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Abstract
Gender is a critical determinant of mental health and mental illness. Gender is an interesting example of a complex factor that may influence the development or course of mental illnesses. It affects all aspects of mental disorder. For example; it affects prevalence, age at onset, course, response to treatment and even methods of treatment.
The effect of gender on different psychiatric disorders will be summarized as follows:
Schizophrenia:
The incidence of schizophrenia ranges from approximately 0.5 to 2.0 per 10000 populations, and the prevalence from 1 to 12% in different countries. It occurs more commonly in males and also it has a later age at onset in females and also has a more favorable course in females than males. Studies showed that males younger than age 45 years had the highest incidence compared to young females. Women older than age 45 years had a signifi¬cantly higher incidence of schizophrenia than men older than age 45but the higher incidence among older women did not offset the higher incidence among younger males. Gender effect on the age of onset was apparent in the different subtypes of schizophrenia as well, with female patients having onset later 5 years than their male counterpart’s. Women also present someway differently from men. Female patients have briefer and fewer hospitalizations, more mood features, fewer negative symptoms and better preserved social skills. Specific positive symptoms have been found to be higher in women, such as more paranoia or persecu-tory delusions and auditory hallucinations. Women had a more rapid and better treatment response to typical antipsychotic medications. Work on sex differences in response to atypical antipsychotic medications is in its infancy. Also faster symptom improvement was achieved using estrogen replacement therapy as an adjunct to neuroleptics.
Depression:
Depression is more than ordinary sadness also there is a recognized difference between normal grief and clinical depression. Women experience major depression about twice as men. The lifetime risk of major depression in women is about 20% to 26%, compared to about 8% to 12% for men. Prepubescent boys are more likely than girls to be depressed. During adolescence a dramatic shift occurs between the ages of 11 and 13 years, this trend in depression rates is reversed. By 15 years of age, females are approximately twice as likely as males to have experienced an episode of depression, and this gender gap persists for the next 35 to 40 years. The results of several studies have not supported gender and racial differences in the incidence of depression. Men and women share the same core set of depression symptoms: depressed mood, lack of motivation, loss of pleasure, changes in appetite, sleep disturbances, feelings of guilt and difficulty concentrating. However, studies suggest that some differences in the symptom patterns exhibited by men and women. It is uncertain whether gender differences in antidepressant res-ponse exist. One of the most commonly reported differences in male and female suicide behavior is which of the suicide methods they select. Men tend to choose more violent—and thus more likely to be lethal—suicide methods.
Bipolar Disorders:
Gender differences in bipolar disorder are becoming increasingly apparent, but have been less studied. Men and women are equally affected by bipolar disorder. The onset of bipolar disorder was a mean 3.2 years later in women than men. Women may be more likely than men to develop late onset bipolar disorder (45-49 years). Women with bipolar disorder tend to have more depressive and fewer manic episodes than men do. Women are also more likely to have bipolar II, which is a milder form of the disorder. Rapid cycling is also more common in patients with bipolar II disorder. There is no evidence that gender affects treatment response to mood stabilizers. However, women may be more susceptible to delayed diagnosis and treatment.
Anxiety disorders:
Anxiety disorders are very widespread phenol-menon. The prevalence rate is higher in women compared to men for all types of anxiety disorders. Panic disorder is 2.5 times more prevalent among women than men. Also women may suffer more debilitating forms of panic disorder. Three symptoms predicted female gender: shortness of breath, nausea and feeling smothered while two symptoms predicted male gender: sweating and pain in the stomach. Relapse rate in panic disorder over 8 years of follow up was three fold higher in women compared to men. Also, women were more than twice as likely as men to meet diagnostic criteria for Agoraphobia (ratio of 2.2:1.0). Similar results were seen in generalized anxiety disorder and post traumatic stress syndrome. It is a well established fact that women develop post-traumatic stress disorder (PTSD) more often than men do despite the fact that men experience up to four times as many potentially traumatic events during their lifetime.
Somatoform Disorders:
Somatization disorder, Conversion disorder and Pain disorder occur more frequently in females. Other types of somatoform disorders like Hypochondriasis and Body Dysmorphic Disorder occurs equally in males and females.
Eating Disorders:
Both anorexia nervosa and bulimia nervosa are more common in females. Studies on anorexia nervosa have noted a higher incidence rate among women with male to female ratio 1:10 to 1:20 while studies on bulimia nervosa have noted that women outnumber men ten to one.
Sleep disorders:-
Research on gender difference in sleep disorders suggests that obstructive sleep apnea and narcolepsy are more common in males than females while insomnia and restless leg syndrome are more common in females. Studies on REM sleep behavior disorder had shown that it occurs most exclusively in men with male to female ratio 9:1.
Personality disorders:
DSM-IV reports that borderline, histrionic and dependant personality disorders occur more frequently in females, whereas schizoid, schizotypal, paranoid, antisocial, narcissistic and obsessive-compulsive personality disorders are more diagnosed in men. Antisocial and borderline personality disorders are most notable for the degree of gender difference with the male to female ratio for the former being 3:1 and the latter being 1:3. The course of these disorders is usually chronic.
Child psychiatry:
Attention deficit hyperactivity syndrome, Autism, Conduct disorder ”CD” and Stuttering are common childhood disorders. They are more common among boys compared to girls. It is estimated that boys are two to three times more likely to have ADHD than girls also boys are at higher risk for ”Autism Spectrum Disorders” ASD than girls. The sex ratio averages 4.3:1.Simillarly, boys diagnosed with CD outnumbers girls by roughly four to one in nearly all settings. As regard to stuttering, in older children and adults the male-to-female ratio is large, about 4 to 1 or greater.
Geriatric psychiatry:
Dementia is more common in females and also has a different clinical manifestation from males. Major tranquilizers are used more in males.
Substance abuse:
It is well known that males are more likely than females to abuse drugs. Research shows that these gender differences in drug abuse are not related to gender differences in susceptibility but once given the opportunity to use, males and females are equally likely to use drugs. Women and men are equally likely to become addicted to nicotine. Women are more socially stigmatized and so they face different barriers to treatment than men, particularly financial hardship, social isolation, and greater physiological complications. Treatment for women should be specifically tailored to meet the needs of female clients