The mother of a 23-year-old man brings her son to a psychiatrist for a second opinion one week after his discharge from the hospital. The young man had been hospitalized for one week due to the new onset of auditory hallucinations and tangentiality of thoughts. During his hospitalization, he was diagnosed with schizophreniform disorder and was treated with risperidone 2 mg PO BI D. A medical work-up for this first episode of psychosis was negative. In discussing course and prognosis with the patient and his mother, which of the following features would be considered a good prognostic indicator?
A. Family history of schizophrenia
B. Lack of any known precipitating factors or acute stressors
C. Onset of psychotic symptoms within a month of the first change in behavior
D. Poor premorbid educational and occupational performance
E. Withdrawn, autistic behavior and flat affect
Explanation: The correct answer is C. In schizophreniform disorder or schizophrenia, several features are associated with better long-term prognosis. The onset of psychotic symptoms within four weeks of the first noticeable change in usual behavior or functioning is one such feature. Other good prognostic features include: confusion or perplexity at the height of the psychotic episode, good premorbid social and occupational functioning, and the absence of blunted or flat affect. A family history of schizophrenia (choice A) is associated with a poorer prognosis in schizophrenia, whereas a family history of mood disorders (especially depressive disorders) is a good prognostic indicator. A lack of precipitating factors or acute stressors (choice B) is a poor prognostic indicator, whereas obvious precipitating factors before an episode of psychosis may be associated with a better prognosis. Poor premorbid educational or occupational functioning (choice D) is a poor prognostic indicator. Withdrawn, autistic behavior and flat affect (choice E) are poor prognostic indicators, whereas the lack of these negative symptoms may be associated with a better prognosis.