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Women
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Psychosis in Women
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Psychosis in Women

A special issue of Women (ISSN 2673-4184).

Deadline for manuscript submissions: 30 December 2025 | Viewed by 35982

Special Issue Editors

Dr. Susana Ochoa

E-Mail Website
Guest Editor
Parc Sanitari Sant Joan de Déu, MERITT Group, Institut de Recerca Sant Joan de Déu, CIBERSAM, C/Dr. Pujades, 42, Sant Boi de Llobregat, 08330 Barcelona, Spain
Interests: clinical; cognitive; metacognitive and psychosocial basis of schizophrenia and other psychotic disorders
Prof. Dr. Mary V. Seeman
*
Website
Guest Editor
Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A8, Canada
Interests: women; schizophrenia; psychosis; clinical psychiatry; neuroscience
* We dedicate the memory of the editor, M.V.S., who passed away during this special issue period.
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Whatever the form of psychosis, women do not necessarily present clinically in the same way as men. Age of presentation may differ as well symptoms, help seeking, progression, and response to treatment. Triggers for the development of psychotic reactions are often more prevalent in one sex than the other due to different rates of exposure. For instance, vulnerability during reproductive periods and the prescription of exogenous hormones are problems that are unique to women. The problems caused by psychosis also differ in men and women, whether they are problems of general health, victimization, violence, child bearing, child rearing, or tasks of caregiving or survival. This Special Issue of Women will explore these issues and will provide clinical recommendations for best practice.

Dr. Susana Ochoa
Prof. Dr. Mary V. Seeman
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Women is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gender
  • psychosis
  • diagnosis
  • victimization
  • violence
  • treatment

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Published Papers (7 papers)

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Review

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14 pages, 472 KiB  
Review
A Review of Cardiovascular Risk Factors in Women with Psychosis
by Alexandre González-Rodríguez, Mary V. Seeman, Armand Guàrdia, Mentxu Natividad, Eloïsa Román, Eduard Izquierdo and José A. Monreal
Women 2023, 3(2), 200-213; https://doi.org/10.3390/women3020016 - 10 Apr 2023
Cited by 3 | Viewed by 1808
Abstract
The presence of medical comorbidities in women with psychotic disorders can lead to poor medical and psychiatric outcomes. Of all comorbidities, cardiovascular disease is the most frequent, and the one most likely to cause early death. We set out to review the evidence [...] Read more.
The presence of medical comorbidities in women with psychotic disorders can lead to poor medical and psychiatric outcomes. Of all comorbidities, cardiovascular disease is the most frequent, and the one most likely to cause early death. We set out to review the evidence for cardiovascular risk factors (CRFs) in women with schizophrenia-related disorders and for interventions commonly used to reduce CRFs. Electronic searches were conducted on PubMed and Scopus databases (2017–2022) to identify papers relevant to our aims. A total of 17 studies fulfilled our inclusion criteria. We found that CRFs were prevalent in psychotic disorders, the majority attributable to patient lifestyle behaviors. We found some inconsistencies across studies with regard to gender differences in metabolic disturbances in first episode psychosis, but general agreement that CRFs increase at the time of menopause in women with psychotic disorders. Primary care services emerge as the best settings in which to detect CRFs and plan successive intervention strategies as women age. Negative symptoms (apathy, avolition, social withdrawal) need to be targeted and smoking cessation, a heart-healthy diet, physical activity, and regular sleep routines need to be actively promoted. The goal of healthier hearts for women with psychotic disorders may be difficult, but it is achievable. Full article
(This article belongs to the Special Issue Psychosis in Women)
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14 pages, 471 KiB  
Review
Review of Male and Female Care Needs in Schizophrenia: A New Specialized Clinical Unit for Women
by Alexandre González-Rodríguez, Mary V. Seeman, Mentxu Natividad, Pablo Barrio, Eloïsa Román, Ariadna Balagué, Jennipher Paola Paolini and José Antonio Monreal
Women 2023, 3(1), 107-120; https://doi.org/10.3390/women3010009 - 21 Feb 2023
Cited by 6 | Viewed by 3215
Abstract
Women with schizophrenia require health interventions that differ, in many ways, from those of men. The aim of this paper is to review male and female care needs and describe a newly established care unit for the treatment of women with schizophrenia. After [...] Read more.
Women with schizophrenia require health interventions that differ, in many ways, from those of men. The aim of this paper is to review male and female care needs and describe a newly established care unit for the treatment of women with schizophrenia. After reviewing the literature on the differentiated needs of men and women with schizophrenia, we describe the new unit’s assessment, intervention, and evaluation measures. The program consists of (1) individual/group patient/family therapy, (2) therapeutic drug monitoring and adherence checks, (3) perinatal mental health, (4) medical liaison, (5) suicide prevention/intervention, (6) social services with special focus on parenting, domestic abuse, and sexual exploitation, (7) home-based services, (8) peer support, (9) occupational therapies (physical activity and leisure programs), and (10) psychoeducation for both patients and families. Still in the planning stage are quality evaluation of diagnostic assessment, personalized care, drug optimization, health screening (reproductive health, metabolic syndrome, cardiovascular health, cancer, menopausal status), and patient and family satisfaction with services provided. Woman-specific care represents an important resource that promises to deliver state-of-the-art treatment to women and, ideally, prevent mental illness in their offspring. Full article
(This article belongs to the Special Issue Psychosis in Women)
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18 pages, 1215 KiB  
Review
Potential Explanatory Models of the Female Preponderance in Very Late Onset Schizophrenia
by Samantha Johnstone, Gil Angela Dela Cruz, Todd A. Girard, Tarek K. Rajji and David J. Castle
Women 2022, 2(4), 353-370; https://doi.org/10.3390/women2040033 - 14 Oct 2022
Cited by 3 | Viewed by 4078
Abstract
Epidemiological and clinical studies have uniformly reported an overrepresentation of females with very-late-onset schizophrenia-like psychotic disorder (VLOS), in stark contrast to the sex distribution of early-onset schizophrenia. Various explanatory models have been proposed to account for these sex differences, including (a) antidopaminergic effects [...] Read more.
Epidemiological and clinical studies have uniformly reported an overrepresentation of females with very-late-onset schizophrenia-like psychotic disorder (VLOS), in stark contrast to the sex distribution of early-onset schizophrenia. Various explanatory models have been proposed to account for these sex differences, including (a) antidopaminergic effects of estrogen, (b) differential vulnerability to subtypes, (c) neurodegenerative differences between the sexes, and (d) and sex differences in age-related psychosocial and neurological risk factors; however, these models have not yet been critically evaluated for their validity. Keywords related to VLOS symptomatology, epidemiology, and sex/gender were entered into the PubMed, MEDLINE, and Google Scholar databases spanning all years. Through a narrative review of symptomatology and pathophysiology of VLOS, we examine the strengths and limitations of the proposed models. We present a comprehensive biopsychosocial perspective to integrate the above models with a focus on the role of neuroinflammation. There is significant room for further research into the mechanisms of VLOS that may help to explain the female preponderance; the effects of estrogen and menopause, neuroinflammation, and dopaminergic transmission; and their interaction with age-related and lifetime psychosocial stressors and underlying biological vulnerabilities. Full article
(This article belongs to the Special Issue Psychosis in Women)
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17 pages, 480 KiB  
Review
Psychiatric Partial Hospitalization Programs: Following World Health Organization Guidelines with a Special Focus on Women with Delusional Disorder
by Alexandre González-Rodríguez, Aida Alvarez, Armand Guàrdia, Rafael Penadés, José Antonio Monreal, Diego J. Palao, Javier Labad and Mary V. Seeman
Women 2021, 1(2), 80-96; https://doi.org/10.3390/women1020008 - 22 Apr 2021
Cited by 4 | Viewed by 5187
Abstract
The World Health Organization (WHO) developed a 7-year Mental Health Action Plan in 2013, which recommends integration of health and social care services into community-based settings, implementation of strategies for health promotion and prevention of illness, and support of research. In this review, [...] Read more.
The World Health Organization (WHO) developed a 7-year Mental Health Action Plan in 2013, which recommends integration of health and social care services into community-based settings, implementation of strategies for health promotion and prevention of illness, and support of research. In this review, we highlight partial hospitalization programs (PHPs) for delusional disorder (DD), with a special focus on the health and psychosocial needs of women. We suggest that PHPs are, in many ways, ideal settings for carrying out WHO recommendations. PHPs are multidisciplinary and consequently are able to provide a wide range of flexible program offerings. Programming in PHPs is able to address, with proven efficacy, individual needs, such as those presented by women at the various stages of their reproductive life. PHPs are a community bridge between hospital and outpatient services and can quickly adapt to specific needs as affected by gender, but also by age and cultural origins. They are ideal settings for professional training and for conducting clinical research. PHPs operate on the principle of shared decision making, and thus more readily than many other treatment sites, engaging difficult-to-treat patients, such as those with DD, by successfully establishing long-term relationships of trust. Full article
(This article belongs to the Special Issue Psychosis in Women)
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14 pages, 431 KiB  
Review
Care for Women with Delusional Disorder: Towards a Specialized Approach
by Alexandre González-Rodríguez, Mary V. Seeman, Aida Álvarez, Armand Guàrdia, Nadia Sanz, Genís F. Fucho, Diego J. Palao and Javier Labad
Women 2021, 1(1), 46-59; https://doi.org/10.3390/women1010004 - 15 Jan 2021
Cited by 5 | Viewed by 9641
Abstract
Delusional disorder is a difficult-to-treat clinical condition with health needs that are often undertreated. Although individuals with delusional disorder may be high functioning in daily life, they suffer from serious health complaints that may be sex-specific. The main aim of this narrative review [...] Read more.
Delusional disorder is a difficult-to-treat clinical condition with health needs that are often undertreated. Although individuals with delusional disorder may be high functioning in daily life, they suffer from serious health complaints that may be sex-specific. The main aim of this narrative review is to address these sex-specific health needs and to find ways of integrating their management into service programs. Age is an important issue. Delusional disorder most often first occurs in middle to late adult life, a time that corresponds to menopause in women, and menopausal age correlates with increased development of both somatic and psychological health problems in women. It is associated with a rise in the prevalence of depression and a worsening of prior psychotic symptoms. Importantly, women with delusional disorder show low compliance rates with both psychiatric treatment and with medical/surgical referrals. Intervention at the patient, provider, and systems levels are needed to address these ongoing problems. Full article
(This article belongs to the Special Issue Psychosis in Women)
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15 pages, 338 KiB  
Review
Schizophrenia Psychosis in Women
by Mary V. Seeman
Women 2021, 1(1), 1-15; https://doi.org/10.3390/women1010001 - 15 Sep 2020
Cited by 8 | Viewed by 6040
Abstract
A first step towards personalized medicine is to consider whether, for some disorders, the safest and most effective treatment of women needs to differ from standard guideline recommendations developed on the basis of clinical trials conducted, for the most part, in men. A [...] Read more.
A first step towards personalized medicine is to consider whether, for some disorders, the safest and most effective treatment of women needs to differ from standard guideline recommendations developed on the basis of clinical trials conducted, for the most part, in men. A second step is to consider how women’s reproductive stages—pre-pubertal years, menstrual phases, pregnancy trimesters, lactation and postpartum periods, menopausal and postmenopausal/aging status—affect the optimal choice of treatment. This review focuses on these two steps in the treatment of psychosis, specifically schizophrenia. It discusses genetics, precursors and symptoms of schizophrenia, reproductive and associated ethical issues, antipsychotic drug response and adverse effects, substance abuse, victimization and perpetration of violence, and issues of immigration and of co-morbidity. The conclusions, while often based on clinical experience and theoretical considerations rather than strictly on the evidence of randomized controlled trials, are that clinical recommendations need to consider clinical and role differences that exist between men and women and make appropriate correction for age and reproductive status. Full article
(This article belongs to the Special Issue Psychosis in Women)

Other

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12 pages, 470 KiB  
Systematic Review
Sex Selection Bias in Schizophrenia Antipsychotic Trials—An Update Systematic Review
by Lais Fonseca, Viviane Machado, Yaskara C. Luersen, Felipe Paraventi, Larissa Doretto and Ana Cristina Chaves
Women 2021, 1(2), 97-108; https://doi.org/10.3390/women1020009 - 20 May 2021
Cited by 1 | Viewed by 3580
Abstract
The lack of female participation in antipsychotic trials for schizophrenia poses an important issue regarding its applicability, with direct and real-life repercussions to clinical practice. Here, our aim is to systematically review the sampling sex bias among randomized clinical trials (RCTs) of second-generation [...] Read more.
The lack of female participation in antipsychotic trials for schizophrenia poses an important issue regarding its applicability, with direct and real-life repercussions to clinical practice. Here, our aim is to systematically review the sampling sex bias among randomized clinical trials (RCTs) of second-generation antipsychotics—namely risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole—as an update to a previous 2005 review. We searched MEDLINE and the Cochrane database for studies published through 7 September 2020 that assessed adult samples of at least 50 subjects with a diagnosis of schizophrenia, schizophrenia spectrum disorder, or broad psychosis, in order to investigate the percentage of women recruited and associated factors. Our review included 148 RCTs, published from 1993 to 2020, encompassing 43,961 subjects. Overall, the mean proportion of women was 34%, but only 17 trials included 50% or more females. Younger samples, studies conducted in North America, pharmaceutical funding and presence of specific exclusion criteria for women (i.e., pregnancy, breast-feeding or lack of reliable contraceptive) were associated with a lower prevalence of women in the trials. Considering the possible different effects of antipsychotics in both sexes, and our lack of knowledge on the subject due to sampling bias, it is imperative to expand actions aimed at bridging this gap. Full article
(This article belongs to the Special Issue Psychosis in Women)
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