Prognosis

Question 1

Dementia

Answer 1

Short-term: Good if treatment and social support

Long-term: Medications delay progression by about 6 months. Support can help keep a person at home.

Question 2

Personality disorder

Answer 2

Lifelong. Tend to mitigate naturally with age - reduced aggression but relationships poor
Complications include depressive disorder, substance misuse, accidents
High suicide rates

Question 3

Depression

Answer 3

• First episode of depression lasts 4-30 weeks for mild-moderate and 6 months on average for severe depression.
• Majority recur (30% at 10 years, 60% at 20 years)
• Recurrent episodes tend to be shorter but more severe (4-16 weeks)
• Increased risk of recurrence when residual symptoms after remission (e.g. low mood, anxiety, sleep disturbance).

Question 4

Bipolar

Answer 4

• Average length of manic episode is 4 months.
• Runs a relapsing and remitting course in around 90%.
• Around ½ of these will have some future episodes, other ½ with persistent recurrence.

Question 5

Schizophrenia

Answer 5

In general:

1. 1/5 of people will recover entirely
2. 3/5 will get better but will have relapses later in life
3. 1/5 will develop a chronic course and will not have significant improvement.

Question 6

GAD

Answer 6

Tends to be chronic and wax and wane over the patient’s lifetime.
With treatment, the likelihood of developing secondary depression is reduced

Question 7

OCD

Answer 7

30% significantly improve
40% show moderate improvement
30% have chronic or worsening symptoms.
Suicide rates increased esp. if there is secondary depression.

Question 8

Social phobia

Answer 8

With treatment, response rates may be up to 90%, especially with combined approaches.

Question 9

Panic disorder

Answer 9

With treatment, functional recovery is seen in 25–75% after the first 1–2yrs.
Long-term, around 50% will experience only mild symptoms.

Question 10

Alcohol dependence

Answer 10

In dependence, chronic relapsing

Up to 50% remain abstinent after detoxification

Question 11

Anorexia nervosa

Answer 11

If untreated, this condition carries one of the highest mortality figures for any psychiatric disorder (10–15%).

• If treated, ‘rule of thirds’ (1/3 full recovery, 1/3 partial recovery, 1/3 chronic problems).

Question 12

Bulimia nervosa

Answer 12

Generally good, unless there are significant issues of low self-esteem or evidence of severe personality disorder.

Question 13

Somatization

Answer 13

tendency is for chronic morbidity with periods of relative remission

Question 14

Conversion disorder

Answer 14

For acute conversion symptoms, especially those with a clear precipitant, the prognosis is good, with expectation of complete

Question 15

Chronic fatigue

Answer 15

Outcome is difficult to predict but the severely affected cases and those with very chronic symptoms appear to do worse.
Depends on severity

Question 16

Agoraphobia

Answer 16

If present continuously for a year, persistent for up to 5 years

Question 17

PTSD

Answer 17

Majority recover in 1 year

30% have symptoms for many years

Question 18

Delirium

Answer 18

Serious, mortality as high as 50% at one-year

Question 19

Alzheimers

Answer 19

Life expectancy 5-8 years

Question 20

Vascular

Answer 20

Life expectancy 4-5 years

Question 21

Lewy body

Answer 21

Life expectancy 4-10 years, worse quality of life if also Parkinson’s features

Question 22

Self-harm and suicide

Answer 22

15 and 25% who harmed will do so again in next year, 1-2% attempt suicide

Question 23

Bipolar depression

Answer 23

Tends to be more severe than unipolar depressive episode, requires more treatment, more social impairment

Question 24

Hypochondriasis

Answer 24

If untreated tends to be chronic, with varying intensity over time

Question 25

Facticious disorder

Answer 25

Most often chronic

Question 26

Opiate dependence

Answer 26

Chronic relapsing. 90% can withdraw sucessfully, one third will be abstinent at 7 years

Question 27

Pueperal psychosis

Answer 27

Most recover, few remain chronically ill

Question 28

Post natal depression

Answer 28

Without treatment 3-6 months

25% have it for a year