Perhaps
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A 37yo male comes to the physician for a routine follow-up examination. Eight years ago, he had the gradual onset of symptoms of schizophrenia without any apparent precipitating factors. He lives alone and is able to care for himself. He has no history of depression. He has had two brief hospitalizations for medication adjustment. His only medication is risperidone. Physical examination shows no abnormalities. Mental status examination shows a mildly constricted affect. He is concerned about his prognosis. Which of the following historical factors is most predictive of a good prognosis for this patient?
A) Absence of depression
B) Absence of precipitating factors for symptoms
C) Gradual onset of symptoms
D) Late onset of symptoms
E) Living independently
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| Perhaps
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For THIS particular patient, he is living independently, should it be E?
Late onset is a good prognosis sign in genral.
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| frank100
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aschizophrenia poor prognosis factors:
poor premorbid funtioning
early onset
no precipitating factors
single, divorces, widowed
family history of schizophrenia
negative symptoms: flat affect, no speech, apathy, anhedonia.
poor support system
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| frank100
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(d)
good prognostic factors:
good premorbid functioning
LATE ONSET
obvous precipitating factors
married
family history of mood disorders
positive symptoms: deluions, hallusinations, bizarre behavior, tough disorder, poor atention.
good support system
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| frank100
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(d) is my answer
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| Perhaps
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frank100, you picked D?
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| frank100
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yes I did...
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| frank100
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LIVING ALONE IS POOR PROGNOSTIC FACTOR. making (e) unlikely
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| Perhaps
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Thanks frank100!
I only looked at living 'independently' in the answer options, as a positive word. He does live alone, which goes with the line of 'single, ... etc'. It makes sense then.
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| humbty
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I took E.
If a schizophrenic patient manages to live independently for 8 years its pretty probable that he can maintain that.
Imagine the same patient would now live dependently in a closed psychiatric ward, whats his prognosis in comparison?
I know that late onset is a good prognostic factor but I thought in this particular patient it is a more important factor that he already managed his disease for 8 years and still lives independently.
I first took D but then changed to E. But its a tricky question.
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| mazinger
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D all the way..
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original mazinger z
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