Psychosis Prognosis — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisPsychosis PrognosisMRCPsych Paper B

A 20-year-old man experiencing a first episode of schizophrenia asks about his long-term prognosis. According to a contemporary systematic review and meta-analysis, approximately what proportion of people with first-episode schizophrenia achieve clinical recovery over a mean follow-up of about 10 years?

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Correct answer: D — 20–30%

The correct answer is D. A contemporary meta-analysis of first-episode schizophrenia found a pooled clinical recovery rate of 20.8% over a mean follow-up of 9.5 years, so 20–30% is the closest estimate. Clinical recovery is a stricter outcome than symptomatic remission because it incorporates sustained symptomatic and functional improvement. This distinction is important: studies of the broader first-episode psychosis population report symptomatic remission in approximately half of patients, making C plausible if the question asked only about remission. However, symptomatic improvement does not necessarily imply recovery of occupational and social functioning. A is below the pooled estimate, while D and E substantially overstate long-term clinical recovery.

Reference: Hansen HG et al. Clinical Recovery Among Individuals With a First-Episode Schizophrenia: An Updated Systematic Review and Meta-Analysis. Schizophrenia Bulletin. 2023;49(2):297–308. https://pubmed.ncbi.nlm.nih.gov/36029094/