The functional decline and onset of psychosis that individuals with schizophrenia experience suggests that schizophrenia has a neurodegenerational origin. However, current research favors a neurodevelopmental model in which individuals with schizophrenia develop abnormalities during brain development. The abnormality that leads to psychosis and deterioration remains latent as the brain develops but emerges concurrently with the brain’s normal development or after an outside event that leads to changes in brain function. Prenatal adversity may underlie the neurodevelopmental process and neurodegeneration of schizophrenia. Because psychosis may be a clinically identifiable marker of an underlying neuropathologic process associated with deterioration, the best way to treat the illness is to reduce the duration of untreated psychosis, aim for full remission of psychosis, and combine medication with other therapies.

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J Clin Psychiatry 2006;67(8):e07