What’s My Daughter’s Prognosis?

By Kristina Randle, Ph.D., LCSW

My 20 year old daughter, after 1 year, was diagnosed with Psychotic Disorder NOS and PTSD (symptoms due to her delusions and hallucinations). She has on going treatment from a psychiatrist to manage her medications (Geodon, Sertraline, trihexyphenidyl and temazepam), has sessions with a therapist and recently finished attending a day treatment center (specialization in treatment of young adults/first psychotic break). She is actually doing very well and is working.

She was always aware that her hallucinations (visual, auditory, tactile and olfactory) were not real. We always thought she did not suffer from delusions but after she was in the day treatment center found out she had delusions of childhood abuse. I think those delusions were harder for me to deal with than the hallucinations.
Her psychiatrist from outside of the treatment center originally diagnosed her as Major Depression with psychotic features. About 6 months later he told us she needed treatment for schizophrenia and that is when we sought out treatment facilities and she had to leave college. In the treatment center they said it was not schizophrenia and ended up with the diagnosis of Psychotic Disorder NOS and PTSD. They kept her on the same medication that her psychiatrist had her on when she entered the treatment program with only some changes in the dosages. I was told that it was more important to treat the symptoms and not be too worried about the diagnosis. That if she was getting better, that was the most important thing,which I agree with.

My question is this, what is the prognosis for this? Is it likely to progress into schizophrenia or bipolar disorder? There is a history of Bipolar, depression and schizophrenia on both sides of our family.

Thank you for any insight, advice or information you can give us.

A. In terms of your daughter’s disorder progressing to schizophrenia or to bipolar disorder and her prognosis, those are difficult questions to answer. I would like to address each of these concepts/questions separately below.

With regard to progression into schizophrenia or bipolar disorder, your daughter was initially diagnosed with major depressive disorder with psychotic features and then schizophrenia. Major depressive disorder with psychotic features, schizophrenia and schizoaffective disorder are oftentimes confused. The mainreason it happens is because the three disorders are very similar. They tend to mimic each other’s symptoms. That is why it is not unusual to receive a diagnosis of schizophrenia or schizoaffective from one clinician and major depressive disorder with psychotic features from another. It is possible that your daughter has schizophrenia or schizoaffective disorder and was misdiagnosed with major depressive disorder with psychotic features. The opposite may also be true as well and thus she has been correctly diagnosed. The fact is that it is difficult to receive an accurate diagnosis. I concur with the treatment professionals who are focused on the fact that your daughter’s condition has significantly improved. In my opinion, I believe this is the correct way to view the situation.

In terms of your daughter’s prognosis, I believe there is much to be hopeful about. One reason is because she has your support. Having supportive friends and family members can make a major difference in one’s prognosis. Many studies have shown this to be true, not only in the case of psychiatric disorders but with medical illnesses as well.

The second reason that I believe your daughter has reason to be hopeful is because she has insight into her illness. Among individuals with serious mental illnesses such as schizophrenia, bipolar disorder, or psychotic disorders in general, at least half cannot recognize that they are ill. This is thought to be due to a neurological condition known as anosognosia (a term used interchangeably with the phrase lack of insight). Individuals who lack insight into their illness have a worse prognosis than those who recognize their disorder. If an individual does not believe that he or she is ill they will often refuse treatment. If an individual is unwilling to accept treatment, the unfortunate outcome for some is that they will have repeated illness relapses. Your daughter recognizes that she has an illness and is willing to treat it. It is also encouraging that she knows the difference between her psychotic symptoms and reality. These are all very good signs.

As a side note, the New York Times has an interesting five-part series about anosognosia and related concepts that can be found here.

What is also fortunate about her situation is that she entered treatment early. You mentioned that she has received treatment from a facility that focuses on first episode psychosis. The sooner an individual with a psychotic disorder receives treatment the better their prognosis. Your daughter continues to be fully engaged in treatment. In addition, she is working and is doing very well. All of the aforementioned facts bode well for her prognosis.

It seems as if she is receiving the best possible care. The proof of this is that she is doing very well. Again, I believe she is very fortunate to have someone who is supportive of her and who is concerned about her well-being. The support you are providing to her can have (and probably already has had) a major positive impact on her prognosis. I would encourage you to continue to support her. I would also encourage her to continue taking her medication and attending treatment. It is possible that if she continues taking medication and remains in treatment, her disorder may never progress. That may or may not be the outcome but research shows that consistent treatment and adherence to medication are the best ways to prevent future psychotic episodes.

I really appreciate your question because it gives me a chance to point out the many positive aspects of your daughter’s situation. Psychotic disorders are complicated and they can be chronic. She will have good periods and bad but continued treatment should be the goal.

If you have any future questions please don’t hesitate to ask. If you would, please consider writing back and letting me know how your daughter is doing. Thanks for your question. Please take care.

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Last reviewed: By John M. Grohol, Psy.D. on 29 Jun 2010

APA Reference
Randle, K. (2010). What’s My Daughter’s Prognosis?. Psych Central. Retrieved on December 18, 2014, from http://psychcentral.com/ask-the-therapist/2010/06/29/whats-my-daughters-prognosis/

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