Which of the following features carries the worst prognosis in a patient with functional neurological symptom disorder (conversion disorder)?

• A Abrupt onset immediately after an identifiable stressor
• B Short interval between symptom onset and initiation of treatment
• C Young age at onset with intact premorbid functioning
• D Insidious onset with symptoms persisting years before diagnosis and comorbid personality disorder ✓

Explanation

Good prognostic markers are acute onset after a recognisable precipitant, brief duration of symptoms, young age, good premorbid personality, and a treatable underlying stressor. Conversely, insidious onset, long delay before diagnosis, fixed symptoms, and comorbid personality pathology predict persistence. Option A, B, and C each describe a recognised favourable prognostic feature, which is what makes them attractive but incorrect distractors.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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