{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T06:28:21Z","timestamp":1793687301096,"version":"4.5.1"},"reference-count":43,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_PC_17214"],"award-info":[{"award-number":["MC_PC_17214"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,3,16]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposure(s) (for observational studies)<\/jats:title>\n                    <jats:p>Gender (male vs female).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome(s) and measure(s)<\/jats:title>\n                    <jats:p>Presence of positive, negative, depressive, mania and disorganisation symptoms at initial clinical presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-042949","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T21:23:14Z","timestamp":1618953794000},"page":"e042949","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Gender differences in clinical presentation and illicit substance use during first episode psychosis: a natural language processing, electronic case register study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2847-6508","authenticated-orcid":false,"given":"Jessica","family":"Irving","sequence":"first","affiliation":[{"name":"Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Colling","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitesh","family":"Shetty","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Pritchard","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK"},{"name":"Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stewart","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK"},{"name":"Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Fusar-Poli","sequence":"additional","affiliation":[{"name":"Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"McGuire","sequence":"additional","affiliation":[{"name":"Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK"},{"name":"Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9259-8788","authenticated-orcid":false,"given":"Rashmi","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, London, UK"},{"name":"Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"key":"2025121603161416000_11.4.e042949.1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20490"},{"key":"2025121603161416000_11.4.e042949.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0031660","article-title":"Incidence of schizophrenia and other psychoses in England, 1950\u20132009: a systematic review and meta-analyses","volume":"7","author":"Kirkbride","year":"2012","journal-title":"PLoS One"},{"key":"2025121603161416000_11.4.e042949.3","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s00737-018-0847-9","article-title":"Sex and gender differences in schizophrenic psychoses\u2014a critical review","volume":"21","author":"Riecher-R\u00f6ssler","year":"2018","journal-title":"Arch Womens Ment Health"},{"key":"2025121603161416000_11.4.e042949.4","doi-asserted-by":"crossref","DOI":"10.1155\/2012\/916198","article-title":"Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review","volume":"2012","author":"Ochoa","year":"2012","journal-title":"Schizophr Res Treatment"},{"key":"2025121603161416000_11.4.e042949.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2012.11.005"},{"key":"2025121603161416000_11.4.e042949.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/430735","article-title":"Gender differences in individuals at high-risk of psychosis: a comprehensive literature review","volume":"2015","author":"Barajas","year":"2015","journal-title":"Sci World J"},{"key":"2025121603161416000_11.4.e042949.7","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1111\/eip.12235","article-title":"Gender differences in one-year outcomes of first-presentation psychosis patients in inner-city UK early intervention services","volume":"11","author":"Tseliou","year":"2017","journal-title":"Early Interv Psychiatry"},{"key":"2025121603161416000_11.4.e042949.8","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/22.2.257"},{"key":"2025121603161416000_11.4.e042949.9","doi-asserted-by":"crossref","unstructured":"Hayashi N , Igarashi Y , Yamashina M . Is there a gender difference in a factorial structure of the positive and negative syndrome scale? A test by structural equation modeling, 2002. Available: www.karger.comwww.karger.com\/journals\/psp","DOI":"10.1159\/000056213"},{"key":"2025121603161416000_11.4.e042949.10","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2009.36"},{"key":"2025121603161416000_11.4.e042949.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2009.07.002"},{"key":"2025121603161416000_11.4.e042949.12","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-008-0384-3"},{"key":"2025121603161416000_11.4.e042949.13","doi-asserted-by":"crossref","unstructured":"Talamo A , Centorrino F , Tondo L , et al . Comorbid substance-use in schizophrenia: relation to positive and negative symptoms. Schizophr Res 2006.","DOI":"10.1016\/j.schres.2006.04.004"},{"key":"2025121603161416000_11.4.e042949.14","doi-asserted-by":"crossref","unstructured":"Solowij N , Michie PT . Cannabis and cognitive dysfunction: parallels with endophenotypes of schizophrenia? J Psychiatry Neurosci 2007.","DOI":"10.1139\/jpn.0705"},{"key":"2025121603161416000_11.4.e042949.15","doi-asserted-by":"crossref","first-page":"2757","DOI":"10.1017\/S0033291718000399","article-title":"Investigating ethnic variations in reporting of psychotic symptoms: a multiple-group confirmatory factor analysis of the psychosis screening questionnaire","volume":"48","author":"Heuvelman","year":"2018","journal-title":"Psychol Med"},{"key":"2025121603161416000_11.4.e042949.16","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.eurpsy.2016.09.003","article-title":"Deconstructing vulnerability for psychosis: meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk","volume":"40","author":"Fusar-Poli","year":"2017","journal-title":"Eur Psychiatry"},{"key":"2025121603161416000_11.4.e042949.17","doi-asserted-by":"crossref","unstructured":"Oliver D , Reilly TJ , Baccaredda Boy O . What causes the onset of psychosis in individuals at clinical high risk? A meta-analysis of risk and protective factors. Schizophr Bull. 2019.","DOI":"10.1093\/schbul\/sbz039"},{"key":"2025121603161416000_11.4.e042949.18","doi-asserted-by":"crossref","unstructured":"Mann F , Fisher HL , Major B , et al . Ethnic variations in compulsory detention and hospital admission for psychosis across four UK early intervention services. BMC Psychiatry. 2014;14.doi:10.1186\/s12888-014-0256-1","DOI":"10.1186\/s12888-014-0256-1"},{"key":"2025121603161416000_11.4.e042949.19","doi-asserted-by":"crossref","unstructured":"Hankivsky O . Women\u2019s health, men\u2019s health, and gender and health: Implications of intersectionality. Soc Sci Med 2012.","DOI":"10.1016\/j.socscimed.2011.11.029"},{"key":"2025121603161416000_11.4.e042949.20","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbx197"},{"key":"2025121603161416000_11.4.e042949.21","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/S2215-0366(16)30379-0","article-title":"Oestrogens, prolactin, hypothalamic-pituitary-gonadal axis, and schizophrenic psychoses","volume":"4","author":"Riecher-R\u00f6ssler","year":"2017","journal-title":"Lancet Psychiatry"},{"key":"2025121603161416000_11.4.e042949.22","doi-asserted-by":"crossref","unstructured":"Riecher-R\u00f6ssler A , Kulkarni J . Estrogens and gonadal function in schizophrenia and related psychoses. Berlin, Heidelberg: Springer, 2010: 155\u201371.","DOI":"10.1007\/7854_2010_100"},{"key":"2025121603161416000_11.4.e042949.23","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s00281-018-0723-8","article-title":"Sex differences in autoimmune disorders of the central nervous system","volume":"41","author":"Gold","year":"2019","journal-title":"Semin Immunopathol"},{"key":"2025121603161416000_11.4.e042949.24","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012012","article-title":"Natural language processing to extract symptoms of severe mental illness from clinical text: the clinical record interactive search comprehensive data extraction (CRIS-CODE) project","volume":"7","author":"Jackson","year":"2017","journal-title":"BMJ Open"},{"key":"2025121603161416000_11.4.e042949.25","doi-asserted-by":"crossref","unstructured":"Irving J , Patel R , Oliver D . Using natural language processing on electronic health records to enhance detection and prediction of psychosis risk. Schizophr Bull 2020.","DOI":"10.1093\/schbul\/sbaa126"},{"key":"2025121603161416000_11.4.e042949.26","doi-asserted-by":"crossref","unstructured":"Downs J , Dean H , Lechler S . Negative symptoms in early-onset psychosis and their association with antipsychotic treatment failure. Schizophr Bull 2018.","DOI":"10.1093\/schbul\/sbx197"},{"key":"2025121603161416000_11.4.e042949.27","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-028929","article-title":"Recorded poor insight as a predictor of service use outcomes: cohort study of patients with first-episode psychosis in a large mental healthcare database","volume":"9","author":"Ramu","year":"2019","journal-title":"BMJ Open"},{"key":"2025121603161416000_11.4.e042949.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-007619","article-title":"Negative symptoms in schizophrenia: a study in a large clinical sample of patients using a novel automated method","volume":"5","author":"Patel","year":"2015","journal-title":"BMJ Open"},{"key":"2025121603161416000_11.4.e042949.29","doi-asserted-by":"crossref","unstructured":"von Elm E , Altman DG , Egger M , et al . The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014.","DOI":"10.1016\/j.ijsu.2014.07.013"},{"key":"2025121603161416000_11.4.e042949.30","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2020.577110","article-title":"Early intervention services for first episode of psychosis in South London and the Maudsley (SLAM): 20 years of care and research for young people","volume":"11","author":"Fusar-Poli","year":"2020","journal-title":"Front Psychiatry"},{"key":"2025121603161416000_11.4.e042949.31","unstructured":"CRIS Natural Language Processing Applications Library . Available: https:\/\/www.maudsleybrc.nihr.ac.uk\/facilities\/clinical-record-interactive-search-cris\/cris-natural-language-processing\/ [Accessed 23 July 2020]."},{"key":"2025121603161416000_11.4.e042949.32","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291709990651"},{"key":"2025121603161416000_11.4.e042949.33","doi-asserted-by":"crossref","unstructured":"Benjamini Y , Hochberg Y . Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B 1995.","DOI":"10.1111\/j.2517-6161.1995.tb02031.x"},{"key":"2025121603161416000_11.4.e042949.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2006.07.018"},{"key":"2025121603161416000_11.4.e042949.35","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1097\/01.nmd.0000253784.59708.dd","article-title":"Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study","volume":"195","author":"Thorup","year":"2007","journal-title":"J Nerv Ment Dis"},{"key":"2025121603161416000_11.4.e042949.36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7325.1336"},{"key":"2025121603161416000_11.4.e042949.37","doi-asserted-by":"crossref","DOI":"10.1155\/2015\/615356","article-title":"A role for estrogen in schizophrenia: clinical and preclinical findings","volume":"2015","author":"Gogos","year":"2015","journal-title":"Int J Endocrinol"},{"key":"2025121603161416000_11.4.e042949.38","doi-asserted-by":"crossref","DOI":"10.1001\/archgenpsychiatry.2011.5","article-title":"Cannabis use and earlier onset of psychosis","volume":"68","author":"Large","year":"2011","journal-title":"Arch Gen Psychiatry"},{"key":"2025121603161416000_11.4.e042949.39","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2005.00554.x"},{"key":"2025121603161416000_11.4.e042949.40","doi-asserted-by":"publisher","DOI":"10.1016\/S0920-9964(00)00114-6"},{"key":"2025121603161416000_11.4.e042949.41","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-9338(03)00027-0"},{"key":"2025121603161416000_11.4.e042949.42","doi-asserted-by":"crossref","unstructured":"Leonard EA , Marshall RJ . Cardiovascular disease in women. Prim Care - Clin Off Pract 2018.","DOI":"10.1016\/j.pop.2017.10.004"},{"key":"2025121603161416000_11.4.e042949.43","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.968792"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-042949","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:16:27Z","timestamp":1765883787000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-042949"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":43,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,20]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/bmjopen-2020-042949"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-042949","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}