Hostname: page-component-797576ffbb-5676f Total loading time: 0 Render date: 2023-12-03T14:22:21.654Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "useRatesEcommerce": true } hasContentIssue false

Sex Differences in Cognitive Functioning in At-Risk Mental State for Psychosis, First Episode Psychosis and Healthy Control Subjects

Published online by Cambridge University Press:  15 April 2020

S. Ittig
Psychiatric University Outpatient Department, Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland
E. Studerus
Psychiatric University Outpatient Department, Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland
M. Papmeyer
Psychiatric University Outpatient Department, Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland
M. Uttinger
Psychiatric University Outpatient Department, Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland
S. Koranyi
Psychiatric University Outpatient Department, Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland Jena University Hospital, Friedrich Schiller University Jena, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany
A. Ramyead
Psychiatric University Outpatient Department, Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland
A. Riecher-Rössler*
Psychiatric University Outpatient Department, Psychiatric University Clinics Basel, University of Basel, Basel, Switzerland
*Corresponding author. Psychiatric University Clinics Basel, Center for Gender Research and Early Detection, Kornhausgasse 7, 4051 Basel, Switzerland. Tel.: +41 61 325 81 61; fax: +41 61 325 81 60. E-mail (A. Riecher-Rö ssler).
Get access



Several sex differences in schizophrenia have been reported including differences in cognitive functioning. Studies with schizophrenia patients and healthy controls (HC) indicate that the sex advantage for women in verbal domains is also present in schizophrenia patients. However, findings have been inconsistent. No study focused on sex-related cognitive performance differences in at-risk mental state for psychosis (ARMS) individuals yet. Thus, the aim of the present study was to investigate sex differences in cognitive functioning in ARMS, first episode psychosis (FEP) and HC subjects. We expected a better verbal learning and memory performance of women in all groups.


The neuropsychological data analysed in this study were collected within the prospective Früherkennung von Psychosen (FePsy) study. In total, 118 ARMS, 88 FEP individuals and 86 HC completed a cognitive test battery covering the domains of executive functions, attention, working memory, verbal learning and memory, IQ and speed of processing.


Women performed better in verbal learning and memory regardless of diagnostic group. By contrast, men as compared to women showed a shorter reaction time during the working memory task across all groups.


The results provide evidence that women generally perform better in verbal learning and memory, independent of diagnostic group (ARMS, FEP, HC). The finding of a shorter reaction time for men in the working memory task could indicate that men have a superior working memory performance since they responded faster during the target trials, while maintaining a comparable overall working memory performance level.

Original article
Copyright © Elsevier Masson SAS 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Abel, K.M., Drake, R., Goldstein, J.M.. Sex differences in schizophrenia. Int Rev Psychiatry 2010;22 :417428.CrossRefGoogle Scholar
Addington, J., Addington, D., Maticka-Tyndale, E.. Cognitive functioning and positive and negative symptoms in schizophrenia. Schizophr Res 1991;5 :123134.CrossRefGoogle Scholar
Albus, M., Hubmann, W., Mohr, F., Scherer, J., Sobizack, N., Franz, U., et al.Are there gender differences in neuropsychological performance in patients with first-episode schizophrenia?. Schizophr Res 1997;28 :3950.CrossRefGoogle ScholarPubMed
Andreasen, N.C.. The scale for the assessment of negative symptoms (SANS): conceptual and theoretic foundations. Br J Psychiatry 1989;155 :4952.CrossRefGoogle Scholar
Ayesa-Arriola, R., Rodriguez-Sanchez, J.M., Gomez-Ruiz, E., Roiz-Santianez, R., Reeves, L.L., Crespo-Facorro, B.. No sex differences in neuropsychological performance in first episode psychosis patients. Prog Neuropsychopharmacol Biol Psychiatry 2014;48 :149154.CrossRefGoogle ScholarPubMed
Basso, M.R., Nasrallah, H.A., Olson, S.C., Bornstein, R.A.. Neuropsychological correlates of negative, disorganized and psychotic symptoms in schizophrenia. Schizophr Res 1998;31 :99111.CrossRefGoogle Scholar
Benjamini, Y., Hochberg, Y.. Controlling the false discovery rate – a practical and powerful approach to multiple testing. J R Stat Soc B Method 1995;57 :289300.Google Scholar
Bilder, R.M., Lipschutz-Broch, L., Reiter, G., Geisler, S.H., Mayerhoff, D.I., Lieberman, J.A.. Intellectual deficits in first-episode schizophrenia: evidence for progressive deterioration. Schizophr Bull 1992;18 :437448.CrossRefGoogle ScholarPubMed
Bora, E., Murray, R.M.. Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis?. Schizophr Bull 2014;40 :744755.CrossRefGoogle ScholarPubMed
Box, G., Cox, D.. An analysis of transformation. J R Stat Soc 1964;26 (2):211243.Google Scholar
Bozikas, V.P., Kosmidis, M.H., Peltekis, A., Giannakou, M., Nimatoudis, I., Karavatos, A., et al.Sex differences in neuropsychological functioning among schizophrenia patients. Aust N Z J Psychiatry 2010;44 :333341.CrossRefGoogle ScholarPubMed
Brewer, W.J., Francey, S.M., Wood, S.J., Jackson, H.J., Pantelis, C., Phillips, L.J., et al.Memory impairments identified in people at ultra-high risk for psychosis who later develop first-episode psychosis. Am J Psychiatry 2005;162 :7178.CrossRefGoogle ScholarPubMed
Delis, D.C., Kramer, J.H., Kaplan, E., Ober, B.A.California Verbal Learning Test (CVLT). San Antonio (TX): Psychological Corporation; 1987.Google Scholar
Drühe-Wienholt, C.M., Wienholt, W.CKV: Computergestütztes Kartensortierverfahren. Frankfurt am Main: Swets und Zeitlinger Testservices; 1998.Google Scholar
Enders, C.K.Applied missing data analysis. New York: Guilford Press; 2010.Google Scholar
Eranti, S.V., MacCabe, J.H., Bundy, H., Murray, R.M.. Gender difference in age at onset of schizophrenia: a meta-analysis. Psychol Med 2013;43 :155167.CrossRefGoogle ScholarPubMed
Farage, M.A., Osborn, T.W., MacLean, A.B.. Cognitive, sensory, and emotional changes associated with the menstrual cycle: a review. Arch Gynecol Obstet 2008;278 :299307.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Deste, G., Smieskova, R., Barlati, S., Yung, A.R., Howes, O., et al.Cognitive functioning in prodromal psychosis: a meta-analysis. Arch Gen Psychiatry 2012;69 :562571.CrossRefGoogle ScholarPubMed
Gedika, G., Schöttke, H.Der Turm von Hanoi – TvH. Hogrefe Testsystem (HTS). Göttingen: Hogrefe; 1994.Google Scholar
Giuliano, A.J., Li, H., Mesholam-Gately, R.I., Sorenson, S.M., Woodberry, K.A., Seidman, L.J.. Neurocognition in the psychosis risk syndrome: a quantitative and qualitative review. Curr Pharm Des 2012;18 :399415.CrossRefGoogle ScholarPubMed
Goldberg, T.E., Gold, J.M., Torrey, E.F., Weinberger, D.R.. Lack of sex-differences in the neuropsychological performance of patients with schizophrenia. Am J Psychiatry 1995;152 :883888.Google ScholarPubMed
Goldstein, J.M., Seidman, L.J., Goodman, J.M., Koren, D., Lee, H., Weintraub, S., et al.Are there sex differences in neuropsychological functions among patients with schizophrenia?. Am J Psychiatry 1998;155 :13581364.CrossRefGoogle ScholarPubMed
Graham, J.W., Olchowski, A.E., Gilreath, T.D.. How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prev Sci 2007;8 :206213.CrossRefGoogle ScholarPubMed
Häfner, H., Maurer, K., Loffler, W., Fatkenheuer, B., an der Heiden, W., Riecher-Rössler, A., et al.The epidemiology of early schizophrenia. Influence of age and gender on onset and early course. Br J Psychiatry Suppl 1994;23 :2938.CrossRefGoogle Scholar
Halari, R., Hines, M., Kumari, V., Mehrotra, R., Wheeler, M., Ng, V., et al.Sex differences and individual differences in cognitive performance and their relationship to endogenous gonadal hormones and gonadotropins. Behav Neurosci 2005;119 :104117.CrossRefGoogle ScholarPubMed
Halpern, D.F.. A cognitive-process taxonomy for sex differences in cognitive abilities. Curr Dir Psychol Sci 2004;13 :135139.CrossRefGoogle Scholar
Han, M., Huang, X.F., Chen da, C., Xiu, M.H., Hui, L., Liu, H., et al.Gender differences in cognitive function of patients with chronic schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2012;39 :358363.CrossRefGoogle ScholarPubMed
Hausmann, M.Gehirn und Geschlecht. Kognitive Geschlechtsunterschiede Berlin: Springer; 2007. p.105123.Google Scholar
Hausmann, M., Slabbekoorn, D., Van Goozen, S.H., Cohen-Kettenis, P.T., Gunturkun, O.. Sex hormones affect spatial abilities during the menstrual cycle. Behav Neurosci 2000;114 :12451250.CrossRefGoogle ScholarPubMed
Heaton, R.K., Chelune, G.H., Talley, J.L., Kay, G.G., Curtis, G.WCST – Wisconsin Card Sorting Test (computerised version) Swets & Zeitlinger; 1998.Google Scholar
Hedman, A.M., van Haren, N.E.M., van Baal, C.G.M., Kahn, R.S., Pol, H.E.H.. IQ change over time in schizophrenia and healthy individuals: a meta-analysis. Schizophr Res 2013;146 :201208.CrossRefGoogle ScholarPubMed
Hoff, A.L., Wieneke, M., Faustman, W.O., Horon, R., Sakuma, M., Blankfeld, H., et al.Sex differences in neuropsychological functioning of first-episode and chronically ill schizophrenic patients. Am J Psychiatry 1998;155 :14371439.CrossRefGoogle ScholarPubMed
Hoff, A.L., Kremen, W.S., Wieneke, M.H., Lauriello, J., Blankfeld, H.M., Faustman, W.O., et al.Association of estrogen levels with neuropsychological performance in women with schizophrenia. Am J Psychiatry 2001;158 :11341139.CrossRefGoogle ScholarPubMed
Horn, W.Leistungsprüfsystem (LPS). Göttingen, Toronto, Zürich: Verlag für Psychologie; 1983.Google Scholar
Hyde, J.S.. How large are cognitive gender differences – a meta-analysis using omega-2 and D. Am Psychol 1981;36 :892901.CrossRefGoogle Scholar
Jimenez, J.A., Mancini-Marie, A., Lakis, N., Rinaldi, M., Mendrek, A.. Disturbed sexual dimorphism of brain activation during mental rotation in schizophrenia. Schizophr Res 2010;122 :5362.CrossRefGoogle Scholar
Kahn, R.S., Fleischhacker, W.W., Boter, H., Davidson, M., Vergouwe, Y., Keet, I.P., et al.Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008;371 :10851097.CrossRefGoogle ScholarPubMed
Kimura, D.. Sex hormones influence human cognitive pattern. Neuro Endocrinol Lett 2002;23 (Suppl. 4):6777.Google ScholarPubMed
Kimura, D., Hampson, E.. Cognitive pattern in men and women is influenced by fluctuations in sex-hormones. Curr Dir Psychol Sci 1994;3 :5761.CrossRefGoogle Scholar
Koutsouleris, N., Davatzikos, C., Bottlender, R., Patschurek-Kliche, K., Scheuerecker, J., Decker, P., et al.Early recognition and disease prediction in the at-risk mental states for psychosis using neurocognitive pattern classification. Schizophr Bull 2012;38 :12001215.CrossRefGoogle ScholarPubMed
Lehrl, S. Balingen: Perimed-spitta. 1991.Google Scholar
Lewine, R.R., Walker, E.F., Shurett, R., Caudle, J., Haden, C.. Sex differences in neuropsychological functioning among schizophrenic patients. Am J Psychiatry 1996;153 :11781184.Google ScholarPubMed
Lewine, R.R.J., Thurston-Snoha, B.J., Ardery, R.. Sex, gender, and neuropsychological functioning in schizophrenia. J Clin Exp Neuropsychol 2006;28 :13621372.CrossRefGoogle Scholar
Little, R.J.A., Rubin, D.B.Statistical analysis with missing data. New York; Chichester [etc.]: J. Wiley; 1987.Google Scholar
Longenecker, J., Dickinson, D., Weinberger, D.R., Elvevag, B., Dickinson, D.. Cognitive differences between men and women: a comparison of patients with schizophrenia and healthy volunteers. Schizophr Res 2010;120 :234235.CrossRefGoogle ScholarPubMed
Lukoff, D., Nuechterlein, K.H., Ventura, J.. Manual for the expanded brief psychiatric rating scale. Schizophr Bull 1986;12 :594602.Google Scholar
Miller, D.I., Halpern, D.F.. The new science of cognitive sex differences. Trends Cogn Sci 2014;18 :3745.CrossRefGoogle ScholarPubMed
Moriarty, P.J., Lieber, D., Bennett, A., White, L., Parrella, M., Harvey, P.D., et al.Gender differences in poor outcome patients with lifelong schizophrenia. Schizophr Bull 2001;27 :103113.CrossRefGoogle ScholarPubMed
Nieuwenhuis, S., Forstmann, B.U., Wagenmakers, E.J.. Erroneous analyses of interactions in neuroscience: a problem of significance. Nat Neurosci 2011;14 :11051107.CrossRefGoogle ScholarPubMed
Ochoa, S., Usall, J., Cobo, J., Labad, X., Kulkarni, J.. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treat 2012;2012 :916198.Google ScholarPubMed
Palmer, B.W., Dawes, S.E., Heaton, R.K.. What do we know about neuropsychological aspects of schizophrenia?. Neuropsychol Rev 2009;19 :365384.CrossRefGoogle ScholarPubMed
Perlick, D., Mattis, S., Stastny, P., Teresi, J.. Gender differences in cognition in schizophrenia. Schizophr Res 1992;8 :6973.CrossRefGoogle ScholarPubMed
Pflueger, M.O., Gschwandtner, U., Stieglitz, R.D., Riecher-Rössler, A.. Neuropsychological deficits in individuals with an at risk mental state for psychosis – working memory as a potential trait marker. Schizophr Res 2007;97 :1424.CrossRefGoogle Scholar
Raykov, T.. On testability of missing data mechanisms in incomplete data sets. Struct Equ Model 2011;18 :419429.CrossRefGoogle Scholar
Riecher-Rössler, A., Rössler, W.. The course of schizophrenic psychoses: what do we really know? A selective review from an epidemiological perspective. Eur Arch Psychiatry Clin Neurosci 1998;248 :189202.CrossRefGoogle Scholar
Riecher-Rössler, A., Pflueger, M.O., Aston, J., Borgwardt, S.J., Brewer, W.J., Gschwandtner, U., et al.Efficacy of using cognitive status in predicting psychosis: a 7-year follow-up. Biol Psychiatry 2009;66 :10231030.CrossRefGoogle ScholarPubMed
Riecher-Rössler, A., Gschwandtner, U., Aston, J., Borgwardt, S., Drewe, M., Fuhr, P., et al.The Basel early-detection-of-psychosis (FePsy)-study – design and preliminary results. Acta Psychiatr Scand 2007;115 :114125.CrossRefGoogle ScholarPubMed
Riecher-Rössler, A., Aston, J., Ventura, J., Merlo, M., Borgwardt, S., Gschwandtner, U., et al.Das Basel Screening Instrument fur Psychosen (BSIP): Entwicklung, Aufbau, Reliabilität und Validität. Fortschr Neurol Psychiatr 2008;76 :207216.CrossRefGoogle Scholar
Riecher-Rössler, A., Pflueger, M.O., Borgwardt, S.Schizophrenia in women In: Kohen, D., Oxford Textbook of women and mental health Oxford: Oxford University Press; 2010. p. 102114.Google Scholar
Rosvold, H.E., Mirsky, A.F., Sarason, I., Bransome, E.D.J., Beck, L.H.. A continuous performance test of brain damage. J Consult Psychol 1956;20 :343350.CrossRefGoogle Scholar
Seidman, L.J., Goldstein, J.M., Goodman, J.M., Koren, D., Turner, W.M., Faraone, S.V., et al.Sex differences in olfactory identification and Wisconsin Card Sorting performance in schizophrenia: relationship to attention and verbal ability. Biol Psychiatry 1997;42 :104115.CrossRefGoogle ScholarPubMed
Stanislaw, H., Todorov, N.. Calculation of signal detection theory measures. Behav Res Methods Instrum Comput 1999;31 :137149.CrossRefGoogle ScholarPubMed
Team, R.C. R: a language and environment for statistical computing. 2013.Google Scholar
van Buuren, S., Groothuis-Oudshoorn, K.. MICE: multivariate imputation by chained equations in R. J Stat Softw 2011;45 :167.Google Scholar
Vaskinn, A., Sundet, K., Simonsen, C., Hellvin, T., Melle, I., Andreassen, O.A.. Sex differences in neuropsychological performance and social functioning in schizophrenia and bipolar disorder. Neuropsychology 2011;25 :499510.CrossRefGoogle ScholarPubMed
Ventura, J., Lukoff, D., Nuechterlein, K.H., Liberman, R.P., Green, M., Shaner, A.. Training and quality assurance with the brief psychiatric rating scale: “The Drift Busters”; appendix 1 the Brief Psychiatric Rating Scale (expanded version). Int J Methods Psychiatr Res 1993;3 :221224.Google Scholar
Walder, D.J., Seidman, L.J., Cullen, N., Su, J., Tsuang, M.T., Goldstein, J.M.. Sex differences in language dysfunction in schizophrenia. Am J Psychiatry 2006;163 :470477.CrossRefGoogle Scholar
Walder, D.J., Mittal, V., Trotman, H.D., McMillan, A.L., Walker, E.F.. Neurocognition and conversion to psychosis in adolescents at high-risk. Schizophr Res 2008;101 :161168.CrossRefGoogle ScholarPubMed
Wright, D.B. SDTALT: signal detection theory and alternatives. R package version 1.03. 2011.Google Scholar
Yung, A.R., Phillips, L.J., McGorry, P.D., McFarlane, C.A., Francey, S., Harrigan, S., et al.Prediction of psychosis. A step towards indicated prevention of schizophrenia. Br J Psychiatry Suppl 1998;172 :1420.CrossRefGoogle ScholarPubMed
Yung, A.R., McGorry, P.D., Francey, S.M., Nelson, B., Baker, K., Phillips, L.J., et al.PACE: a specialised service for young people at risk of psychotic disorders. Med J Aust 2007;187 2 [S43–S6].CrossRefGoogle ScholarPubMed
Zhang, X.Y., Chen da, C., Xiu, M.H., Yang, F.D., Haile, C.N., Kosten, T.A., et al.Gender differences in never-medicated first-episode schizophrenia and medicated chronic schizophrenia patients. J Clin Psychiatry 2012;73 :10251033.CrossRefGoogle ScholarPubMed
Zimmermann, P., Fimm, B.Testbatterie zur Aufmerksamkeitsprüfung (TAP). Version 1.02 Handbuch. Würselen: Vera Fimm/Psychologische Testsysteme; 1993.Google Scholar
Supplementary material: File

Ittig et al. supplementary material

Supplementary materials

Download Ittig et al. supplementary material(File)
File 286 KB
Submit a response


No Comments have been published for this article.