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Gender differences in clinical presentation and illicit substance use during first episode psychosis: a natural language processing, electronic case register study

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Article numbere042949
JournalBMJ Open
Issue number4
Accepted/In press16 Mar 2021
Published21 Apr 2021

Bibliographical note

Funding Information: Funding HS, MP, RS and PM receive funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, which also supports the development and maintenance of the BRC Case Register. RP has received support from a Medical Research Council (MRC) Health Data Research UK Fellowship (MR/S003118/1) and a Starter Grant for Clinical Lecturers (SGL015/1020) supported by the Academy of Medical Sciences, The Wellcome Trust, MRC, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK. Funding Information: Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: RS has received research funding from Roche, Janssen, GSK and Takeda. PFP has received grant funds from Lundbeck and honoraria from Lundbeck, Menarini and Angelini outside the current study. RP has received grant funds from Janssen and consultancy fees from Induction Healthcare and Holmusk. The other authors declare no competing interests. Publisher Copyright: © 2021 Author(s) (or their employer(s). Re-use permitted under CC BY. Published by BMJ. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Objective To determine whether gender differences in symptom presentation at first episode psychosis (FEP) remain even when controlling for substance use, age and ethnicity, using natural language processing applied to electronic health records (EHRs). Design, setting and participants Data were extracted from EHRs of 3350 people (62% male patients) who had presented to the South London and Maudsley NHS Trust with a FEP between 1 April 2007 and 31 March 2017. Logistic regression was used to examine gender differences in the presentation of positive, negative, depressive, mania and disorganisation symptoms. Exposure(s) (for observational studies) Gender (male vs female). Main outcome(s) and measure(s) Presence of positive, negative, depressive, mania and disorganisation symptoms at initial clinical presentation. Results Eight symptoms were significantly more prevalent in men (poverty of thought, negative symptoms, social withdrawal, poverty of speech, aggression, grandiosity, paranoia and agitation). Conversely, tearfulness, low energy, reduced appetite, low mood, pressured speech, mood instability, flight of ideas, guilt, mutism, insomnia, poor concentration, tangentiality and elation were more prevalent in women than men. Negative symptoms were more common among men (OR 1.85, 95% CI 1.33 to 2.62) and depressive and manic symptoms more common among women (OR 0.30, 95% CI 0.26 to 0.35). After adjustment for illicit substance use, the strength of associations between gender and negative, manic and depression symptoms increased, whereas gender differences in aggression, agitation, paranoia and grandiosity became insignificant. Conclusions There are clear gender differences in the clinical presentation of FEP. Our findings suggest that gender can have a substantial influence on the nature of clinical presentation in people with psychosis, and that this is only partly explained by exposure to illicit substance use.

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