 , Giulia Menculini  7 , Alfonso Tortorella  7 , Isabella Pacchiarotti  3 , Clemente Garcia-Rizo  4 , Josep Antoni Ramos-Quiroga  8 , Anabel Martínez-Arán  9 , Eduard Vieta  10 , Norma Verdolini  11
Affiliations
Free article

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

Roberto Palacios-Garran et al. J Affect Disord. .
Free article

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.

Keywords: Bipolar disorder; Early psychosis; Emotional intelligence; First episode mania; First episode psychosis; Prodromes; Sex differences.

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Conflict of interest statement

Declaration of competing interest RPG has received financial support for CME activities and travel funds the following entities (unrelated to the present work): Angelini, Janssen, Lundbeck, Rovi and Otsuka. SA has been a consultant to and/or has received honoraria/grants from Otsuka-Lundbeck, with no financial or other relationship relevant to the subject of this article. MG has received grants and served as consultant or advisor for Ferrer, Lundbeck, and Janssen-Cilag. MSV has received financial support for CME activities and travel funds from Janssen-Cilag and Lundbeck, and reports no financial or other relationship relevant to the subject of this article. JARQ was on the speakers' bureau and/or acted as consultant for Eli-Lilly,Janssen-Cilag, Novartis, Shire, Takeda, Bial, Shionogui, Lundbeck, Almirall, Braingaze, Sincrolab, Medice, Rubió and Raffo in the last 5 years. He also received travel awards (air tickets + hotel) for taking part in psychiatric meetings from Janssen-Cilag, Rubió, Shire, Takeda, Shionogui, Bial, Medice and Eli-Lilly. The Department of Psychiatry chaired by him received unrestricted educational and research support from the following companies in the last 5 years: Eli-Lilly, Lundbeck, Janssen-Cilag, Actelion, Shire, Ferrer, Oryzon, Roche, Psious and Rubió. VSG has received financial support for CME activities and travel funds the following entities (unrelated to the present work): Angelini, Janssen, Lundbeck, Otsuka. GM served as speaker/consultant or received travel funds from Angelini, Janssen and Labor Est. AMA has received funding for research projects and/or honoraria as a consultant or speaker for the following companies and institutions (work unrelated to the topic of this manuscript): Otsuka, Pfizer, AstraZeneca, Bristol-Myers Squibb, Lundbeck, the Spanish Ministry of Economy and Competitiveness and Instituto de Salud Carlos III. IP has received CME-related honoraria or consulting fees from ADAMED, Janssen-Cilag and Lundbeck. EV has received grants and served as consultant, advisor or CME speaker for the following entities: AB-Biotics, AbbVie, Adamed, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Compass, Dainippon Sumitomo Pharma, Ethypharm, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Medincell, Merck, Novartis, Orion Corporation, Organon, Otsuka, Roche, Rovi, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris, outside the submitted work. NV has received financial support for CME activities and travel funds from the following entities (unrelated to the present work): Angelini, Janssen, Lundbeck, Otsuka. The rest of authors report no biomedical financial interests or potential conflicts of interest related to the present article.