Prognosis of Psychiatric Disorders
From Kaplan and Sadock's Synopsis of Psychiatry (2014)
Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia
Schizoaffective Disorder
Schizophreniform Disorder
Delusional Disorder
Done by Abdulaziz Alzahrani, 2016
(5 – 10) year period after first hospitalization:
 10 - 20 % good outcome
 50 % poor outcome (repeated hospitalizations,
exacerbations of symptoms, episodes of major
mood disorders, and suicide attempts)
 Prognostic factors:
Remission rates (10 - 60 %)
20 - 30 % able to lead normal lives (Reasonable estimate)
20 - 30 % experience moderate symptoms
40 - 60 % significantly impaired
Better prognosis: predominant affective symptoms.
Worse prognosis: predominant schizophrenic symptoms.
 Outcome resembled schizophrenia more than a
mood disorder with psychotic features.
 60 - 80 % progress to schizophrenia
 20 - 40 % prognosis unknown
 Single episode is probably a rare occurrence.
Considered a fairly stable diagnosis.
 50 % recovered at long-term follow-up
 20 % decreased symptoms
 30 % no change
Good prognosis:
High levels of occupational, social, and functional
adjustments; female sex; onset < age 30 years; sudden
onset; short duration; presence of precipitating factors
 Persecutory, somatic, and erotic have better
prognosis than grandiose and jealous delusions.
Prognosis of Psychiatric Disorders
From Kaplan and Sadock's Synopsis of Psychiatry (2014)

 50 % display chronic syndromes such as

schizophrenia
 Generally good prognosis
 50 - 80 % : No further major psychiatric problems
 Good Prognostic Factors:

Brief Psychotic Disorder

Mood Disorders

 Poorer prognosis than MDD

 40 - 50 % have a second manic episode within 2
years of the first
 50 - 60 % achieve significant control with lithium

Good prognosis:
 Short duration of manic episodes
 Advanced age of onset
 Few suicidal thoughts and comorbidities

Poor prognosis:
 Premorbid poor occupational status
 Alcohol dependence
 Psychotic features
Bipolar Disorder  Depressive features
 Inter-episode depressive features
 Male gender

o 7 % No recurrence of symptoms
o 45 % have more than one episode
o 40 % have a chronic disorder

On long-term follow-up:
 15 % are well
 45 % well but have multiple relapses
 30 % partial remission
 10 % chronically ill

 ⅓ have chronic symptoms and significant social

decline.

Done by Abdulaziz Alzahrani, 2016

Prognosis of Psychiatric Disorders
From Kaplan and Sadock's Synopsis of Psychiatry (2014)

 50 % recovery in the first year after first episode

 This percentage decreases by repeated
hospitalization and passing time
 Many unrecovered patients remain affected with
Dysthymia

Recurrence:

 25 % in the first 6 months after discharge

 30 - 50 % in the following 2 years
 50 - 75 % in 5 years
Lower in:
 Patients who continue treatment
 Patients with only 1 or 2 depressive episodes

Major Depressive Disorder Good prognosis:

Mild episodes
NO psychotic symptoms
Short hospital stay
Solid friendships during adolescence
Stable family functioning
Sound social functioning for the 5 years preceding illness
NO comorbid psychiatric or personality disorder
NO more than one previous hospitalization
Advanced age of onset

Poor prognosis:
Coexisting dysthymic disorder
Abuse of alcohol and other substances
Anxiety disorder symptoms
> 1 previous depressive episode
Men are more likely to experience a chronic course

Early onset of symptoms are at risk of MDD or bipolar I

 20 % progressed to MDD
 15 % to bipolar II
Dysthymia  < 5 % to bipolar I
10 - 15 % remission 1 year after diagnosis
25 % never attain a complete recovery.
 Overall prognosis is good with treatment.

⅓ of patients develop a major mood disorder, most often

Cyclothymia bipolar II disorder

Done by Abdulaziz Alzahrani, 2016

Prognosis of Psychiatric Disorders
From Kaplan and Sadock's Synopsis of Psychiatry (2014)

Anxiety Disorders
At long-term follow-up:
 30 - 40 % symptom free
 50 % have mild symptoms
 10 - 20 % significant symptoms

 Depression : 40 - 80 %
Panic Disorder  Alcohol and other substance dependence: 20 - 40 %
 OCD may also develop

Good prognosis:
 Good premorbid functioning
 Brief duration of symptoms
 Phobias that begin in childhood and persist into
adulthood will continue to persist for many years.
Specific Phobia
 Severity remains constant (other anxiety disorders
have waxing and waning course)
 Chronic disorder
Social Anxiety Disorder
 Patients who remit tend to stay well

Generalized Anxiety Chronic condition that may be lifelong.

Disorder Prognosis difficult to predict because of high comorbidity.

Obsessive-Compulsive and Related Disorders

20 - 30 %: significant improvement
40 - 50 %: moderate improvement
20 - 40 %: either remain ill or their symptoms worsen.

 ⅓ of patients with OCD have MDD

Good prognosis:
 Good social and occupational adjustment
 Presence of a precipitating event
Obsessive-Compulsive  Episodic nature of the symptoms
Disorder  Obsessional content does not seem to be related to the
(OCD) prognosis.
Poor prognosis:
 Yielding to (rather than resisting) compulsions
 Childhood onset
 Bizarre compulsions
 Need for hospitalization
 Coexisting MDD, delusional beliefs
 Presence of overvalued ideas (i.e., some acceptance
of obsessions and compulsions)
 Presence of a personality disorder (especially
Schizotypal personality).

Done by Abdulaziz Alzahrani, 2016

Prognosis of Psychiatric Disorders
From Kaplan and Sadock's Synopsis of Psychiatry (2014)

 Chronic with a treatment-resistant course.

Hoarding Disorder  Symptoms may fluctuate, full remission is rare.
 Earlier onset: longer and more chronic course.
Early onset (< age 6): remit and responds to suggestions,
support, and behavioral strategies.
Hair-pulling Disorder
Late onset (> age 13): ↑ chronicity and poor prognosis
(Trichotillomania)
 ⅓ of patients: ≤ 1 year
 Some cases: > 20 years duration
Excoriation or Skin-picking  Waxing and waning
Disorder  44 % of women: coincides with menstrual cycle.
Trauma- and Stressor-Related Disorders
Untreated:
 30 % of patients recover completely
 40 % continue to have mild symptoms
 20 % continue to have moderate symptoms
 10 % remain unchanged or become worse.
 After 1 year: 50 % of patients will recover.

Good prognosis:
Posttraumatic Stress
 Rapid onset, short duration (< 6 months)
Disorder (PTSD)
 Good premorbid functioning
 Strong social supports
 Absence of psychiatric, medical comorbidities

 Patients at extremes of age have more difficulty with

traumatic events than do those in midlife.
 PTSD with comorbidity is more severe, more chronic
and difficult to treat.
 Overall prognosis is generally favorable.
 Most patients return to baseline within 3 months.
 Some persons (particularly adolescents) later have
Adjustment Disorders
mood or substance related disorders.
 Adolescents require a longer time to recover than
adults
Somatic symptom and related Disorders
 One third to one half improve significantly
Good prognosis:
 High socioeconomic status
 Treatment-responsive anxiety or depression
Somatic Symptom Disorder  Sudden onset
 Absence of a personality disorder
 Absence of nonpsychiatric medical condition.
 Most children recover by late adolescence or early
adulthood

Done by Abdulaziz Alzahrani, 2016

Prognosis of Psychiatric Disorders
From Kaplan and Sadock's Synopsis of Psychiatry (2014)
Conversion Disorder
Factitious Disorder
Anorexia Nervosa
Done by Abdulaziz Alzahrani, 2016

95 % of acute cases remit spontaneously within 2
weeks
 If symptoms last ≥ 6 months, prognosis for symptom
resolution is < 50 %
 ↑ duration → ↓ prognosis for resolution
 Recurrence occurs in one fifth to one fourth of
people within 1 year of the first episode.
 One episode is a predictor for future episodes.
Good prognosis:
 Acute onset
 Clearly identifiable stressors
 Early treatment
 Above average intelligence
 Paralysis, aphonia, and blindness → good prognosis
 Tremor and seizures → poor prognosis

Poor prognosis in most cases

No adequate data are available about outcome

Few patients die as a result of needless medication,
instrumentation, or surgery
Good prognosis:
 Depressive-masochistic personality
 Functioning at a borderline, not psychotic, level
 The attributes of an antisocial personality disorder
with minimal symptoms.
Eating Disorders
Restricting-type less likely to recover.
Short-term response to treatment programs is good.
Mortality rates from 5 to 18 %.
Good prognosis:
 Admission of hunger
 Lessening of denial and immaturity
 Improved self-esteem.
 25 % recover completely
 50 % markedly improved
 18 % chronic underweight and poor function
 7 % mortality rate
 Over 20- and 30-year period, mortality rate 18 %
 50 % will have the symptoms of bulimia within the first
year after the onset
Prognosis of Psychiatric Disorders
From Kaplan and Sadock's Synopsis of Psychiatry (2014)

1. Higher rates of recovery compared with anorexia

2. Untreated patients tend to remain chronic or show
small improvement with time

In 10-year follow-up study:

 No. of women who continued to meet full criteria
declined as duration of follow-up increased.
 30 % continued to engage in recurrent binge-
Bulimia Nervosa
eating or purging behaviors.

Poor prognosis:
 History of substance use
 Longer duration.

 40 % fully recovered at follow-up

 Mortality rate 2 % per decade
Severe obesity is a long-term effect in > 3 %
Binge Eating Disorder 5 years-follow-up:
< one fifth still had clinically significant symptoms.

Substance Use Disorders

Good prognosis:
1. Absence of antisocial personality or other
substance use.
2. General life stability with a job, continuing close
family contacts, and absence of severe legal
problems.
3. Full course of initial rehabilitation (2 - 4 weeks).

 Combination of these three attributes predicts at

Alcohol Use Disorder
least a 60 % chance for 1 or more years of
abstinence.
 1 year abstinence is associated with a good chance
for continued abstinence over an extended period.
 Alcoholic persons with severe drug problems
(especially IV drug use or cocaine or amphetamine)
and those who are homeless have only 10 – 15 %
chance of achieving 1 year of abstinence.


Done by Abdulaziz Alzahrani, 2016 az3z3@hotmail.com