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Background <p>Psychotic symptoms, which affect a significant proportion of patients with bipolar disorder (BD), are associated with adverse prognostic outcomes. Currently, sex-specific patterns of psychotic symptoms remain inadequately characterized in BD. This study seeks to investigate sex-based differences in psychotic symptoms among first-episode drug-naïve (FEDN) BD patients among Han Chinese population.</p> Methods <p>A total of 577 FEDN BD patients, comprising 271 males and 306 females, were recruited in this study. Demographic characteristics were collected using a specialized questionnaire. The positive subscale of the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Scale, Young Mania Rating Scale, and Clinical Global Impression Scale-Severity of Illness were used to evaluate clinical symptoms. Moreover, fasting blood glucose, prolactin, lipids, and thyroid hormone levels, alongside metabolic syndrome (MetS) were assessed.</p> Results <p>The prevalence of psychotic symptoms showed no significant sex differences in the FEDN BD cohort (<i>p</i> = 0.968). Nevertheless, multiple linear regression revealed that MetS score (<i>p</i> = 0.001) was significantly associated with the PANSS Positive subscale score (PANSS-P) among males, whereas thyroid-stimulating hormone (TSH) levels (<i>p</i> &lt; 0.001) and high-density lipoprotein cholesterol (HDL-C) levels (<i>p</i> &lt; 0.001) were significantly associated with PANSS-P among females. Binary logistic regression revealed that MetS score (<i>p</i> = 0.002) was a significant correlate of the prevalence of psychotic symptoms among males only, whereas TSH levels (<i>p</i> &lt; 0.001) significantly correlated with the prevalence of psychotic symptoms among females only.</p> Conclusions <p>Among Han Chinese FEDN BD patients, our study revealed the following: (1) No significant sex difference was observed in the prevalence of psychotic symptoms; (2) HDL-C functions as a meaningful protective factor against the prevalence of psychotic symptoms in both males and females, while its association with symptom severity is observed exclusively in females; (3) Sex-specific indicators correlate with psychotic symptoms, specifically MetS dominates in males, while TSH in females. Our results call for sex-informed clinical protocols that integrate metabolic-endocrine monitoring and targeted interventions to reduce psychosis risk in BD.</p>

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Sex differences in prevalence and clinical correlates for psychotic symptoms in first-episode drug-naïve patients with bipolar disorder: a cross-sectional study

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  • 发表日期：

    2026年4月7日

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  • Yehong Chen,
  • Yujia Zhai,
  • Hao Chen,
  • Xuebing Liu

摘要

Background

Psychotic symptoms, which affect a significant proportion of patients with bipolar disorder (BD), are associated with adverse prognostic outcomes. Currently, sex-specific patterns of psychotic symptoms remain inadequately characterized in BD. This study seeks to investigate sex-based differences in psychotic symptoms among first-episode drug-naïve (FEDN) BD patients among Han Chinese population.

Methods

A total of 577 FEDN BD patients, comprising 271 males and 306 females, were recruited in this study. Demographic characteristics were collected using a specialized questionnaire. The positive subscale of the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Scale, Young Mania Rating Scale, and Clinical Global Impression Scale-Severity of Illness were used to evaluate clinical symptoms. Moreover, fasting blood glucose, prolactin, lipids, and thyroid hormone levels, alongside metabolic syndrome (MetS) were assessed.

Results

The prevalence of psychotic symptoms showed no significant sex differences in the FEDN BD cohort (p = 0.968). Nevertheless, multiple linear regression revealed that MetS score (p = 0.001) was significantly associated with the PANSS Positive subscale score (PANSS-P) among males, whereas thyroid-stimulating hormone (TSH) levels (p < 0.001) and high-density lipoprotein cholesterol (HDL-C) levels (p < 0.001) were significantly associated with PANSS-P among females. Binary logistic regression revealed that MetS score (p = 0.002) was a significant correlate of the prevalence of psychotic symptoms among males only, whereas TSH levels (p < 0.001) significantly correlated with the prevalence of psychotic symptoms among females only.

Conclusions

Among Han Chinese FEDN BD patients, our study revealed the following: (1) No significant sex difference was observed in the prevalence of psychotic symptoms; (2) HDL-C functions as a meaningful protective factor against the prevalence of psychotic symptoms in both males and females, while its association with symptom severity is observed exclusively in females; (3) Sex-specific indicators correlate with psychotic symptoms, specifically MetS dominates in males, while TSH in females. Our results call for sex-informed clinical protocols that integrate metabolic-endocrine monitoring and targeted interventions to reduce psychosis risk in BD.