Background It is not known whether mothers with psychotic disorders are clinically and socially distinct from women with psychoses who have not had children. Aims To determine the proportion of mothers in an epidemiologically representative population of women with psychotic disorders, to examine the factors associated with having children, and to examine the factors associated with having children ‘looked after’ by social services. Method Descriptive analysis and two case–control studies. Results Sixty-three per cent of women with psychotic disorders were mothers. There were no clinical differences between women with or without children, but mothers were more likely to be older and live in unsupported accommodation. Having had a ‘looked after’ child was associated with Mental Health Act detention, younger age, a forensic history and being Black African. Conclusion Many women with psychoses are mothers. Mothers with psychoses are as disabled and have as many needs as women with psychoses without children.

Psychosocial characteristics and needs of mothers with psychotic disorders.

Purpose of review The effectiveness, side-effect profiles, and numerous other characteristics of antipsychotic medications have been extensively studied. However, the majority of publications do not address the many potential sex differences in efficacy and doses of medications, as well as other sex-specific considerations. Recent findings Of studies that exist, some suggest that female patients respond to lower doses of antipsychotic medications than males and that side-effect profiles vary between the sexes. However, the majority of preclinical trials use only male laboratory animals, and human clinical trials consist of too few women to analyze their response as a separate group. Summary Although changes in hormone production occurring at multiple stages throughout a women's life (such as during pregnancy, breast feeding, menopause, and postmenopausal) are presented as too complex to deal with in clinical trials, they could instead be embraced as clinical dilemmas that require additional study and consideration. We suggest that a focus should be made to reanalyze data from existing major treatment trials of antipsychotics to determine what medications specifically provide the most efficacy for female patients and at what dose range. In addition, new prospective studies are needed to specifically address appropriate adjustments in psychopharmacologic treatment for female patients during pregnancy, and when postmenopausal. More studies of the effects of antipsychotics on male and female fetuses in utero and during breast feeding are also needed to better manage women with schizophrenia and their offspring on a long-term basis in the community. There is currently too little known about sex differences in neuropharmacology. With the new USA National Institutes of Health policy to include sex in all new proposals, the time has come to close this gap in knowledge.

Issues related to sex differences in antipsychotic treatment.

Many brain diseases, including schizophrenia, affect men and women unequally - either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.

Women who suffer from schizophrenia: Critical issues.

Schizophrenia has long been known to affect men and women somewhat differently. It has been shown that men have a higher incidence, a younger age of onset, more impaired social and vocational functioning, and poorer response to treatment. Generally acknowledged risk factors such as season of birth, obstetric complications, head trauma and substance abuse affect males more than females. This review examines other potential predictive factors, both genetic and environmental, that have come to attention over the last 5 years, and examines their relative gender risk. Recent findings pertinent to women with schizophrenia have emerged with respect to hormonal effects, antipsychotic metabolism and antipsychotic side effects. A new concept relative to outcome is recovery, which, thus far, shows no gender difference. The review also addresses the needs of specific groups of women affected by schizophrenia – those in the early stages of illness, those who are pregnant, those who are mothers and those who are in their postmenopausal years. Several new findings are advancing the field of women and schizophrenia.

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Women and schizophrenia: new findings

Background Research in schizophrenia and pregnancy has traditionally been conducted in small samples. More recently, secondary analysis of routine healthcare data has facilitated access to data on large numbers of women with schizophrenia. Aims To discuss four scientific advances using data from Canada, Denmark and the UK from population-level health registers and clinical data sources. Method Narrative review of research from these three countries to illustrate key advances in the area of schizophrenia and pregnancy. Results Health administrative and clinical data from electronic medical records have been used to identify population-level and clinical cohorts of women with schizophrenia, and follow them longitudinally along with their children. These data have demonstrated that fertility rates in women with schizophrenia have increased over time and have enabled documentation of the course of illness in relation with pregnancy, showing the early postpartum as the time of highest risk. As a result of large sample sizes, we have been able to understand the prevalence of and risk factors for rare outcomes that would be difficult to study in clinical research. Advanced pharmaco-epidemiological methods have been used to address confounding in studies of antipsychotic medications in pregnancy, to provide data about the benefits and risks of treatment for women and their care providers. Conclusions Use of these data has advanced the field of research in schizophrenia and pregnancy. Future developments in use of electronic health records include access to richer data sources and use of modern technical advances such as machine learning and supporting team science.

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Schizophrenia around the time of pregnancy: leveraging population-based health data and electronic health record data to fill knowledge gaps.

Objective: Recognizing that needs differ between men and women with schizophrenia and that they vary over time, this review attempts to categorize the needs that are relevant to younger and to older women Method: This is a selective literature review focusing on topic areas the two authors determined to be most germane to women with schizophrenia Articles were selected on the basis of currency, comprehensiveness, and study design Particular attention was paid to the voices of the women themselves Results: There is considerable overlap between the needs of younger and older women with schizophrenia, but as a general rule, younger women require preventive strategies to stop the escalation of illness while older women require recovery interventions to regain lost hopes and abilities Conclusions: There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely dia

Rina Gupta

Papers

Selective review of age-related needs of women with schizophrenia.