The necessary gender perspective on psychosis
Gender influences all aspects related to a person's mental health: the stressful situations that may precede the onset of a disorder, the symptomatic expression, the behavior when seeking help, how they will be treated in the health system, the social support they will receive, the socioeconomic status, expectations and all the other factors that can interact in individual vulnerability. And it also plays an important role in the expressions of discomfort and in the definitions of normality and pathology.
Several studies have revealed differences between men and women in the prevalence, etiology, presentation, course and treatment of different mental disorders. Some of them have been related to pregnancy, childbirth, the menstrual cycle and menopause, aspects specific to women, which make gender a variable that must be taken into account. Therefore, it is important to include a gender perspective in the approach to different mental disorders.
Why do women have more depressive disorders than men?
Diagnosis of mental disorders in women
If we keep these differences in mind, it is necessary to take into account how disorders and treatments can affect women and men differently. In this sense, it is necessary for the professional to ask specific questions for women and men to obtain the most relevant and detailed information and be able to offer a more effective therapeutic approach.
In the case of women, in order to make a good diagnosis and treatment, it is important to have information and ask about these aspects:
- Phase of the menstrual cycle
- Oral contraceptives
- Pregnancy
- Postpartum and breastfeeding period
- Abortion
- Infertility
- Perimenopause and menopause (natural or surgical)
- Drugs: hormonal treatment and over-the-counter drugs (supplements)
- Diet evaluation
- Toxic habits: drug abuse
- Family psychiatric history: family history of premenstrual syndrome and postpartum depression
- Menstrual history: assess symptoms related to menstruation, perimenstruation, pregnancy, and perimenopause
- Family and social history: explore whether there was sexual, physical or emotional abuse in childhood and adulthood and whether the person has suffered or is currently suffering from gender-based violence.
Women with severe mental illness have worse physical health
Sex differences in psychotic disorders
Studies on sex differences have generated new hypotheses about the etiology of psychotic disorders and new perspectives on treatment. To begin with, the incidence of these disorders is slightly higher in men, and is highest in young men and in women over 45 years of age.
Symptoms, functioning and needs
In terms of symptoms and functioning, women tend to have more affective symptoms , such as depression and anxiety. In contrast, men tend to have more negative symptoms and more substance use. In general, women have a better course of the disease and social functioning, and therefore their prognosis is also better.
In reference to needs, women have more needs for services ( information, transportation, social assistance), while men have more basic needs (food, personal care, etc.) and functioning (daily and household activities).
On the other hand, sexual problems are common in women with psychosis, both due to the symptoms of the disorder and the side effects of medication.
Response to treatment
Women, in general, respond better to treatment than men and, at the same time, require lower doses of medication . However, after menopause, they may need an increase in the dose and not have such a good response to treatment. However, they tend to have more side effects from the medication , such as weight gain, metabolic alterations, sexual dysfunction and cardiovascular effects. In addition, they are also more likely to have hyperprolactinemia, which is usually accompanied by menstrual and sexual alterations.
Women tend to experience more side effects from medication, such as weight gain, metabolic alterations, sexual dysfunction and cardiovascular problems.
They also respond better to psychological treatment, especially cognitive-behavioral therapy . Metacognitive treatment, for example, has been shown to be more effective in reducing symptoms and improving cognitive insight in women.
Woman, bipolar disorder and the desire to be a mother
Menopause and psychosis
Estrogens have a modulating effect on the dopaminergic, serotoninergic and glutamatergic systems that are involved in psychosis. And, therefore, they may have a protective effect on women who are vulnerable to having this disorder. For this reason, it is very important to keep in mind the phase of the menstrual cycle that the woman is in or if she is menopausal.
During menopause, psychotic symptoms may worsen , but symptoms specific to menopause may also be aggravated, due to factors associated with the psychotic disorder.
In summary, it is important to always work from a gender perspective to be able to offer specific care and treatment, give maximum support and help to the affected person and achieve optimal recovery.
