Unraveling the gender divide: A systematic review of gender-specific differences at the first episode of psychosis

This systematic review aims to explore gender differences in the first episode of psychosis (FEP) among individuals aged 13 to 24 years, focusing on clinical, demographic, and outcomecharacteristics, with an emphasis on how gender-related differences in symptom presentation maycontribute to misdiagnosis, particularly among females. A comprehensive search was conducted across PubMed, Embase, and PsycInfo databases, targetingstudies published between 2014 and 2024. Inclusion criteria were observational and experimentalstudies reporting gender-disaggregated data on the FEP in adolescents and young adults aged 13 to24 years. The screening and selection process followed a systematic approach, and data wereextracted focusing on gender-based differences in onset, clinical presentation, and outcomes ofpsychosis. The final section comprised six studies involving 3798 individuals with a diagnosis of FEP. Thefindings highlighted a later onset of psychosis in females, along with a more affective and atypicalsymptom presentation compared to males, who exhibited more overt psychotic features. Femaleswere more frequently misdiagnosed with mood disorders before receiving a correct psychosisdiagnosis, contributing to delayed interventions. Despite better short-term treatment responses inwomen, they showed higher vulnerability to relapse, particularly in hormonally sensitive periods. The differences in clinical presentation between males and females in FEP may contribute to highermisdiagnosis rates in women. By examining these gender differences, this review highlights theneed for more accurate diagnostic criteria and tailored interventions for both genders, which couldimprove early intervention.