It is true that men and patients with earlier onset schizophrenia have more negative and cognitive disorder symptoms at baseline than women and those with later onset; however, after adjusting for baseline symptoms as a factor, gender and age at onset are not involved in mediating disease course; in other words, it is baseline symptom severity per se that really determines disease course, not these two demographic factors; gender and age at onset have limited prognostic value, and Baseline symptom severity is the real and only adverse prognostic factor. According to conventional wisdom, masculinity and early age of onset are often associated with poor treatment outcome in schizophrenia as a prognostic consideration. However, a group of researchers from the University of Manchester and other institutions in the United Kingdom argued that many of the previous studies on the subject did not have representative samples and did not adjust for symptom severity at onset. They demonstrated through a study that gender and age at onset could influence symptom severity at baseline in patients, but that age and gender did not predict regression after adjusting for this variable. The study was published online Feb. 16 in the Journal of Clinical Psychiatry (IF 5.498). The investigators used data from two large prospective cohort studies from Canada and the United Kingdom that included a total of 628 subjects, a sequential group of patients presenting over time, aged 14-65 years, suffering from non-emotional psychiatric disorders that met ICD-9 or DSM-IV diagnostic criteria, including schizophrenia and delusional disorder. The investigators prospectively assessed symptom severity in these subjects using the PANSS scale and explored the correlation between gender/age of onset and mid-course regression (12-18 months). Their findings: 1. With respect to age of onset, the distribution pattern of male and female patients was highly similar, with two peaks each: one in early adulthood (female, 23 years; male, 22 years) and the other in midlife (female, 46 years; male, 47 years); however, more males than females had an earlier onset and more females than males had a later onset. 2. The negative and cognitive disorder symptoms were more severe in males and those with earlier onset. Overall, compared with female patients, male patients had higher total PANSS scores at baseline, higher negative symptom scores (1.84 points higher than female patients, 95% CI, 1.05-2.58; P<0.001), and more severe cognitive disorder symptoms, but lower depression/anxiety symptom scores. After adjusting for gender, earlier onset was similarly associated with more negative and cognitive disorder symptoms. 3. Critically, after adjusting for the factor of baseline symptom severity, neither gender nor age at onset was involved in mediating symptom progression after baseline In other words, it was symptom severity at baseline, not gender/age at onset and its associated symptom worsening, that really led to group differences: if a male patient with an earlier onset was not symptomatic at baseline, it did not predict that his gender and age at onset were "poor prognosis"; conversely, a female patient with a late onset who has severe negative symptoms will not have gender and age of onset as protective factors per se. The present study suggests that gender and age at onset were independently associated with symptoms at baseline, but after adjusting for baseline symptom severity, these two factors were not associated with symptom severity thereafter. This implies that age at onset and gender are of limited value in determining disease course and prognosis, and that it is the symptoms that really play an important role. Thus, attention should shift from certain demographic factors to symptoms themselves: early intervention when symptoms are less severe is important for improving long-term outcome; reducing the duration of untreated psychosis (DUP) can also help reduce baseline symptom severity and lead to better outcome. In any case, it may be inappropriate to continue to write in the "prognosis estimate" section of the major medical record: "Patient is male, early age of onset ...... This is an unfavorable prognostic factor".