Effect of Sex on Treatment Compliance and Brain Activity Alterations in Patients with Schizophrenia: A Pilot Study

Background: As antipsychotic agents are the primary treatment for schizophrenia, treatment compliance plays an important role in the prognosis of patients. Previous studies have reported that sex can influence the adverse effects and compliance of antipsychotics. However, sex-related effects on treatment compliance and brain activity patterns remain to be investigated in schizophrenia. We conducted a pilot study to (1) investigate how sex may influence treatment compliance in patients with schizophrenia and to (2) characterize brain activity features associated with sex-specific differences in treatment compliance.

Methods: We enrolled 53 male and 45 female patients with schizophrenia in this pilot study. The Adherence Rating Scale (MARS) was adopted to evaluate the treatment compliance of patients, while global functional connectivity density (gFCD) was used to assess brain activity features. The positive and negative assessment scale (PANSS) was adopted to assess the psychotic symptoms.

Results: Using the 3T-MRI functional technology, male patients demonstrated increased gFCD in the prefrontal lobe, posterior parietal cortex, cingulate cortex, central anterior sulcus, and superior frontal gyrus, especially in the left hemisphere. However, both male and female patients showed decreased gFCD as compared to healthy controls (P<0.001, FEW-corrected).

Conclusions: Despite the limitations of this pilot study, our findings suggest that males with schizophrenia show better treatment compliance and higher brain activity, primarily in the central executive network and dorsal attention network, as compared to females. These findings provide clues for further exploration of treatment compliance-related mechanisms in schizophrenia.

To cite this article: Chen X, Ji F, Li R, Ma X, Wang L, Li G, Jia F, Wang Y, Zhuo C, Zhu J, Shan P. Effect of Sex on Treatment Compliance and Brain Activity Alterations in Patients with Schizophrenia: a Pilot Study. Psychiatry and Clinical Psychopharmacology 2020;30(3):214-221