Women did better than men in early psychosis treatment, but the gap narrowed after 10 years

At first contact, women were older at onset, had higher premorbid adjustment and IQ, were more often employed and living independently. During the first 3 years in specialized early intervention services (EIS), women had higher recovery rates (50% vs 30.8%) and responded better to lower antipsychotic doses. After 10 years (following discharge from EIS to community services), women only maintained an advantage in negative symptoms; recovery rates no longer differed significantly (46.7% vs 34.4%). Antipsychotic doses increased after EIS discharge. Cannabis use remained more common among men at all time points.

Longitudinal cohort of 209 first-episode psychosis patients (95 females, 114 males) reassessed 8-16 years after initial contact with the PAFIP early intervention program in Spain.

The narrowing of the sex gap after specialized care ends raises questions about whether longer-duration EIS programs could maintain women's early advantage.

This study suggests that the well-known female advantage in psychosis outcomes may partly reflect the benefit of specialized, lower-dose treatment rather than an inherent biological advantage that persists indefinitely.

Single EIS program. Some attrition over 10 years. Observational design. Cannabis use differences may contribute to sex differences beyond biological factors.