The second presentation was by Matcheri Keshavan from Harvard, who reviewed the neurobiology of schizophrenia. The first question
he posed was, "When do psychotic disorders really begin?" He presented evidence that although psychosis typically begins in
adolescence, there is a long preadolescent prodrome during which premorbid brain alterations occur, followed by cognitive
and language impairments, attentional/impulse control deficits, affect dysregulation, and social deficits—all before the appearance
of psychosis itself. Keshavan then illustrated the stages of brain development in childhood and adolescence, stipulating that
the prefrontal cortex is the last part of the brain to mature and that cognitive control, emotion regulation, and capacity
to cope with stress only come online in later developmental stages. All parents of teenagers know this already, of course!
But the sobering parts of the talk were the remarkable differences in the side-by-side images of the developing brains of
unaffected young people, compared with the images of those later diagnosed with schizophrenia.