A1 Journal article – refereed

Gender, age at onset and duration of being ill as predictors for the long-term course and outcome of Schizophrenia: An international multi-center study

List of Authors: Fountoulakis Konstantinos N, Dragioti Elena,T Theofilidis Antonis T, Wiklund Tobias, Atmatzidis Xenofon,Nimatoudis Ioannis,Thys Erik, Wampers Martien, Hranov Luchezar, Hristova Trayana, Aptalidis Daniil,Milev Roumen,Iftene Felicia, Spaniel Filip, Pavel Knytl Pavel,Furstova Petra, From Tiina, Karlsson Henry, Walta Maija, Salokangas Raimo K.R.,Azorin Jean-Michel, Bouniard Justine, Montant Julie, Juckel Geord, Haussleiter Ida S., Douzenis Athanasios, Michopoulos Ioannis, Ferentinos Panagiotis, Smyrnis Nikolaos, Mantonakis Leonidas, Nemes Zsófia, Gonda Xenia, Vajda Dora, Juhasz Anita, Amresh Shrivastava Amresh, Waddington John, Pompili Maurizio, Comparelli Anna, Corigliano Valentina, Rancans Elmars, Navickas Alvydas, Hilbig Jan, Bukelskis Laurynas, Stevovic Lidija I, Vodopic Sanja, Esan Oluyomi, Oladele Oluremi, Osunbote Christopher, Rybakowski Janusz K.,Wojciak Pawel, Domowicz Klaudia, Figueira Maria L, Linhares Ludgero, Crawford Joana, Panfil Anca-Livia, Smirnova Daria, Izmailova Olga, Lecic-Tosevski Dusica, Temmingh Henk, Howells Fleur, Bobes Julio, Garcia-Portilla Maria P., García-Alvarez Leticia, Erzin Gamze, Karadağ Hasan, De Sousa Avinash, Bendre Anuja, Hoschl Cyril, Bredicean Christina, Papava Ion, Vukovic Olivera, Pejuskovic Bojana, Russell Vincent, Louka Athanasiadis, Konsta Anastasia, Fountoulakis Nikolaos K, Stein Dan, Berk Michael Berk, Dean Olivia, Tandon Tajiv, Kasper Siegfried, De Hert Marc

Publisher: Cambridge University Press

Publication year: 2021

Journal: CNS Spectrums

eISSN: 2165-6509

DOI: http://dx.doi.org/10.1017/S1092852921000742

URL: https://doi.org/10.1017/S1092852921000742



The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia.


Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects.


There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness.


Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

Last updated on 2021-22-10 at 10:17