Gender and short-term outcome in schizophrenia

227 first-contact schizophrenic patients (DSM-III) were followed-up for 2 years. The psychiatric teams responsible for the treatment of the patients conducted a detailed, standardized interview with the patients at entry and during the follow-up. Men showed a poorer premorbid heterosexual development and they also tended to be more withdrawn than women. Following the onset of the illness, men still failed to establish satisfactory heterosexual relationships, they suffered more often from negative symptoms, and they displayed poorer working capacity and functional ability than women. At the beginning of the follow-up men had a more pessimistic view of the development of their life situation over the next 2 years, a prediction which turned out to be correct. The predictions made by the psychiatric teams were very similar. In their plans for treatment the psychiatric teams recommended primarily psychotherapeutic methods for female patients--and women actually went to psychotherapy more often than men--whereas it was felt that the rehabilitation of men should concentrate on working capacity and basic social skills. The poorer psychosocial outcome of men seems to be due to their poor premorbid development--specifically heterosexual development--and negative symptoms. Together, these factors form a particularly harmful combination from the point of view of the social role of men in our society. The treatment system seems to be unable to adequately respond to the specific needs of men suffering from schizophrenia.