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

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.