Learning about Schizophrenia: Rays of Hope

A Reference Manual for Families & Caregivers

Revised Fourth Edition (2012)

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To download the 2012 fourth revised edition of Rays of Hope (PDF), please click here.

Printed copies of Rays of Hope are available from the Schizophrenia Society of Nova Scotia at a cost of $10.00 (including shipping).  To order a copy with payment by Visa, MasterCard, or American Express, please call (902) 465-2601 or 1-800-465-2601 (toll-free in Nova Scotia), or send a cheque or money order to:

Schizophrenia Society of Nova Scotia
Room B-23, Purdy Building
P.O. Box 1004
Dartmouth, Nova Scotia
B2Y 3Z9

First-Episode Psychosis - Academic Re-Entry Promotion Project -- Research Recruitment

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To download the a PDF of the poster, please click here.

Psychosis - Fact Sheets

From the Early Psychosis Prevention and Intervention Centre:

Fact Sheets

These fact sheets, in English, and 10 linguistically diverse languages, provide information specific to early psychosis. The information is most useful for young people, their family and friends. Anyone can print these fact sheets out and distribute them. The fact sheets provide information about the different types of psychotic disorders, and the phases of assessment, treatment, and recovery.

• What is psychosis?
• Getting help early
• Recovering from psychosis
• How can I help?
  

These information sheets are also available in other languages.

• French
• Arabic
• Croatian
• Greek
• Italian
• Serbian
• Spanish
• Turkish
• Vietnamese
• Simplified Chinese
• Traditional Chinese

Click here to go to the Free Downloads page

Early warning signs of schizophrenia

An article published today by the Boston Globe:

By Emily Anthes

These symptoms, alone or in combination, do not necessarily mean that a child has psychosis or psychosis risk syndrome. But they may indicate a need for evaluation.

• Mild hallucinations or delusions, often accompanied by the awareness that the experience is not real. Teens may feel as though they are being followed, for instance, even though they know that’s probably not true.

• Strange bodily sensations, such as the feeling that one’s brain is bouncing back and forth inside the skull.

• Difficulty focusing mentally, especially if this is a new problem. A sudden diagnosis of attention deficit disorder in an older teen or young adult can be a red flag.

• Other cognitive difficulties, such as trouble remembering. People with psychosis risk syndrome often complain that their minds aren’t “working right.’’

• Social withdrawal and isolation.

• Trouble sleeping.

• Blunted facial expressions or a blank gaze.

• Any other sudden changes in interest, activity, or functioning.

Screening children for mental illness

In 2008, Massachusetts began requiring doctors to offer mental health screening to all children on MassHealth, the state’s Medicaid program, during checkups. The number of children screened has been steadily increasing, reaching more than 60 percent of those who had checkups in the first quarter of this year. Of those screened, 8 percent to 10 percent might need further attention, says Emily Sherwood, director of the state Children’s Behavioral Health Initiative.



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Also see:

Getting ahead of trouble


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Duration of untreated psychosis is associated with more negative schizophrenia symptoms after acute treatment for first-episode psychosis

The abstract of an article published in the March 1st edition of
Clinical Psychologist:

Abstract

By Niklas Granö, Jenni Lindsberg, Marjaana Karjalainen, Peter Grönroos, and Ari-Pekka Blomberg

Evidence of association between duration of untreated psychosis (DUP) and negative symptoms of schizophrenia in first-episode psychosis (FEP) patients is inconsistent in the recent literature. In the present study, DUP, schizophrenia symptoms, duration of medication, and diagnosis were obtained from hospital archives in a sample of FEP patients. The sample included 41 first-episode patients who had an ICD-10 schizophrenia spectrum diagnosis (F20-F29) and were treated with antipsychotic medication. Longer duration in days from the first psychotic symptoms to the initiation of antipsychotic medication had a statistically significant positive correlation with mean level of negative symptoms (Spearman's ρ = .38; p < .05). Results suggests that DUP is associated with a higher level of negative symptoms after the onset of adequate antipsychotic treatment. This should be considered in the care of FEP.

Keywords: duration of untreated psychosis; first-episode psychosis; negative symptoms

Posting of this abstract is for the purposes of research into psychosis and schizophrenia.

First symptoms of psychosis evident in 12-year-olds

An article posted today by Lab Spaces:

Children normally experience flights of fancy, including imaginary friends and conversations with stuffed animals, but some of them are also having hallucinations and delusions which might be the early signs of psychosis.

A study of British 12-year-olds that asked whether they had ever seen things or heard voices that weren't really there, and then asked careful follow-up questions, has found that nearly 6 percent may be showing at least one definite symptom of psychosis.

To read the entire article, please click here.

I thank Terri Vernon for bringing this article to my attention.

Also see:


Etiological and Clinical Features of Childhood Psychotic Symptoms: Results From a Birth Cohort

Childhood Psychotic Symptoms: Etiologic and Clinical Features

McGorry urges mental health overhaul

An article published in today's edition of The Sydney Morning Herald:

By Julia Medew

The Australian of the Year, Patrick McGorry [pictured], has called for a massive overhaul of the mental health system to direct funds away from acute hospital services to more community-based care.

Only weeks after accepting his award, Professor McGorry has moved to capitalise on his role by asking the federal Health Minister, Nicola Roxon, for at least $200 million in new services this year.

On top of his list is a significant expansion of specialised treatment facilities for young people aged 15 to 24 who are experiencing early psychosis and other serious mental health disorders such as schizophrenia.

He said the only such facility in Australia, Orygen Youth Health, should be used as a model for 10 new centres in other cities this year, with a commitment to another 10 in regional hubs over the next five years.

The rollout would cost $100 million this year, he said, with recurrent spending rising to about $250 million a year when all 21 centres are operating.

"This investment will be recouped three times over because early intervention is highly cost-effective and rapidly shrinks the need for care in the medium to long term," he said.

"This will free up resources for the long-term disabled cases and the broader range of mental disorders. The health economics case is unassailable."

Professor McGorry, who directs Orygen Youth Health, said he had also asked for 60 new "headspace" centres, which currently provide mental health, education, employment and drug and alcohol services to young people aged 12 to 25 at 30 sites across the country.

He said this expansion, which would cost $100 million to set up and the same in recurrent spending, would make headspace centres the first port of call for young people showing signs of mental illness, who could then be referred on to the specialised treatment facilities if need be.

"This is a low-risk reform strategy with rapid and dramatic benefits in health gain and cost savings. Failure to invest in early psychosis reform will result in another lost generation of young Australians consigned to unnecessary disability as well as premature death from suicide and cardiovascular disease," he said.

Professor McGorry said he wanted to see the centre of gravity of mental health services shifted away from hospitals to community-based facilities because the sector had suffered enormously from being moved out of "asylums" and into hospitals in the 1990s. He said the transition was like "boarding a sinking ship" for mental health professionals who had struggled to work with scarce funds ever since.

''The acute pressure [on the hospital system] has made mental health budgets very vulnerable,'' he said. ''The mental health system needs to be scaled up significantly now. It needs to double in size and the states can't do it alone.''

Professor McGorry said that after consulting widely in recent weeks, he also hoped federal and state and territory governments would fund more mobile treatment teams for people with delayed recovery and persistent conditions so they were not forced to go to hospital emergency departments during crises.

"We need to disinvest in emergency departments as the place for acute and crisis care. EDs are the wrong places for people with mental health problems to be treated," he said.

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Scientists try to stop schizophrenia in its tracks

An article posted on July 26th by ABC News:

Seeking to block voices, 'odd thoughts,' scientists try to stop schizophrenia in young people

By Malcolm Ritter, Associated Press

PORTLAND, Maine — She was sociable and happy in high school. But in college that changed abruptly: Depressed and withdrawn, some days she couldn't get out of bed.

And that wasn't all.

"I had really odd thoughts," recalled the woman, now 21, who asked that her name not be used. While walking across campus at the University of Southern Maine, "sometimes I'd feel like people were just right behind me (who might) jump me or something."

She knew it wasn't true, but she couldn't shake the feeling.

Sometimes, while driving, she saw imaginary, shadowy people on the sidewalk. And now and then, out of nowhere, there would be a woman's voice in her ear during class, or random soft noises like knocking or the fizzy hiss of a newly opened soda can.

When she visited the university health service and talked about feeling depressed, a nurse practitioner saw another problem: a possible case of schizophrenia in the making.

This schizophrenia "prodrome" — the early signs — involves a troubled mental state usually found in teens and young adults. It can lead to psychosis, the loss of touch with reality that marks not only schizophrenia, but also some forms of depression or manic-depression. The prodrome can linger for weeks, or years, before it gives way to psychosis — or mysteriously disappears without a trace.

Researchers have known about this warning phase for decades, but they're still working on how to treat it. Now they're calling in tools like brain scans, DNA studies and hormone research to dig into its biology. They hope that will reveal new ways to detect who's on the road to psychosis and to stop that progression.

In the prodrome, people can see and hear imaginary things or have odd thoughts. But significantly, they understand these experiences are just illusions, or they have a reasonable explanation.

In contrast, people with psychosis firmly cling to unreasonable explanations instead. When someone interprets an odd halo of light over a bedroom doorway as an urgent message from a dead relative, "that's when they have gone over to the psychotic side," said Dr. Thomas McGlashan, a Yale University psychiatry professor.

Some early signs of the prodrome are subtle. "Sometimes kids will (say) light seems different," and windows are too bright, said Ann Lovegren Conley, the family nurse practitioner at USM who spotted apparent prodromal symptoms in the student on her campus.

That can signal "this is not just typical depression or situational stress," Conley said. "There's something more here."

After hearing the student's story, Conley put her in touch with the Portland Identification and Early Referral program, called PIER, one of about 20 clinics in the United States that focus on treating prodrome cases. PIER has trained her and thousands of other school nurses and counselors, pediatricians and others in greater Portland in how to spot them.

PIER emphasizes non-drug therapies for its patients, ages 12 to 25, although about three-quarters of them take anti-psychotic medication.

The treatment regimen includes group meetings in which patients and families brainstorm about handling the condition's day-to-day stresses. It also focuses on keeping patients in school and in touch with their families and social networks.

With a grant from the Robert Wood Johnson Foundation, the PIER approach is also being tried in California, Oregon, Michigan and New York.

Even before treatment begins, a patient's encounter with someone who understands can be dramatic. McGlashan recalled that one young woman at the Yale clinic burst into tears when being asked about symptoms, explaining, "I thought I was the only person in the world who was having these experiences."

Or, when asked if they've felt like the television was speaking to them personally, young clients may reply, "How did you know?" McGlashan said.

Studying the schizophrenia prodrome has been tough for the small but growing group of researchers in the area, because the condition is relatively uncommon. A typical community may get only one new case per 10,000 people each year,* and only a fraction of those people would end up in a research study.

A federally funded project kicked into gear this year to uncover biological signals that will help identify people headed toward psychosis. There's already early evidence, for example, that combining brain scans with a standardized interview can greatly help, said Tyrone Cannon of the University of California, Los Angeles.

Such research should also point the way to better treatments, by exposing the biological roots of psychosis, Cannon said. He's the principal investigator of the project, which is being carried out at several medical centers.

When it comes to treating the prodrome, scientists say they have some promising approaches but no firmly proven treatments to prevent psychosis from appearing.

Low doses of anti-psychotic drugs dampen symptoms. But it's not clear whether those drugs can actually prevent psychosis. Side effects like serious weight gain are a problem, especially since many treated patients would never have developed psychosis anyway. What's more, the weight gain can turn young people away from anti-psychotic drugs, even if they move on to become psychotic and clearly need them.

Researchers are finding promise in psychosocial treatments, like those aimed at helping patients learn to manage stresses in their lives or understand and interpret their symptoms. Efforts to help young people complete their education, hold a job and stay connected to peers will help them avoid unemployment and social isolation later on, whether they progress to psychosis or not, experts say.

In fact, keeping up social contacts may help manage the prodrome. "We're convinced that if they start closeting themselves, coming home after school and just spending time in their bedroom, that will accelerate any process toward psychosis," McGlashan said. "If you dim your social life, it makes it easier for your brain to hallucinate and develop strange ideas."

The PIER program, which began eight years ago, hasn't yet published detailed results on its effectiveness. Its goal is to cut the rate of hospitalizations for first episodes of psychosis in Portland. Dr. William McFarlane, who directs it, says early analyses of the results look promising but that it's too early to draw conclusions.

And results from other locations trying the PIER approach won't be available for a couple of years, says Jane Lowe of the sponsoring Johnson foundation.

Still, in Portland, McFarlane said, "we see kids getting better every day."

One of them was the college student Conley referred. With the help of individual counseling, antidepressants and an anti-schizophrenia drug, "gradually I opened up to people," the young woman said.

She started playing tennis, joined a sorority and began exercising in the school gym. She wasn't sad all the time any more. And she stopped hearing and seeing things that weren't there.

On the Net:

• PIER and similar programs: www.preventmentalillness.org

* This statistic represents 94 people per year in Nova Scotia; not an insignificant number, particularly as it relates to the individuals, families, friends, and coworkers who are affected.

Early and network-oriented care may help adolescents at risk of developing psychosis

A press release posted May 14th by EurekAlert:

Family and network oriented, stress-reducing care improves level of overall functioning and mental health in adolescents at risk of developing psychosis, suggests a recent Finnish study.

Jorvi Early psychosis Recognition and Intervention (JERI) project at Helsinki University Central Hospital (HUCH), Jorvi Hospital, Finland, is a project with an early intervention team for adolescents at risk of developing first-episode psychosis. As developing psychosis has been suggested to be a result of a combination of acute life stressors and trait-like vulnerability to psychosis, the intervention is based on the idea of multiprofessional, need-adapted, community-, family- and network-oriented, stress-reducing, overall functioning supporting and low-threshold care.

The JERI team meets with adolescents at ages 12-20 in their natural surroundings, e.g. at school or at home, together with their parents and community co-worker, who has originally contacted the JERI team because of unclear mental health problems. The aim of the team is to recognize potential risk cases and reduce the stress level by family and network intervention.

A follow-up study was performed to test how presented intervention will help adolescents at risk. Data was collected between January 2007 and May 2008. During the intervention, mean scores rose statistically significantly on overall functioning and scores on quality of life, depression, anxiety and pre-psychotic symptoms decreased statistically significantly, showing an improvement in overall functioning and mental health in adolescents at risk of developing first-episode psychosis. Adolescents did not receive other therapy or any antipsychotic medication.

"JERI- intervention seems to improve level of overall functioning and support mental health in adolescents at risk of developing first-episode psychosis, even though further study with larger number of subjects, with a proper control group and with a longer follow-up time is needed", says Dr. Niklas Granö, the leader of the research.

###

Results are published in the journal Early Intervention in Psychiatry.

For further information, please contact:

Niklas Granö, PhD.
E-mail: niklas.grano@hus.fi
Tel. + 358 9 471 83007

Reference:

Niklas Granö, Marjaana Karjalainen, Jukka Anto, Arja Itkonen,Virve Edlund and Mikko Roine: An intervention to improve level of overall functioning and mental condition of adolescents at high risk of developing first-episode psychosis in Finland. Early Intervention in Psychiatry (2009; 3: 94-98)

Facing Psychosis Video

Posted by ReachOut on January 28th:

This short video, made by and for youth and persons with psychosis, gives an excellent summary of what to watch out for in this brain illness.

Also see:

Scientists Can Predict Psychotic Illness in up to 80 Percent of High-Risk Youth

Early detection of psychosis – Establishing a service for persons at risk

An abstract published in the January 2009 edition of European Psychiatry:

By Frauke Schultze-Lutter, Stephan Ruhrmann, and Joachim Klosterkötter [pictured]

University of Cologne, Department of Psychiatry and Psychotherapy, Early Recognition and Intervention Centre for Mental Crises (FETZ), 50924 Cologne, Germany

Purpose

The establishment phase of an early detection centre for prodromal psychosis is introduced and characterised, along with its detaining and promoting factors within a universal multi-payer health care system.

Method

Across the first six years (1998–2003), users' characteristics are compared between different diagnostic groups and to the local population statistics; and, for an exemplary 12-months period (3-1-2002 to 2-28-2003), the characteristics of telephone contacts with the service are studied.

Results

Rising steadily in number across the first three years, 872 persons, predominately of German citizenship and higher education, consulted the service until 2003, 326 with first-episode psychosis and 144 not fulfilling criteria for a current or beginning psychosis. Of the 402 putatively prodromal patients, 94% reported predictive basic symptoms, 68.9% attenuated and 20.6% transient psychotic symptoms. Most contacts by persons meeting any prodromal criterion were initiated by mental health professionals (psychiatrists or psychologists) and counselling services.

Conclusion

Supported by public awareness campaigns, an early detection service is well received by its users and private practitioners as reflected by the large proportion of referrals from the latter. However, persons of non-German background as well as of lower education were underrepresented indicating that these sub-groups should be approached by tailored programmes.

Keywords: Psychosis; Early detection; Prodrome; Outpatient health services; Program evaluation

To download the entire article, click here (PDF).

Posting of this abstract is for the purposes of research into early psychosis.

Also see:

Early Detection Fact Sheet (PDF)

Nova Scotia Early Psychosis Program

Photograph of Joachim Klosterkötter courtesy of the University of Cologne.

Beyond the critical period: longitudinal study of 8-year outcome in first-episode non-affective psychosis

An abstract published in the January 1st edition of the British Journal of Psychiatry by Crumlish et al.:

Background

The critical period hypothesis proposes that deterioration occurs aggressively during the early years of psychosis, with relative stability subsequently. Thus, interventions that shorten the duration of untreated psychosis (DUP) and arrest early deterioration may have long-term benefits.

Aims

To test the critical period hypothesis by determining whether outcome in non-affective psychosis stabilises beyond the critical period and whether DUP correlates with 8-year outcome; to determine whether duration of untreated illness (DUI) has any independent effect on outcome.

Method

We recruited 118 people consecutively referred with first-episode psychosis to a prospective, naturalistic cohort study.

Results

Negative and disorganised symptoms improved between 4 and 8 years. Duration of untreated psychosis predicted remission, positive symptoms and social functioning at 8 years. Continuing functional recovery between 4 and 8 years was predicted by DUI.

Conclusions

These results provide qualified support for the critical period hypothesis. The critical period could be extended to include the prodrome as well as early psychosis.

Life of Francis

From the October 23rd edition of The Weekly Albertan:

By Michelle Lindstrom

Earlier this month during Mental Illness Awareness Week, a group of about 15 people from Calgary's medical community and those affected by mental illness gathered to view A Map of the mind fields: Managing adolescent psychosis, and to discuss the stigma of mental illness.

Later, outside the group setting, Francis, a brown-haired artsy-looking girl with glasses, approaches and offers to tell her story to The Weekly Albertan.

To read the entire article, click here.

Photograph courtesy of The Weekly Albertan.

The Staglin Family Announce Largest Ever Grant for Research in Prevention of Mental Disorders at 14th Annual Festival for Mental Health

From the September 15th edition of The Wall Street Journal:

The Pointer Sisters Electrify the Crowd

Chefs Mark Dommen and Todd Humphries Shine on Historic Day


RUTHERFORD, Calif., Sep 15, 2008 (BUSINESS WIRE) -- The 14th Annual Staglin Family Music Festival for Mental Health raised approximately $3 million at its September 13 event to help support pioneering mental health research. Co-hosts Shari and Garen Staglin announced that scientists who have been conducting research with seed funding from previous festival earnings were recently awarded a $21 million grant by the National Institute of Mental Health (NIMH) to begin a large multi-center study. A jubilant mood set in as R&B legends The Pointer Sisters took the stage and enticed guests to hit the dance floor in celebration of the historic day.

Dr. Ty Cannon, PhD, Departments of Psychology and Psychiatry and Biobehavioral Sciences at UCLA helped the Staglins make the historic announcement of the $21 million grant for the North American Prodromal Longitudinal Study (NAPLS). Dr. Cannon has taken a lead in NAPLS, a consortium of eight North American prodromal (an early symptom indicating the onset of an attack or a disease) research centers, which study teens who are at risk for developing psychosis and can be identified and treated before the onset of a full-blown illness. Through this funding, Dr. Cannon is heading a team of scientists and clinicians to develop the means to head off psychosis as a regular clinical intervention, as the effects of an episode produce long-term changes in the brain that are far harder to treat. Currently, their testing has resulted in the ability to identify 40% of at-risk subjects who would develop psychosis before they actually do. This NAPLS grant will allow for further assessment, using an array of biological analyses, with the goal of raising the tests' predictive sensitivity to 80%. This would mean that a full 80% of people who would develop psychosis could be treated early, and, hopefully, be saved from it. The group also aims to uncover the specific neural and molecular changes that drive the emergence of schizophrenia and related illnesses, knowledge that will aid in the development of new approaches to early intervention.

"Funding from the Staglin Music Festival for Mental Health was absolutely instrumental in helping us secure this grant from the NIMH, both through the provision of 'seed' funding for the UCLA early detection of psychosis program and through support of a series of grant planning meetings of the NAPLS investigators," Dr. Cannon stated. "We feel very strongly that, with this major funding, an 80% predictive sensitivity rate is very achievable. This alone can greatly change the way we treat mental illness," Cannon added.

To read the entire article, click here.

reachoutpsychosis.com

Click on the either arrow to start the video.

For more information, visit reachoutpsychosis.com.

Worsening of Symptoms Prevented by Early Detection

From the July 4th edition of Psychiatric News:

By Mark Moran

Negative symptoms such as cognitive deficits and lack of affect and volition have long been considered unmodifiable and appear to represent core neurobiological deficits of schizophrenia.

Reducing the duration of untreated acute psychosis in first-episode patients appears to prevent the worsening of negative symptoms—such as cognitive deficits and lack of volition, among others—at two-year follow-up.

That finding, from analysis of a public health intervention in Norway, suggests that early identification and treatment of acute psychotic symptoms may affect the core neurobiological deficit process of schizophrenia, and through this alter the course and prognosis for the better.

To read the entire article, click here.

Also see:
Prevention of Negative Symptom Psychopathologies in First-Episode Schizophrenia: Two-Year Effects of Reducing the Duration of Untreated Psychosis.

A disorder in disguise

Poor grades, irritability, suspicion. What distinguishes the beginnings of schizophrenia from normal adolescent turmoil? New research identifies key warning signs, Tralee Pearce reports

To read this article published in the March 25th edition of The Globe and Mail, click here.

Also see:

Scientists Can Predict Psychotic Illness In Up To 80 Percent Of High-risk Youth

Scientists Can Predict Psychotic Illness In Up To 80 Percent Of High-risk Youth

For the full story, click here.

For the abstract of the paper published in the Archives of General Psychiatry, click here.

For a related story published in the February 1st issue of Psychiatric News, click here.

Early detection in psychosis

From the Care Improvement Partnership, National Institute for Mental Health in England. Click here to visit the website.

'Babble test' predicts onset of schizophrenia-spectrum disorders

Source: Reuters Health
Author: Karla Gale
Date: 5 November 2007

In patients with prodromal symptoms of psychosis, extracting spurious phrases from garbled, incomprehensible voices indicates that they are at risk of developing frank schizophrenia-spectrum disorders, according to results of a multicenter study.

In previous research, "we noticed that more extended babble-induced speech illusions were elicited among patients whose illness was recent onset, compared to normal subjects and patients with established, long-standing schizophrenia," Dr. Ralph Hoffman told Reuters Health.

"We subsequently wondered if babble-induced speech illusions might also be a predictor of those high-risk patients who actually go on to develop schizophrenia," he added.

During the 'babble task,' participants listen with headphones to overlapping recordings of six speakers reading neutral texts, the investigators explain in the October issue of the British Journal of Psychiatry. Patients are instructed to repeat words or phrases they believe they hear while listening to the babble, and the number of words is recorded as the length of speech illusion (LSI) score.

Dr. Hoffman, at Yale University in New Haven, Connecticut, and associates tested their theory in a cohort of subjects with prodromal symptoms. Forty-three subjects were tested in the absence of antipsychotic medication, and a subset of the subjects were also tested during treatment with olanzapine for a year.

Twelve converted to a schizophrenia-spectrum disorder.

In the 'no medication state,' the LSI score was significantly associated with subsequent conversion (hazard ratio, 1.78, p = 0.0011). With an LSI cutoff of 4 or above, the positive predictive value was 0.80 and negative predictive value was 0.94 (p = 0.0001).

Dr. Hoffman was careful to preclude any possible clinical recommendations until after their findings are independently replicated. Still, he said, "a test that was established to be predictive at the high rate we found ... could be enormously beneficial."

Data from their preliminary study "suggest that high LSI scores in persons with prodromal symptoms would be an indication to start antipsychotic medication," Dr. Hoffman said. "In contrast, individuals with low LSI scores appear to be at much lower risk," and would not require medication.

Currently, research is dominated by expensive and complex procedures, such as brain scans and neuropsychological testing, he pointed out. "However, I believe that a very careful probing of the positive symptoms of schizophrenia could provide some simple methods for detecting underlying brain changes in their early phase, which could afford a great opportunity to shut down these (psychologically) malignant processes before they take hold."