Open Access Open Badges Research article

Gender differences in first episode psychotic mania

Sue M Cotton12*, Martin Lambert3, Michael Berk1245, Benno G Schimmelmann6, Felicity J Butselaar12, Patrick D McGorry12 and Philippe Conus7

Author Affiliations

1 Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Victoria, 3052, Australia

2 Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia

3 Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

4 School of Medicine, Deakin University, Geelong, Australia

5 Florey Institute for Neuroscience and Mental Health, Parkville, Australia

6 University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland

7 Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, Prilly, Switzerland

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BMC Psychiatry 2013, 13:82  doi:10.1186/1471-244X-13-82

Published: 13 March 2013



The aim of this paper was to delineate the impact of gender on premorbid history, onset, and 18 month outcomes of first episode psychotic mania (FEPM) patients.


Medical file audit assessment of 118 (male = 71; female = 47) patients with FEPM aged 15 to 29 years was undertaken on clinical and functional measures.


Males with FEPM had increased likelihood of substance use (OR = 13.41, p < .001) and forensic issues (OR = 4.71, p = .008), whereas females were more likely to have history of sexual abuse trauma (OR = 7.12, p = .001). At service entry, males were more likely to be using substances, especially cannabis (OR = 2.15, p = .047), had more severe illness (OR = 1.72, p = .037), and poorer functioning (OR = 0.96, p = .045). During treatment males were more likely to decrease substance use (OR = 5.34, p = .008) and were more likely to be living with family (OR = 4.30, p = .009). There were no gender differences in age of onset, psychopathology or functioning at discharge.


Clinically meaningful gender differences in FEPM were driven by risk factors possibly associated with poor outcome. For males, substance use might be associated with poorer clinical presentation and functioning. In females with FEPM, the impact of sexual trauma on illness course warrants further consideration.

Gender; Mania; Psychosis; Bipolar disorder