Background
Methods
Female and male patient groups
Laboratory methods
Instrument-based diagnostics
Electroencephalography (EEG)
Magnetic resonance imaging (MRI)
Available data sets
Parameters | Total N (female/male) | |
---|---|---|
Cerebrospinal fluid (CSF) markers | ||
Signs of BCSFB dysfunction | Albumin quotients (AQ) | 989 (545/444) |
Further CSF basic analyses | Total protein | 988 (544/444) |
White blood cell count | 979 (536/443) | |
IgG index | 989 (545/444) | |
OCBs in CSF | 965 (529/436) | |
OCBs in serum | 964 (529/435) | |
Instrument-based diagnostics | ||
EEG | Resting state | 951 (519/432) |
Hyperventilation period | 802 (441/361) | |
MRI of the brain | T1/MPRAGE/DWI/FLAIR | 894 (498/396) |
Statistical analyses
Results
Description of the study population
All patients (N = 989) | Statistics | ||
---|---|---|---|
Females (N = 545; 55%) | Males (N = 444; 45%) | ||
Age (range) in years ± SD | 43.77 ± 17.21 (from 18–90) | 41.33 ± 18.61 (from 18–85) | F = 8.183 p = 0.033 |
Syndrome | |||
Schizophreniform syndrome | N = 248 (46%) | N = 208 (47%) | |
Affective syndrome | |||
Depressive syndrome | N = 249 (46%) | N = 203 (46%) | |
Bipolar syndrome | N = 48 (9%) | N = 33 (7%) | |
Clinical course | |||
First episode | 143 (27%) | 135 (30%) | |
Chronic (> 2 years) | 133 (25%) | 125 (28%) | |
Recurrent | 261 (49%) | 183 (41%) | |
Unknown | 8 (1%) | 1 (0.2%) | |
Previous/current comorbid psychiatric disorders | |||
Neurodevelopmental disordersa | 38 (7%) | 51 (11%) | |
Personality disorders | 26 (5%) | 17 (4%) | |
Substance abuse/dependence | 50 (9%) | 63 (14%) | |
Anxiety disorders | 17 (3%) | 16 (4%) | |
OCD | 17 (3%) | 7 (2%) | |
PTSD | 12 (2%) | 6 (1%) | |
Cognitive disorders (MCI) | 15 (3%) | 26 (6%) | |
Sleep disturbances | 9 (2%) | 9 (2%) | |
Eating disorders | 16 (3%) | 0 (0%) | |
Somatoform disorderb | 20 (4%) | 12 (3%) | |
Othersc | 7 (1%) | 2 (0.5%) | |
Previous/current comorbid neurological disorders | |||
Neurovascular | 10 (2%) | 14 (3%) | |
Demyelinatingd | 2 (0.4%) | 1 (0.2%) | |
Extrapyramidal/movement | 3 (0.6%) | 7 (2%) | |
Infectious | 3 (0.6%) | 3 (0.7%) | |
Tumors | 2 (0.4%) | 1 (0.2%) | |
Paroxysmal | 12 (2%) | 7 (2%) | |
Traumatic injuries | 11 (2%) | 12 (3%) | |
Polyneuropathy | 7 (1%) | 13 (3%) | |
Migraine and other headaches | 36 (7%) | 10 (2%) | |
Restless Legs Syndrome | 9 (2%) | 7 (2%) | |
Hydrocephalus | 4 (0.7%) | 5 (1%) | |
Others | 12 (2%) | 10 (2%) | |
School education | |||
No degree | 9 (2%) | 5 (1%) | |
Low degree | 87 (20%) | 86 (23%) | |
Medium degree | 137 (31%) | 97 (26%) | |
High degree | 201 (46%) | 182 (49%) | |
Other | 3 (0.7%) | 5 (1%) | |
Unknown | 108 (20%) | 69 (16%) | |
Occupation | |||
Employed | 150 (33%) | 114 (30%) | |
House-wife/-husband | 28 (6%) | 0 (0%) | |
Unemployed | 59 (13%) | 67 (18%) | |
Disability pension | 56 (12%) | 45 (12%) | |
Retirement pension | 72 (16%) | 59 (16%) | |
In-training/in studies/retraining | 68 (15%) | 81 (21%) | |
Others | 18 (4%) | 10 (3%) | |
Unknown | 94 (17%) | 67 (15%) |
All patients (N = 989) | Statistics | ||
Females (N = 545; 55%) | Males (N = 444; 45%) | ||
Overall psychopharmacological treatment | |||
Yes | 498 (94%) | 415 (95%) | Chi2 = 0.811 p = 0.368 |
No | 34 (6%) | 22 (5%) | |
Unknown | 13 (1%) | 7 (2%) | |
Antidepressants | |||
Overall | 295 (59%) | 221 (53%) | |
Tricyclic | 31 (11%) | 28 (13%) | |
SSRI, SNRI, NDRI, NARI | 261 (88%) | 188 (85%) | |
MAO inhibitors | 3 (1%) | 5 (2%) | |
Antipsychotics | |||
Overall | 384 (77%) | 286 (69%) | |
“Typical” | 83 (17%) | 59 (14%) | |
Low-potency | 61 (73%) | 39 (66%) | |
Medium-potency | 0 (0%) | 0 (0%) | |
High-potency | 22 (27%) | 20 (34%) | |
“Atypical” | 356 (71%) | 263 (63%) | |
Mood stabilizers | |||
Lithium | 92 (18%) | 57 (14%) | |
Anticonvulsants | 85 (17%) | 58 (14%) | |
Benzodiazepines | 87 (17%) | 58 (14%) | |
Number of different medication classes per patient | |||
Same class/only one drug | 174 (35%) | 202 (49%) | |
Two drugs | 189 (38%) | 135 (33%) | |
Three drugs | 97 (19%) | 68 (16%) | |
Four drugs | 35 (7%) | 10 (2%) | |
Five drugs | 3 (0.6%) | 0 (0%) |
CSF-blood albumin quotients
Reference | All patient (N = 989) | Females (N = 545; 55%) | Males (N = 444; 45%) | Statistics | |
---|---|---|---|---|---|
All patients | |||||
Albumin quotients (× 10–3, Mean ± SD, median and range) | 5.81 ± 3.18 5.10 (1.50–38.70) | 5.23 ± 2.56 4.70 (1.50–38.70) | 6.52 ± 3.69 5.70 (2.00–38.30) | F = 52.837 CI = [0.892;1.676] p < 0.001 | |
Increased albumin quotients, numbers of patient | < 40 y.: < 6.5 × 10–3 40–60 y.: < 8 × 103 > 60 y.: < 9.3 × 10–3 | ↑: 174 (18%) ↔ : 815 (82%) | ↑: 57 (10%) ↔ : 488 (90%) | ↑: 117 (26%) ↔ : 327 (74%) | Chi2 = 42.625 p < 0.001 |
Schizophreniform syndrome (N = 456) | Females (N = 248; 54%) | Males (N = 208; 46%) | |||
---|---|---|---|---|---|
Albumin quotients (× 10–3, Mean ± SD) | 5.64 ± 3.18 | 5.29 ± 3.02 | 6.06 ± 3.32 | F = 11.906 CI = [0.187;1.354] p = 0.001 | |
Increased albumin quotients, numbers of patients | < 40 y.: < 6.5 × 10–3 40–60 y.: < 8 × 10–3 > 60y.: < 9.3 × 10–3 | ↑: 85 (19%) ↔ : 371 (81%) | ↑: 33 (13%) ↔ : 215 (87%) | ↑: 52 (25%) ↔ : 156 (75%) | Chi2 = 10.200 p = 0.001 |
Affective syndrome (N = 533) | Females (N = 297, 56%) | Males (N = 236, 44%) | |||
---|---|---|---|---|---|
Albumin quotients (× 10–3, Mean ± SD) | 5.95 ± 3.19 | 5.19 ± 2.11 | 6.92 ± 3.96 | F = 27.991 CI = [1.208;2.260] p < 0.001 | |
Increased albumin quotients, numbers of patients | < 40 y.: < 6.5 × 10–3 40-60 y.: < 8 × 10–3 > 60y.: < 9.3 × 10–3 | ↑: 89 (17%) ↔ : 444 (83%) | ↑: 24 (8%) ↔ : 273 (92%) | ↑: 65 (28%) ↔ : 171 (72%) | Chi2 = 35.808 p < 0.001 |
The effect of neurological comorbidity as a confounding factor on sex differences
Cerebrospinal fluid basic parameters and instrument-based diagnostics
Reference | All patient (N = 989) | Females (N = 545; 55%) | Males (N = 444; 45%) | Statistics | ||
---|---|---|---|---|---|---|
Cerebrospinal fluid (CSF) basic parameters | ||||||
CSF protein concentration (Mean ± SD, range) | 470.91 ± 236.45 (from 107 to 2890 mg/l) | 423.74 ± 196.84 | 528.70 ± 266.44 | F = 60.366 p < 0.001 | ||
Increased CSF protein concentration | < 450 mg/l | ↑: 447 (45%) ↔ : 541 (55%) n.a.: 1 (0.1%) | ↑: 202 (37%) ↔ : 342 (63%) n.a.: 1 (0.2%) | ↑: 245 (55%) ↔ : 199 (45%) n.a.: 0 (0%) | β = 0.859 Wald = 39.542 p < 0.001 | |
WBC counts (Mean ± SD) | 1.96 ± 4.85 (from 1 to 101 /µl) | 1.99 ± 5.33 | 1.93 ± 4.20 | F = 0.070 p = 0.791 | ||
Increased WBC counts | < 5 /µl | ↑: 37 (4%) ↔ : 942 (96%) n.a.: 1 (0.1%) | ↑: 25 (5%) ↔ : 511 (95%) n.a.: 9 (2%) | ↑: 12 (3%) ↔ : 431 (97%) n.a.: 1 (0.2%) | Wald = 2.777 p = 0.096 | |
IgG-Index (Mean ± SD) | 0.50 ± 0.10 | 0.50 ± 0.11 | 0.50 ± 0.09 | F = 0.508 p = 0.476 | ||
Increased IgG indices | ↑: 19 (2%) ↔ : 970 (98%) | ↑: 14 (3%) ↔ : 531 (97%) | ↑: 5 (1%) ↔ : 439 (99%) | Wald = 2.367 p = 0.124 | ||
Isolated OCB in CSF OCBs in CSF and Serum | negative negative | 40 (4%) n.a.: 24 (2%) 52 (5%) n.a.: 25 (3%) | 21 (4%) n.a.: 16 (3%) 27 (5%) n.a.: 16 (3%) | 19 (4%) n.a.: 8 (2%) 25 (6%) n.a.: 9 (2%) | Wald = 0.095 p = 0.758 Wald = 0.456 p = 0.500 | |
Inflammatory CSF changesa | 77 / 989 (8%) | 48 / 545 (9%) | 29 /444 (7%) | Wald = 1.754 p = 0.185 | ||
Overall Basic CSF changesb | 491 / 989 (50%) | 232 / 545 (43%) | 259 / 444 (58%) | β = 0.747 Wald = 30.608 p < 0.001 |
All patients (N = 989) | Females (N = 545; 55%) | Males (N = 444; 45%) | Statistics | |
---|---|---|---|---|
EEG Alterations | N = 951 (96%) | N = 519 (95%) | N = 432 (97%) | |
Continuous generalized slow activity | 34 (4%) | 18 (3%) | 16 (4%) | Wald = 0.105 p = 0.746 |
Continuous regional slow activity | 6 (0.6%) | 1 (0.2%) | 5 (1%) | Wald = 2.748 p = 0.097 |
Intermittent generalized slow activity | 161 (17%) | 95 (18%) | 66 (15%) | Wald = 1.789 p = 0.181 |
Intermittent regional slow activity | 52 (5%) | 31 (6%) | 21 (5%) | Wald = 0.462 p = 0.497 |
Epileptic pattern | 29 (3%) | 15 (3%) | 14 (3%) | Wald = 0.003 p = 0.958 |
EEG overall alterations | 240 / 951 (25%) | 136 / 519 (26%) | 104 / 432 (24%) | Wald = 0.641 p = 0.423 |
MRI Alterations | N = 894 (90%) | N = 498 (91%) | N = 396 (89%) | |
White/Grey matter changes overalla | 460 / 894 (51%) | 269 / 498 (54%) | 191 / 396 (48%) | Wald = 0.906 p = 0.341 |
Non-specific white matter changes | 374 (42%) | 212 (43%) | 162 (41%) | Wald = 0.042 p = 0.837 |
Grey matter changes of amygdalae, hippocampi, other limbic structures | 12 (1%) | 8 (2%) | 4 (1%) | Wald = 0.400 p = 0.527 |
Possible/probable/ definite (post-) inflammatory changes | 77 (9%) | 52 (10%) | 25 (6%) | Wald = 4.360 p = 0.037 |
Atrophic changesb | 107 (12%) | 52 (10%) | 55 (14%) | Wald = 3.702 p = 0.054 |
Macroangiopathic vascular alterations (post-ischemic changes) | 33 (4%) | 17 (3%) | 16 (4%) | Wald = 0.306 p = 0.580 |
Microhemorrhage | 16 (2%) | 10 (2%) | 6 (2%) | Wald = 0.244 p = 0.621 |
Cysts | 118 (13%) | 67 (13%) | 51 (13%) | Wald = 0.213 p = 0.644 |
Tumors | 13 (1%) | 9 (2%) | 4 (1%) | Wald = 0.834 p = 0.361 |
Anatomical variants and other changes | 208 (23%) | 118 (24%) | 90 (23%) | Wald = 0.156 p = 0.693 |
Overall MRI changes | 639 / 894 (71%) | 366 / 498 (73%) | 273 / 396 (69%) | Wald = 0.531 p = 0.466 |