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Centre for Evidence-
Based Medicine

Prognosis: Clinical Scenario

You have been asked by a 25 year old male patient, who has recently recovered from a first psychotic episode, how likely he is to have further episodes of illness. He wants this information before deciding if he should take prophylactic antipsychotic medication.

There remains some uncertainty about the precise diagnosis. He does not meet criteria for DSM-IV criteria at this stage. You prefer to use these criteria because of the important negative aspects of a false positive diagnosis. Your current working diagnosis is therefore non-specific - a first episode non-affective functional psychosis.

You form the structured question "In a patient with first episode functional psychosis, what is the likelihood of remaining free from relapse in the long term?"

You search Evidence-Based Mental Health and find a 15 year follow-up study of a Dutch cohort of patients with non-affective functional psychoses. You track down the original article (Schizophrenia Bulletin 1998 Jan 24 75-85)

Read the article and decide:

  1. Is this evidence about prognosis valid?
  2. Is this valid evidence about prognosis important?
  3. Can you apply this valid and important evidence about prognosis in caring for your patient?

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