<prompt> A 70 year old female with psychiatric symptoms diagnosed of having schizophrenia. Which is the poor prognostic factor in schizophrenia?Acute onsetMiddle ageFamily history of affective disorderGradual onset  <response>: Predictors of poorer outcome in schizophrenia:Age below 20Dilated ventricles, brain atrophy in CT or MRINegative symptoms e.g., flat affect, povey of thought, apathy, asociality; obsessive-compulsive symptomsIrregular occupational recordInsidious onsetSlow rate of progressionmalesYears of duration prior to assessmentCannabis useAbsence of precipitating factorsStressful lifeFamily history of schizophrenia not affective disorderPresence of other adverse social factorsPrenatal adverse eventsPresence of ceain gene polymorphism, e.g., COMT. NMDA2APRef: Meltzer H.Y., Bobo W.V., Heckers S.H., Fatemi H.S. 2008. Chapter 16. Schizophrenia. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman Eds,CURRENT Diagnosis Treatment: Psychiatry, 2e. 