Differences Between Men And Women May Change Treatment For Schizophrenia And Bipolar Disorder

Men and women can experience bipolar disorder and schizophrenia differently. Men tend to have earlier onset, more severe symptoms, and a higher risk of drug use and smoking. Women, on the other hand, tend to have more emotional symptoms and better performance on some memory and attention tests, but they also have more physical health problems, such as thyroid problems and migraines. These results show that treatment needs to consider gender differences to be most effective.

Bipolar disorder and schizophrenia are serious mental illnesses that share some common symptoms, such as difficulty reasoning and the presence of psychotic episodes (hallucinations, delusions, and loss of touch with reality). Despite this similarity, they also have important differences in their onset, their development over time, and the brain mechanisms involved.

One point that has attracted the attention of researchers is how a person's gender (male or female) can influence these disorders. This is because it is already known that men and women can have different ages of symptom onset, present distinct clinical manifestations, and even vary in cognitive aspects and quality of life.

For example, in schizophrenia, men tend to have earlier onset and more severe symptoms, while women have a greater presence of emotional symptoms. In bipolar disorder, women are more prone to hypomania, and men experience more frequent manic episodes and a higher risk of substance use.

Beyond symptoms, there are also cognitive differences. Generally speaking, women tend to perform better in verbal memory and social skills, while men have an advantage in spatial reasoning and motor speed. In the context of severe mental illness, these differences appear in varying ways.

Some studies suggest that men with schizophrenia experience greater impairments in memory and verbal learning from the first episode of psychosis, while other studies find no significant differences between the sexes.

Another point investigated is the physical illnesses that appear alongside severe mental illnesses. People with bipolar disorder and schizophrenia are more likely to develop hypertension, diabetes, migraines, and even some types of cancer when compared to the general population.

Still, there are nuances: men tend to have more hypertension, while women have more thyroid problems. Migraines, on the other hand, are much more common in women, both in the general population and in people with bipolar disorder.

To better understand these differences, researchers at the University of Barcelona (UB), Spain, analyzed data from more than 1,500 people. The study included three groups: individuals with bipolar disorder (543 people), individuals with schizophrenia (517 people), and a comparison group of people without mental illness (456 people).

These people were assessed on several aspects: age, sociodemographic characteristics, clinical symptoms, presence of physical illnesses, performance on tests of memory, attention, and other cognitive functions, as well as quality of life and social functioning. In other words, the study focused not only on psychiatric symptoms, but also on mental and physical health more broadly.

After collecting all this data, the researchers applied statistical models to compare men and women within each diagnosis, and also to compare the different groups among themselves (bipolar disorder, schizophrenia, and healthy individuals). This allowed them to identify how a person's gender impacted symptoms, cognition, and comorbidities.

The findings showed that gender influences both the onset of the illness and behavior related to substance use and the presence of physical illnesses. Men with schizophrenia had higher rates of smoking and drug use.

In contrast, women with bipolar disorder performed better on tests of verbal memory and psychomotor speed compared to men. Furthermore, both men and women with severe mental illnesses reported a higher frequency of thyroid problems compared to those without mental illness.

The results reinforce that gender is not a secondary factor, but a central factor in how bipolar disorder and schizophrenia manifest. This means that treatment strategies must take these differences into account, whether in symptom management, substance use prevention, or the management of associated physical illnesses.

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Influence of Sex and Diagnosis on Clinical Variables and Neurocognitive Performance in Severe Mental Illness. Results From the PsyCourse Study

Maria Serra-Navarro, Maria Heilbronner, Brisa Solé, Roger Borràs, Anabel Martinez-Arán, Kristina Adorjan, Alba Navarro-Flores, Mojtaba Oraki Kohshour, Daniela Reich-Erkelenz, Eva C. Schulte, Fanny Senner, Ion-George Anghelescu, Volker Arolt, Bernhard T. Baune, Udo Dannlowski, Detlef E. Dietrich, Andreas J. Fallgatter, Christian Figge, Markus Jäger, Georg Juckel, Carsten Konrad, Jens Reimer, Eva Z. Reininghaus, Max Schmauß, Andrea Schmitt, Carsten Spitzer, Jens Wiltfang, Jörg Zimmermann, Sergi Papiol, Urs Heilbronner, Peter Falkai, Thomas G. Schulze, Eduard Vieta, Carla Torrent, Monika Budde, and Silvia Amoretti 

Acta Psychiatrica Scandinavica,  03 September 2025

https://doi.org/10.1111/acps.70026

Abstract: 

Bipolar disorder (BD) and schizophrenia (SZ) are serious mental illnesses (SMI) with overlapping symptoms but distinct differences in onset and course. Sex differences are an area of growing interest in SMI. This study aims to examine potential interactions between sex and diagnosis across a broad range of variables, to compare males and females within SZ and BD, and to investigate sex-specific group differences. A total of 1516 individuals were included in a cross-sectional study using baseline data from the multicenter PsyCourse Study, including BD (n = 543), SZ (n = 517), and healthy controls (HC) (n = 456). Sociodemographic characteristics, clinical symptoms, psychosocial functioning, quality of life, neurocognitive performance, and somatic comorbidities were assessed. Generalized linear models were used to analyze differences between groups and sexes. False Discovery Rate (FDR) and Bonferroni post hoc comparisons were performed. Significant interactions were identified in age (p = 0.001), age at treatment (p = 0.05), illness duration (p = 0.03), illicit drug use (p = 0.01), and smoking (p = 0.05). Differences in substance use were observed across groups and sexes, with the highest rates found in males with SZ. The BD group showed better functioning and neurocognitive performance compared with the SZ group. Within the BD group, females reported better performance in verbal memory (p = 0.003) and psychomotor speed (p < 0.001) than males. Moreover, both females and males with SMI showed higher rates of thyroid alterations compared with HC (p = 0.01 for females and p = 0.002 for males). Significant sex differences were observed in substance use and somatic comorbidities. Interactions between diagnosis and sex underscore the importance of considering both factors in clinical assessments. These findings highlight the need to tailor sex-specific treatment for each patient. Further research is needed to explore the role of sex hormones and other biological and societal factors in the presentation and course of these disorders.