Sex and gender differences in schizophrenic psychoses have often been described but treatment approaches so far have hardly taken them into account.

To describe the most important sex and gender differences in schizophrenic psychoses with clinical implications.

Review.

Schizophrenic disorders show a later age of onset in women and a slightly better course, especially in young women. As to pathogenesis, there is some evidence that the age difference might be at least partly due to the female sex hormone estradiol being a protective factor. Differences in course might also have to do with this biological factor, but at the same time with the psychosocial advantages of a higher age of onset and other psychosocial factors.

These gender differences have important implications for assessment and therapy. Thus, we have to consider gender differences in coping behaviour as well as psychosocial burdens and needs deriving from differing roles in partnership, family, household and profession, from dependent relationships, potential abuse and violence. Furthermore, there are specific biological risks such as gonadal dysfunction we have to deal with in both sexes differently. Thus, e.g. women with psychosis can also have very special needs regarding fertility, pregnancy and motherhood. Also, around menopause we have to consider special measures such as replacement of physiological 17-b-estradiol.

Women, but also men, with schizophrenic psychoses should get a gender-sensitive assessment and treatment.

The author has not supplied his declaration of competing interest.