Which combination of features at the time of first presentation predicts the WORST long-term outcome in schizophrenia?

• A Acute onset, prominent affective symptoms, married status, female sex
• B Insidious onset, young age of onset, prominent negative symptoms, family history of schizophrenia ✓
• C Late onset, paranoid subtype, good premorbid functioning, presence of precipitating stressor
• D Catatonic features, abrupt onset after childbirth, absence of family history

Explanation

Established poor prognostic markers include insidious onset, early age of onset, male sex, negative symptoms, poor premorbid adjustment, family history of schizophrenia, substance use, and long duration of untreated psychosis. Good prognosis is associated with acute onset, older age of onset, affective features, paranoid subtype, female sex, marriage, and a clear precipitating stressor, which is exactly the profile in option A and C. Option B collects four independent adverse markers together.

Reference: Shorter Oxford Textbook of Psychiatry, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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