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U of M Expert: Non-specific episodes can signal onset of psychotic illness; early intervention critical

July 25, 2012

As the country steadies itself after last week’s horrific shooting at a Colorado movie theater that left 12 people dead and 58 injured, much of the conversation has now shifted to the suspect himself and how we can try to make sense of a senseless act.

At a Monday court appearance, suspect James Holmes appeared dazed and at times completely detached, prompting discussion around his mental state.  Authorities are investigating whether minor personality shifts and erratic behavior prior to his alleged involvement in the shooting could have in any way signaled the onset of a psychotic illness. 

A University of Minnesota expert who can discuss the warning signs and evolution of psychotic illness is Charles Schulz, M.D., head of the Department of Psychiatry at the University of Minnesota Medical School.

According to Schulz, the onset of most psychotic conditions starts with non-specific episodes which act as precursors to full blown psychosis.  

“In people battling psychosis we’ll often see symptoms such as a drop in academic function or complete academic or workplace withdrawal, increased isolation and unusual thoughts and actions,” said Schulz.  “Non-specific episodes can also include trouble functioning, feelings of paranoia and odd social behavior.”

The challenge, said Schulz, is getting patients evaluated properly at the point of these non-specific episodes to ensure what they’re experiencing isn’t a descent into a much more serious condition.

But many people experiencing a schizophrenic or psychotic episode have zero insight into changes impacting them.  As a result, the onus of identifying subtle changes or warning signs in a once-normal person can often fall to friends or associates.  When someone has already become withdrawn and isolated, this becomes even harder. 

The University of Minnesota has specific programs, the “Prodrome Program” and “First Episode,” that can help evaluate patients for psychosis prior to their condition escalating further.  The programs utilize interviews, cognitive behavior therapy and questionnaires to determine a person’s condition after warning signs trigger alarm.

“The main issue is getting people help, and being aware so that we can get patients evaluated, and if necessary, treated for their condition,” said Schulz.  “It’s rare that violence will result early in a person’s battle with psychosis, but on occasion the first outburst anyone notices is something violent.  Only afterward do we hear about subtle instances where people worried but nothing was done for the patient.  Our goal is earlier awareness and intervention so we can avoid these instances.”

To interview Schulz or for more information contact Justin Paquette at (612) 626-7037 or or Caroline Marin at (612) 624-5680 or

Tags: Academic Health Center

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