Ventricular Enlargement in Schizophrenia: Is There Really a Gender Effect?

To the Editor.—  Andreasen et al¹ claim that the finding of increased ventricular-brain ratio (VBR) in schizophrenia is associated primarily with male and not female patients. Although the authors contend that using a larger sample has allowed them to determine something about female patients with schizophrenia, we note that their finding involves unusual female control data. We are particularly concerned about the interpretation of these data because it is the basis of a far-reaching hypothesis regarding reported gender differences in the clinical manifestations of schizophrenia.In the study, the female controls are unusual in that they had larger mean VBRs than male controls. The authors acknowledged that this had a substantial influence on the gender effect in their analyses. They felt reassured because they found a similar relationship in another study. However, to our knowledge, in well over 40 years of investigation, no other published study of normal populations, regardless