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1. Shard Calculation

Query:

Response:

Calculated Shard: 56 (from laksa150)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa056.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.psychiatrictimes.com/view/early-screening-for-schizophrenia-and-the-opportunity-of-lais\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.psychiatrictimes.com/view/early-screening-for-schizophrenia-and-the-opportunity-of-lais\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.psychiatrictimes.com\/view\/early-screening-for-schizophrenia-and-the-opportunity-of-lais","crawl_time":1776347074,"first_indexed_time":1772024742,"http_code":200,"src_unparsed":"com,psychiatrictimes!www,\/view\/early-screening-for-schizophrenia-and-the-opportunity-of-lais s443","src_root_hash":"1023787353641780656","history_drop_reason":null,"meta_title":"Early Screening for Schizophrenia and the Opportunity of LAIs | Psychiatric Times","meta_descriptions":["Early psychosis screening in teens and young adults helps catch overlooked symptoms sooner."],"attrs_boilerpipe_text":"Early psychosis screening in teens and young adults helps catch overlooked symptoms sooner.\nJames\/Adobe Stock\nLong-acting injectables and generations of antipsychotics are among the choices a patient with schizophrenia may be presented.\n1\nBut even before treatment is needed, screening is essential.\nPsychiatric Times\nsat down with Richard Miller, MD, a psychiatrist specializing in community treatment and schizophrenia, to discuss the importance of early psychosis and schizophrenia screening in younger individuals.\nPsychiatric Times\n: We know schizophrenia tends to develop earlier in life; can you share why early screening is so important for schizophrenia and psychosis?\n2\nRichard W. Miller, MD:\nWe meet individuals with undiagnosed schizophrenia in many environments. We see them in the emergency room, we see them in the inpatient units, and I treat them in the outpatient world. And what we are seeing is individuals come in and some are maybe college students having a break, or young adults who have been undiagnosed for a period of time. So, the earlier you screen, the better, because we know that morphologically the brain is going to change.\nTreatment resistance can happen in as little as 1 or 2 possible stays. And that means, to be effective but cost-effective, you need to have higher doses. And the reality of the situation is the patients wind up spending more time in the hospital. There are times with higher doses of medication, and not to mention the negative outcomes cognitively, financially—you re simply spending more time in the hospital. So the goal is to screen patients, assess them, and treat them. We have a lot of good options for treatment, and we can provide one of those options that is best for that patient.\nPT\n: When working with that variety of patients with schizophrenia, is there an aspect of the diagnosis or treatment that you see is often overlooked?\nDr Miller:\nDefinitely. There are 3 spectrums—3 symptoms. You have your positive symptoms, which unfortunately get most of the attention: hallucinations, delusions, paranoia. For example, when I go to court and I’m testifying, it is usually because patients are hearing auditory hallucinations about violence, or they had a psychotic episode. That usually means we are seeing paranoia, which can get law enforcement involved or becomes more prominent in terms of getting picked up by police.\nNegative symptoms are just as significant, but sometimes do not get as much attention. These are symptoms where the patient might not be showering, not eating, demotivated, depressed, maybe with some cognitive functioning delays, which could be due to depression and lack of motivation.\nThen you have general psychopathology, which is more generalized difficulty functioning, and you see some cognitive problems there as well. Historically, our medications have treated the positive symptoms quite well, and I get that because those are what most commonly get attention in courts and hospitals. But the other symptom clusters, which are just as important, have not been addressed as adequately as we would like over the course of history. So you must treat the whole patient, but understand that positive symptoms are usually what bring them to the hospital.\nPT\n: You mentioned treating the whole patient, is there something you find unique about patients with schizophrenia who might have other psychiatric comorbidities?\nDr Miller:\nOne of the big problems is the type of patients come in and say, “Well, I can’t concentrate. It’s my ADHD.” That happened to me just yesterday. And I said, “Well, let’s look at this. You have schizophrenia. You’ve been using marijuana to self-medicate anxiety for a period of time.” It has been a constant struggle where the patient has been self-medicating to help anxiety, yet at the same time potentially causing worsening anxiety.\nSo they are having concentration issues, which they are attributing to ADHD, which is not really there. It is more a cognitive processing issue due to schizophrenia. I think trying to explain to the patient that they do not need 3 different psych medications—you need 1 medication to treat the entire cluster of symptoms (inattention, anxiety, and disorganization), which is at the core of your illness. That is sometimes a hard discussion to have. My patient in this examples has decent insight, understands he is ill, and he has done well on medication, but still has residual symptoms and thinks he can go without it. But the reality is these are symptoms consistent with schizophrenia.\nPT\n: Similarly, is there a different strategy necessary for working with patients with schizophrenia compared to other disorders?\nDr Miller:\nWhat I love about this population is the specific challenges we can help them face. This type of illness typically hits between ages 18 and 24, which are formative years; individuals are leaving high school, going to the military, starting serious relationships, getting jobs, living independently. And then they get what I call a gut punch and are essentially unable to move forward. They are paralyzed because their illness has given them an all-stop.\nSchizophrenia affects development, the ability to work, to go to school. It’s a heartbreaking illness, and you see it percolate into other aspects of their life. Some folks become homeless, they turn to drugs, they get into legal issues. We have great treatment options, and if we screened better and knew who was more likely to develop schizophrenia, patients might have a better chance. If they started treatment earlier, they would have a great chance.\nWhen I trained at the University of Michigan, we had a program called MP3, where we screened high school students to see who was more likely at risk. That is a great idea—realizing who is more likely to become ill and creating systems to help them get treatment. If you don’t start treatment early, it does not turn out well.\nPT\n: If you could highlight one element, what is most important for clinicians to keep in mind when evaluating patients with psychosis or schizophrenia?\nDr Miller:\nI think this comes back to insight. Some patients with schizophrenia have insight, some do not, and that makes it really hard. If you do not treat the problem, it’s going to get worse, like a snowball, and percolate into other aspects of their lives—socially, legally, financially.\nSecond, we have great treatments out there that are underutilized—long-acting injectables like aripiprazole (Aristada). Only about 10% of patients with schizophrenia are on an LAI, and I’ve been in this field for 15 to 20 years. That’s ridiculously low, when these are great treatments.\nA colleague once asked me, “Why is it so hard for people with schizophrenia to take their medication?” And I said, “You’ve got to realize, a lot of these individuals don’t believe they’re ill.” It’s based on paranoia, delusions, hallucinations. Someone with diabetes usually knows they have diabetes and what happens if they do not take their insulin. But people with schizophrenia often do not believe they are ill. Understanding that insight is compromised makes a lot of things make sense. The illness spirals if you do not treat it, and it hits at such an early age that it can disrupt a life pretty aggressively.\nPT:\nIs there something particular from your community work that has changed the way you view schizophrenia treatment?\nDr Miller:\nAbsolutely. LAIs are underutilized. Ten percent of the population is on them, and we have to be more aggressive about getting that number up. LAIs like Aristada are a great option—it’s a monthly or every-2-month maintenance medication to decrease the burden of illness.\nPatients can be getting meds 6 times a year instead of 365 times a year. That’s incredible. It can be hard to take pills every day, but easier to get an injection a few times a year. It takes 5 or 10 minutes—about an hour a year total. These medications work, and they are underutilized.\nWe have great tools—we just have to use them. And one last thing: when you walk into a hardware store, there’s a reason they sell 50 types of screws, not 1. In the same way, we have many tools to help individuals with schizophrenia. It is not one-size-fits-all. Different medications, different options. LAIs are one of those tools, and they are still underutilized. So again, not one-size-fits-all—we have multiple modalities to give treatment.\nDr Miller\nis the owner of his private practice, Bloom Wellness, a psychiatrist at Elwyn Adult Behavioral Health, and works in inpatient practice in Rhode Island.\nReferences\n1. Schizophrenia. Mayo Clinic. October 16, 2024. Accessed February 18, 2026.\nhttps:\/\/www.mayoclinic.org\/diseases-conditions\/schizophrenia\/diagnosis-treatment\/drc-20354449\n2. Schizophrenia. National Alliance on Mental Illness. December 2025. Accessed February 18, 2026.\nhttps:\/\/www.nami.org\/types-of-conditions\/schizophrenia\/\nNewsletter\nReceive trusted psychiatric news, expert analysis, and clinical insights — subscribe today to support your practice and your patients.","attrs_markdown":"[![](https:\/\/www.psychiatrictimes.com\/logo.webp)](https:\/\/www.psychiatrictimes.com\/)\n\n[News](https:\/\/www.psychiatrictimes.com\/news)\n\nMedia\n\n[Peer Exchange](https:\/\/www.psychiatrictimes.com\/peer-exchange)[Case-Based Psych Perspectives](https:\/\/www.psychiatrictimes.com\/case-based-psych-perspectives)[Clinical Case Collective](https:\/\/www.psychiatrictimes.com\/clinical-case-collective?page=1)[Clinical Forum Insights](https:\/\/www.psychiatrictimes.com\/clinical-forum-insights)[Insights](https:\/\/www.psychiatrictimes.com\/insights)[Peers & Perspectives](https:\/\/www.psychiatrictimes.com\/peers-and-perspectives)[Shorts](https:\/\/www.psychiatrictimes.com\/shorts)[Slideshows](https:\/\/www.psychiatrictimes.com\/slideshows)[Videos](https:\/\/www.psychiatrictimes.com\/videos)\n\nConferences\n\n[Conference Coverage](https:\/\/www.psychiatrictimes.com\/latest-conference)[Conference Listing](https:\/\/www.psychiatrictimes.com\/conferences)\n\nPublication\n\n[Psychiatric Times](https:\/\/www.psychiatrictimes.com\/journals\/psychiatric-times)\n\nMore\n\n[Job Board](https:\/\/jobs.modernmedicine.com\/)\n\n[CME\/CE](https:\/\/www.psychiatrictimes.com\/continuing-education)\n\n[Partners](https:\/\/www.psychiatrictimes.com\/sap-partner)\n\n[Editorial](https:\/\/www.psychiatrictimes.com\/editorial-info)\n\nResources\n\n[Between the Lines](https:\/\/www.psychiatrictimes.com\/between-the-lines)[Expert Perspectives](https:\/\/www.psychiatrictimes.com\/expert-perspectives?page=1)[Clinical Consult](https:\/\/www.psychiatrictimes.com\/clinical-consult)[Clinical Scales](https:\/\/www.psychiatrictimes.com\/resources\/clinical-scales)[Interactive Tools](https:\/\/www.psychiatrictimes.com\/interactive-tools)[Live Events](https:\/\/www.psychiatrictimes.com\/events)[Partner Perspectives](https:\/\/www.psychiatrictimes.com\/partner-perspectives)[Q\\&A](https:\/\/www.psychiatrictimes.com\/resources\/q-a)[Quizzes](https:\/\/www.psychiatrictimes.com\/resources\/quizzes)[Series](https:\/\/www.psychiatrictimes.com\/series)[Special Reports](https:\/\/www.psychiatrictimes.com\/special-reports)[Sponsored](https:\/\/www.psychiatrictimes.com\/resources\/sponsored-resources)\n\n[Subscribe](https:\/\/www.psychiatrictimes.com\/subscribe)\n\nMy Account\n\n- [News](https:\/\/www.psychiatrictimes.com\/news)\n- Media\n- Conferences\n- Publication\n- [Job Board](https:\/\/jobs.modernmedicine.com\/)\n- [CME\/CE](https:\/\/www.psychiatrictimes.com\/continuing-education)\n- [Partners](https:\/\/www.psychiatrictimes.com\/sap-partner)\n- [Editorial](https:\/\/www.psychiatrictimes.com\/editorial-info)\n- Resources\n- [Subscribe](https:\/\/www.psychiatrictimes.com\/subscribe)\n\n- [ADHD](https:\/\/www.psychiatrictimes.com\/topics\/adhd)\n- [Addiction & Substance Use](https:\/\/www.psychiatrictimes.com\/topics\/addiction-suds-compulsive)\n  - 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Miller, MD*](https:\/\/www.psychiatrictimes.com\/authors\/richard-w-miller-md), [*Jessica Walters*](https:\/\/www.psychiatrictimes.com\/authors\/jessica-walters)\n\nListen\n\n0:00 \/ NaN:NaN\n\n### Key Takeaways\n- Earlier screening in late adolescence\/early adulthood may reduce hospitalization burden, limit progression toward treatment resistance, and improve cognitive and functional outcomes by shortening duration of untreated psychosis.\n- Symptom assessment should balance positive symptoms with negative symptoms and general psychopathology, given their outsized contribution to long-term impairment despite historically weaker pharmacologic targeting.\n- Cognitive complaints and anxiety may be misattributed to ADHD or treated via cannabis self-medication, when they reflect schizophrenia-related processing deficits requiring unified, diagnosis-centered pharmacotherapy.\n- Impaired insight is a central driver of nonadherence and life disruption, necessitating strategies that anticipate illness denial and prevent escalating social, legal, and financial sequelae.\n- Long-acting injectable antipsychotics (eg, aripiprazole LAI) are used in ~10% of patients despite lowering adherence burden and offering flexible dosing intervals within a personalized, non–one-size-fits-all toolkit.\n\nSHOW MORE\n\nEarly psychosis screening in teens and young adults helps catch overlooked symptoms sooner.\n\nAdvertisement\n\n![schizophrenia early screening](https:\/\/cdn.sanity.io\/images\/0vv8moc6\/psychtimes\/5442de3094aaf91ab8653a740b8e08dd5a6a6da1-10940x6132.jpg?w=10940&max-h=6132&fit=crop&auto=format)\n\nJames\/Adobe Stock\n\n![](https:\/\/cdn.sanity.io\/images\/0vv8moc6\/psychtimes\/5442de3094aaf91ab8653a740b8e08dd5a6a6da1-10940x6132.jpg?fit=crop&auto=format)\n\nLong-acting injectables and generations of antipsychotics are among the choices a patient with schizophrenia may be presented.1 But even before treatment is needed, screening is essential. *Psychiatric Times* sat down with Richard Miller, MD, a psychiatrist specializing in community treatment and schizophrenia, to discuss the importance of early psychosis and schizophrenia screening in younger individuals.\n\n***Psychiatric Times*: We know schizophrenia tends to develop earlier in life; can you share why early screening is so important for schizophrenia and psychosis?2**\n\n**Richard W. Miller, MD:** We meet individuals with undiagnosed schizophrenia in many environments. We see them in the emergency room, we see them in the inpatient units, and I treat them in the outpatient world. And what we are seeing is individuals come in and some are maybe college students having a break, or young adults who have been undiagnosed for a period of time. So, the earlier you screen, the better, because we know that morphologically the brain is going to change.\n\nTreatment resistance can happen in as little as 1 or 2 possible stays. And that means, to be effective but cost-effective, you need to have higher doses. And the reality of the situation is the patients wind up spending more time in the hospital. There are times with higher doses of medication, and not to mention the negative outcomes cognitively, financially—you re simply spending more time in the hospital. So the goal is to screen patients, assess them, and treat them. We have a lot of good options for treatment, and we can provide one of those options that is best for that patient.\n\n***PT*: When working with that variety of patients with schizophrenia, is there an aspect of the diagnosis or treatment that you see is often overlooked?**\n\n**Dr Miller:** Definitely. There are 3 spectrums—3 symptoms. You have your positive symptoms, which unfortunately get most of the attention: hallucinations, delusions, paranoia. For example, when I go to court and I’m testifying, it is usually because patients are hearing auditory hallucinations about violence, or they had a psychotic episode. That usually means we are seeing paranoia, which can get law enforcement involved or becomes more prominent in terms of getting picked up by police.\n\nNegative symptoms are just as significant, but sometimes do not get as much attention. These are symptoms where the patient might not be showering, not eating, demotivated, depressed, maybe with some cognitive functioning delays, which could be due to depression and lack of motivation.\n\nThen you have general psychopathology, which is more generalized difficulty functioning, and you see some cognitive problems there as well. Historically, our medications have treated the positive symptoms quite well, and I get that because those are what most commonly get attention in courts and hospitals. But the other symptom clusters, which are just as important, have not been addressed as adequately as we would like over the course of history. So you must treat the whole patient, but understand that positive symptoms are usually what bring them to the hospital.\n\n***PT*: You mentioned treating the whole patient, is there something you find unique about patients with schizophrenia who might have other psychiatric comorbidities?**\n\n**Dr Miller:** One of the big problems is the type of patients come in and say, “Well, I can’t concentrate. It’s my ADHD.” That happened to me just yesterday. And I said, “Well, let’s look at this. You have schizophrenia. You’ve been using marijuana to self-medicate anxiety for a period of time.” It has been a constant struggle where the patient has been self-medicating to help anxiety, yet at the same time potentially causing worsening anxiety.\n\nSo they are having concentration issues, which they are attributing to ADHD, which is not really there. It is more a cognitive processing issue due to schizophrenia. I think trying to explain to the patient that they do not need 3 different psych medications—you need 1 medication to treat the entire cluster of symptoms (inattention, anxiety, and disorganization), which is at the core of your illness. That is sometimes a hard discussion to have. My patient in this examples has decent insight, understands he is ill, and he has done well on medication, but still has residual symptoms and thinks he can go without it. But the reality is these are symptoms consistent with schizophrenia.\n\n***PT*: Similarly, is there a different strategy necessary for working with patients with schizophrenia compared to other disorders?**\n\n**Dr Miller:** What I love about this population is the specific challenges we can help them face. This type of illness typically hits between ages 18 and 24, which are formative years; individuals are leaving high school, going to the military, starting serious relationships, getting jobs, living independently. And then they get what I call a gut punch and are essentially unable to move forward. They are paralyzed because their illness has given them an all-stop.\n\nSchizophrenia affects development, the ability to work, to go to school. It’s a heartbreaking illness, and you see it percolate into other aspects of their life. Some folks become homeless, they turn to drugs, they get into legal issues. We have great treatment options, and if we screened better and knew who was more likely to develop schizophrenia, patients might have a better chance. If they started treatment earlier, they would have a great chance.\n\nWhen I trained at the University of Michigan, we had a program called MP3, where we screened high school students to see who was more likely at risk. That is a great idea—realizing who is more likely to become ill and creating systems to help them get treatment. If you don’t start treatment early, it does not turn out well.\n\n***PT*: If you could highlight one element, what is most important for clinicians to keep in mind when evaluating patients with psychosis or schizophrenia?**\n\n**Dr Miller:** I think this comes back to insight. Some patients with schizophrenia have insight, some do not, and that makes it really hard. If you do not treat the problem, it’s going to get worse, like a snowball, and percolate into other aspects of their lives—socially, legally, financially.\n\nSecond, we have great treatments out there that are underutilized—long-acting injectables like aripiprazole (Aristada). Only about 10% of patients with schizophrenia are on an LAI, and I’ve been in this field for 15 to 20 years. That’s ridiculously low, when these are great treatments.\n\nA colleague once asked me, “Why is it so hard for people with schizophrenia to take their medication?” And I said, “You’ve got to realize, a lot of these individuals don’t believe they’re ill.” It’s based on paranoia, delusions, hallucinations. Someone with diabetes usually knows they have diabetes and what happens if they do not take their insulin. But people with schizophrenia often do not believe they are ill. Understanding that insight is compromised makes a lot of things make sense. The illness spirals if you do not treat it, and it hits at such an early age that it can disrupt a life pretty aggressively.\n\n***PT:*** **Is there something particular from your community work that has changed the way you view schizophrenia treatment?**\n\n**Dr Miller:** Absolutely. LAIs are underutilized. Ten percent of the population is on them, and we have to be more aggressive about getting that number up. LAIs like Aristada are a great option—it’s a monthly or every-2-month maintenance medication to decrease the burden of illness.\n\n> Patients can be getting meds 6 times a year instead of 365 times a year. That’s incredible. It can be hard to take pills every day, but easier to get an injection a few times a year. It takes 5 or 10 minutes—about an hour a year total. These medications work, and they are underutilized.\n\nWe have great tools—we just have to use them. And one last thing: when you walk into a hardware store, there’s a reason they sell 50 types of screws, not 1. In the same way, we have many tools to help individuals with schizophrenia. It is not one-size-fits-all. Different medications, different options. LAIs are one of those tools, and they are still underutilized. So again, not one-size-fits-all—we have multiple modalities to give treatment.\n\n**Dr Miller** *is the owner of his private practice, Bloom Wellness, a psychiatrist at Elwyn Adult Behavioral Health, and works in inpatient practice in Rhode Island.*\n\n**References**\n\n1\\. Schizophrenia. Mayo Clinic. October 16, 2024. Accessed February 18, 2026. <https:\/\/www.mayoclinic.org\/diseases-conditions\/schizophrenia\/diagnosis-treatment\/drc-20354449>\n\n2\\. Schizophrenia. National Alliance on Mental Illness. December 2025. Accessed February 18, 2026. <https:\/\/www.nami.org\/types-of-conditions\/schizophrenia\/>\n\n### Newsletter\nReceive trusted psychiatric news, expert analysis, and clinical insights — subscribe today to support your practice and your patients.\n\n[Subscribe Now\\!](https:\/\/www.psychiatrictimes.com\/subscribe)\n\nAdvertisement\n\n[Q\\&A](https:\/\/www.psychiatrictimes.com\/resources\/q-a)\n\n\\|\n\n[Schizophrenia\/Psychosis](https:\/\/www.psychiatrictimes.com\/topics\/schizophrenia)\n***\n## Related Content\nAdvertisement\n\n[![Drazen\/Adobe Stock](https:\/\/cdn.sanity.io\/images\/0vv8moc6\/psychtimes\/6cacfb81352ae72e9c1d3048986c4de8b514db9c-6720x4480.jpg?w=350&fit=crop&auto=format)](https:\/\/www.psychiatrictimes.com\/view\/is-schizophrenia-and-psychosis-related-to-accelerated-aging)\n\n[Is Schizophrenia and Psychosis Related to Accelerated Aging?](https:\/\/www.psychiatrictimes.com\/view\/is-schizophrenia-and-psychosis-related-to-accelerated-aging)\n\nBy[Ethan Whitman,](https:\/\/www.psychiatrictimes.com\/authors\/ethan-whitman)[Jessica Walters](https:\/\/www.psychiatrictimes.com\/authors\/jessica-walters)\n\nApril 16th 2026\n\n[![schizophrenia](https:\/\/cdn.sanity.io\/images\/0vv8moc6\/psychtimes\/35f8e7108d9dde957e8fa24834cc09a9cc52d0b0-5824x3264.jpg?w=350&fit=crop&auto=format)](https:\/\/www.psychiatrictimes.com\/view\/lybalvi-associated-with-improvement-in-negative-symptoms-of-schizophrenia-findings-from-long-term-analysis)\n\n[Lybalvi Associated With Improvement in Negative Symptoms of Schizophrenia: Findings From Long-Term Analysis](https:\/\/www.psychiatrictimes.com\/view\/lybalvi-associated-with-improvement-in-negative-symptoms-of-schizophrenia-findings-from-long-term-analysis)\n\nBy[Leah Kuntz](https:\/\/www.psychiatrictimes.com\/authors\/leah-kuntz)\n\nApril 14th 2026\n\n[![insta\\_photos\/Adobe Stock](https:\/\/cdn.sanity.io\/images\/0vv8moc6\/psychtimes\/6f1fc3562480ffaa5f4964094631d858b03e71d2-5618x3746.jpg?w=350&fit=crop&auto=format)](https:\/\/www.psychiatrictimes.com\/view\/insights-in-treating-anxiety-and-the-pharmaceutical-perspective)\n\n[Insights in Treating Anxiety and the Pharmaceutical Perspective](https:\/\/www.psychiatrictimes.com\/view\/insights-in-treating-anxiety-and-the-pharmaceutical-perspective)\n\nBy[Freda Lewis-Hall, MD,](https:\/\/www.psychiatrictimes.com\/authors\/freda-lewis-hall-md)[Jessica Walters](https:\/\/www.psychiatrictimes.com\/authors\/jessica-walters)\n\nApril 14th 2026\n\n[![youth substance use](https:\/\/cdn.sanity.io\/images\/0vv8moc6\/psychtimes\/4a36ad75b732402d6e9e35533d0dfd4a2f0a296f-5616x3744.jpg?w=350&fit=crop&auto=format)](https:\/\/www.psychiatrictimes.com\/view\/new-adolescent-substance-use-disorder-guidelines-reducing-patient-and-family-burden)\n\n[New Adolescent Substance Use Disorder Guidelines: Reducing Patient and Family Burden](https:\/\/www.psychiatrictimes.com\/view\/new-adolescent-substance-use-disorder-guidelines-reducing-patient-and-family-burden)\n\nBy[Leah Kuntz,](https:\/\/www.psychiatrictimes.com\/authors\/leah-kuntz)[Roueen Rafeyan, MD, DFAPA, FASAM](https:\/\/www.psychiatrictimes.com\/authors\/roueen-rafeyan-md-dfapa-fasam)\n\nApril 10th 2026\n\n[![波 刘\/Adobe Stock](https:\/\/cdn.sanity.io\/images\/0vv8moc6\/psychtimes\/eeb6e08631bafdfa56f8f1bba77aebd2367cbc98-5824x3264.jpg?w=350&fit=crop&auto=format)](https:\/\/www.psychiatrictimes.com\/view\/roluperidone-for-negative-symptoms-of-schizophrenia-insights-from-development-experts)\n\n[Roluperidone for Negative Symptoms of Schizophrenia: Insights from Development Experts](https:\/\/www.psychiatrictimes.com\/view\/roluperidone-for-negative-symptoms-of-schizophrenia-insights-from-development-experts)\n\nBy[Michael Davidson, MD,](https:\/\/www.psychiatrictimes.com\/authors\/michael-davidson-md)[Remy Luthringer, PhD,](https:\/\/www.psychiatrictimes.com\/authors\/remy-luthringer-phd)[Jessica Walters](https:\/\/www.psychiatrictimes.com\/authors\/jessica-walters)\n\nApril 8th 2026\n\n## Latest CME\n[![(CME Track) SoCal Psych 2025: Overcoming Barriers to Long-Acting Injectable Agents in Schizophrenia](https:\/\/media.thoughtindustries.com\/thoughtindustries\/image\/upload\/v1\/course-uploads\/07c0d4e1-23aa-4e1a-8c5f-f2569da581c0\/mcyybmt7s0c5-SOCALSchizophreniaTICatalog750x361.png) Video(CME Track) SoCal Psych 2025: Overcoming Barriers to Long-Acting Injectable Agents in Schizophrenia Gus Alva, MD, DFAPA; 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can you share why early screening is so important for schizophrenia and psychosis?2**\n\n**Richard W. Miller, MD:** We meet individuals with undiagnosed schizophrenia in many environments. We see them in the emergency room, we see them in the inpatient units, and I treat them in the outpatient world. And what we are seeing is individuals come in and some are maybe college students having a break, or young adults who have been undiagnosed for a period of time. So, the earlier you screen, the better, because we know that morphologically the brain is going to change.\n\nTreatment resistance can happen in as little as 1 or 2 possible stays. And that means, to be effective but cost-effective, you need to have higher doses. And the reality of the situation is the patients wind up spending more time in the hospital. There are times with higher doses of medication, and not to mention the negative outcomes cognitively, financially—you re simply spending more time in the hospital. So the goal is to screen patients, assess them, and treat them. We have a lot of good options for treatment, and we can provide one of those options that is best for that patient.\n\n***PT*: When working with that variety of patients with schizophrenia, is there an aspect of the diagnosis or treatment that you see is often overlooked?**\n\n**Dr Miller:** Definitely. There are 3 spectrums—3 symptoms. You have your positive symptoms, which unfortunately get most of the attention: hallucinations, delusions, paranoia. For example, when I go to court and I’m testifying, it is usually because patients are hearing auditory hallucinations about violence, or they had a psychotic episode. That usually means we are seeing paranoia, which can get law enforcement involved or becomes more prominent in terms of getting picked up by police.\n\nNegative symptoms are just as significant, but sometimes do not get as much attention. These are symptoms where the patient might not be showering, not eating, demotivated, depressed, maybe with some cognitive functioning delays, which could be due to depression and lack of motivation.\n\nThen you have general psychopathology, which is more generalized difficulty functioning, and you see some cognitive problems there as well. Historically, our medications have treated the positive symptoms quite well, and I get that because those are what most commonly get attention in courts and hospitals. But the other symptom clusters, which are just as important, have not been addressed as adequately as we would like over the course of history. So you must treat the whole patient, but understand that positive symptoms are usually what bring them to the hospital.\n\n***PT*: You mentioned treating the whole patient, is there something you find unique about patients with schizophrenia who might have other psychiatric comorbidities?**\n\n**Dr Miller:** One of the big problems is the type of patients come in and say, “Well, I can’t concentrate. It’s my ADHD.” That happened to me just yesterday. And I said, “Well, let’s look at this. You have schizophrenia. You’ve been using marijuana to self-medicate anxiety for a period of time.” It has been a constant struggle where the patient has been self-medicating to help anxiety, yet at the same time potentially causing worsening anxiety.\n\nSo they are having concentration issues, which they are attributing to ADHD, which is not really there. It is more a cognitive processing issue due to schizophrenia. I think trying to explain to the patient that they do not need 3 different psych medications—you need 1 medication to treat the entire cluster of symptoms (inattention, anxiety, and disorganization), which is at the core of your illness. That is sometimes a hard discussion to have. My patient in this examples has decent insight, understands he is ill, and he has done well on medication, but still has residual symptoms and thinks he can go without it. But the reality is these are symptoms consistent with schizophrenia.\n\n***PT*: Similarly, is there a different strategy necessary for working with patients with schizophrenia compared to other disorders?**\n\n**Dr Miller:** What I love about this population is the specific challenges we can help them face. This type of illness typically hits between ages 18 and 24, which are formative years; individuals are leaving high school, going to the military, starting serious relationships, getting jobs, living independently. And then they get what I call a gut punch and are essentially unable to move forward. They are paralyzed because their illness has given them an all-stop.\n\nSchizophrenia affects development, the ability to work, to go to school. It’s a heartbreaking illness, and you see it percolate into other aspects of their life. Some folks become homeless, they turn to drugs, they get into legal issues. We have great treatment options, and if we screened better and knew who was more likely to develop schizophrenia, patients might have a better chance. If they started treatment earlier, they would have a great chance.\n\nWhen I trained at the University of Michigan, we had a program called MP3, where we screened high school students to see who was more likely at risk. That is a great idea—realizing who is more likely to become ill and creating systems to help them get treatment. If you don’t start treatment early, it does not turn out well.\n\n***PT*: If you could highlight one element, what is most important for clinicians to keep in mind when evaluating patients with psychosis or schizophrenia?**\n\n**Dr Miller:** I think this comes back to insight. Some patients with schizophrenia have insight, some do not, and that makes it really hard. If you do not treat the problem, it’s going to get worse, like a snowball, and percolate into other aspects of their lives—socially, legally, financially.\n\nSecond, we have great treatments out there that are underutilized—long-acting injectables like aripiprazole (Aristada). Only about 10% of patients with schizophrenia are on an LAI, and I’ve been in this field for 15 to 20 years. That’s ridiculously low, when these are great treatments.\n\nA colleague once asked me, “Why is it so hard for people with schizophrenia to take their medication?” And I said, “You’ve got to realize, a lot of these individuals don’t believe they’re ill.” It’s based on paranoia, delusions, hallucinations. Someone with diabetes usually knows they have diabetes and what happens if they do not take their insulin. But people with schizophrenia often do not believe they are ill. Understanding that insight is compromised makes a lot of things make sense. The illness spirals if you do not treat it, and it hits at such an early age that it can disrupt a life pretty aggressively.\n\n***PT:*** **Is there something particular from your community work that has changed the way you view schizophrenia treatment?**\n\n**Dr Miller:** Absolutely. LAIs are underutilized. Ten percent of the population is on them, and we have to be more aggressive about getting that number up. LAIs like Aristada are a great option—it’s a monthly or every-2-month maintenance medication to decrease the burden of illness.\n\n> Patients can be getting meds 6 times a year instead of 365 times a year. That’s incredible. It can be hard to take pills every day, but easier to get an injection a few times a year. It takes 5 or 10 minutes—about an hour a year total. These medications work, and they are underutilized.\n\nWe have great tools—we just have to use them. And one last thing: when you walk into a hardware store, there’s a reason they sell 50 types of screws, not 1. In the same way, we have many tools to help individuals with schizophrenia. It is not one-size-fits-all. Different medications, different options. LAIs are one of those tools, and they are still underutilized. So again, not one-size-fits-all—we have multiple modalities to give treatment.\n\n**Dr Miller** *is the owner of his private practice, Bloom Wellness, a psychiatrist at Elwyn Adult Behavioral Health, and works in inpatient practice in Rhode Island.*\n\n**References**\n\n1\\. Schizophrenia. Mayo Clinic. October 16, 2024. Accessed February 18, 2026. <https:\/\/www.mayoclinic.org\/diseases-conditions\/schizophrenia\/diagnosis-treatment\/drc-20354449>\n\n2\\. Schizophrenia. National Alliance on Mental Illness. December 2025. Accessed February 18, 2026. <https:\/\/www.nami.org\/types-of-conditions\/schizophrenia\/>\n\n### Newsletter\nReceive trusted psychiatric news, expert analysis, and clinical insights — subscribe today to support your practice and your patients.","meta_canonical":null}

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Boilerpipe Text	Early psychosis screening in teens and young adults helps catch overlooked symptoms sooner. James/Adobe Stock Long-acting injectables and generations of antipsychotics are among the choices a patient with schizophrenia may be presented. 1 But even before treatment is needed, screening is essential. Psychiatric Times sat down with Richard Miller, MD, a psychiatrist specializing in community treatment and schizophrenia, to discuss the importance of early psychosis and schizophrenia screening in younger individuals. Psychiatric Times : We know schizophrenia tends to develop earlier in life; can you share why early screening is so important for schizophrenia and psychosis? 2 Richard W. Miller, MD: We meet individuals with undiagnosed schizophrenia in many environments. We see them in the emergency room, we see them in the inpatient units, and I treat them in the outpatient world. And what we are seeing is individuals come in and some are maybe college students having a break, or young adults who have been undiagnosed for a period of time. So, the earlier you screen, the better, because we know that morphologically the brain is going to change. Treatment resistance can happen in as little as 1 or 2 possible stays. And that means, to be effective but cost-effective, you need to have higher doses. And the reality of the situation is the patients wind up spending more time in the hospital. There are times with higher doses of medication, and not to mention the negative outcomes cognitively, financially—you re simply spending more time in the hospital. So the goal is to screen patients, assess them, and treat them. We have a lot of good options for treatment, and we can provide one of those options that is best for that patient. PT : When working with that variety of patients with schizophrenia, is there an aspect of the diagnosis or treatment that you see is often overlooked? Dr Miller: Definitely. There are 3 spectrums—3 symptoms. You have your positive symptoms, which unfortunately get most of the attention: hallucinations, delusions, paranoia. For example, when I go to court and I’m testifying, it is usually because patients are hearing auditory hallucinations about violence, or they had a psychotic episode. That usually means we are seeing paranoia, which can get law enforcement involved or becomes more prominent in terms of getting picked up by police. Negative symptoms are just as significant, but sometimes do not get as much attention. These are symptoms where the patient might not be showering, not eating, demotivated, depressed, maybe with some cognitive functioning delays, which could be due to depression and lack of motivation. Then you have general psychopathology, which is more generalized difficulty functioning, and you see some cognitive problems there as well. Historically, our medications have treated the positive symptoms quite well, and I get that because those are what most commonly get attention in courts and hospitals. But the other symptom clusters, which are just as important, have not been addressed as adequately as we would like over the course of history. So you must treat the whole patient, but understand that positive symptoms are usually what bring them to the hospital. PT : You mentioned treating the whole patient, is there something you find unique about patients with schizophrenia who might have other psychiatric comorbidities? Dr Miller: One of the big problems is the type of patients come in and say, “Well, I can’t concentrate. It’s my ADHD.” That happened to me just yesterday. And I said, “Well, let’s look at this. You have schizophrenia. You’ve been using marijuana to self-medicate anxiety for a period of time.” It has been a constant struggle where the patient has been self-medicating to help anxiety, yet at the same time potentially causing worsening anxiety. So they are having concentration issues, which they are attributing to ADHD, which is not really there. It is more a cognitive processing issue due to schizophrenia. I think trying to explain to the patient that they do not need 3 different psych medications—you need 1 medication to treat the entire cluster of symptoms (inattention, anxiety, and disorganization), which is at the core of your illness. That is sometimes a hard discussion to have. My patient in this examples has decent insight, understands he is ill, and he has done well on medication, but still has residual symptoms and thinks he can go without it. But the reality is these are symptoms consistent with schizophrenia. PT : Similarly, is there a different strategy necessary for working with patients with schizophrenia compared to other disorders? Dr Miller: What I love about this population is the specific challenges we can help them face. This type of illness typically hits between ages 18 and 24, which are formative years; individuals are leaving high school, going to the military, starting serious relationships, getting jobs, living independently. And then they get what I call a gut punch and are essentially unable to move forward. They are paralyzed because their illness has given them an all-stop. Schizophrenia affects development, the ability to work, to go to school. It’s a heartbreaking illness, and you see it percolate into other aspects of their life. Some folks become homeless, they turn to drugs, they get into legal issues. We have great treatment options, and if we screened better and knew who was more likely to develop schizophrenia, patients might have a better chance. If they started treatment earlier, they would have a great chance. When I trained at the University of Michigan, we had a program called MP3, where we screened high school students to see who was more likely at risk. That is a great idea—realizing who is more likely to become ill and creating systems to help them get treatment. If you don’t start treatment early, it does not turn out well. PT : If you could highlight one element, what is most important for clinicians to keep in mind when evaluating patients with psychosis or schizophrenia? Dr Miller: I think this comes back to insight. Some patients with schizophrenia have insight, some do not, and that makes it really hard. If you do not treat the problem, it’s going to get worse, like a snowball, and percolate into other aspects of their lives—socially, legally, financially. Second, we have great treatments out there that are underutilized—long-acting injectables like aripiprazole (Aristada). Only about 10% of patients with schizophrenia are on an LAI, and I’ve been in this field for 15 to 20 years. That’s ridiculously low, when these are great treatments. A colleague once asked me, “Why is it so hard for people with schizophrenia to take their medication?” And I said, “You’ve got to realize, a lot of these individuals don’t believe they’re ill.” It’s based on paranoia, delusions, hallucinations. Someone with diabetes usually knows they have diabetes and what happens if they do not take their insulin. But people with schizophrenia often do not believe they are ill. Understanding that insight is compromised makes a lot of things make sense. The illness spirals if you do not treat it, and it hits at such an early age that it can disrupt a life pretty aggressively. PT: Is there something particular from your community work that has changed the way you view schizophrenia treatment? Dr Miller: Absolutely. LAIs are underutilized. Ten percent of the population is on them, and we have to be more aggressive about getting that number up. LAIs like Aristada are a great option—it’s a monthly or every-2-month maintenance medication to decrease the burden of illness. Patients can be getting meds 6 times a year instead of 365 times a year. That’s incredible. It can be hard to take pills every day, but easier to get an injection a few times a year. It takes 5 or 10 minutes—about an hour a year total. These medications work, and they are underutilized. We have great tools—we just have to use them. And one last thing: when you walk into a hardware store, there’s a reason they sell 50 types of screws, not 1. In the same way, we have many tools to help individuals with schizophrenia. It is not one-size-fits-all. Different medications, different options. LAIs are one of those tools, and they are still underutilized. So again, not one-size-fits-all—we have multiple modalities to give treatment. Dr Miller is the owner of his private practice, Bloom Wellness, a psychiatrist at Elwyn Adult Behavioral Health, and works in inpatient practice in Rhode Island. References 1. Schizophrenia. Mayo Clinic. October 16, 2024. Accessed February 18, 2026. https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449 2. Schizophrenia. National Alliance on Mental Illness. December 2025. Accessed February 18, 2026. https://www.nami.org/types-of-conditions/schizophrenia/ Newsletter Receive trusted psychiatric news, expert analysis, and clinical insights — subscribe today to support your practice and your patients.
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[Artificial Intelligence](https://www.psychiatrictimes.com/topics/artificial-intelligence) Choose Topic Spotlight - [Long-Acting Injectable Therapy in the Management of Adult Patients with Schizophrenia](https://www.psychiatrictimes.com/expert-perspectives/long-acting-injectable-therapy-in-the-management-of-adult-patients-with-schizophrenia?utm_source=website&utm_medium=spotlight&utm_campaign=Schiz_ExpertPersepctive_Feb25)\\| [Major Depressive Disorder](https://www.psychiatrictimes.com/topics/major-depressive-disorder) Advertisement News\\|Articles\\|February 25, 2026 # Early Screening for Schizophrenia and the Opportunity of LAIs Author(s)[Richard W. Miller, MD](https://www.psychiatrictimes.com/authors/richard-w-miller-md), [Jessica Walters](https://www.psychiatrictimes.com/authors/jessica-walters) Listen 0:00 / NaN:NaN ### Key Takeaways - Earlier screening in late adolescence/early adulthood may reduce hospitalization burden, limit progression toward treatment resistance, and improve cognitive and functional outcomes by shortening duration of untreated psychosis. - Symptom assessment should balance positive symptoms with negative symptoms and general psychopathology, given their outsized contribution to long-term impairment despite historically weaker pharmacologic targeting. - Cognitive complaints and anxiety may be misattributed to ADHD or treated via cannabis self-medication, when they reflect schizophrenia-related processing deficits requiring unified, diagnosis-centered pharmacotherapy. - Impaired insight is a central driver of nonadherence and life disruption, necessitating strategies that anticipate illness denial and prevent escalating social, legal, and financial sequelae. - Long-acting injectable antipsychotics (eg, aripiprazole LAI) are used in ~10% of patients despite lowering adherence burden and offering flexible dosing intervals within a personalized, non–one-size-fits-all toolkit. SHOW MORE Early psychosis screening in teens and young adults helps catch overlooked symptoms sooner. Advertisement ![schizophrenia early screening](https://cdn.sanity.io/images/0vv8moc6/psychtimes/5442de3094aaf91ab8653a740b8e08dd5a6a6da1-10940x6132.jpg?w=10940&max-h=6132&fit=crop&auto=format) James/Adobe Stock ![](https://cdn.sanity.io/images/0vv8moc6/psychtimes/5442de3094aaf91ab8653a740b8e08dd5a6a6da1-10940x6132.jpg?fit=crop&auto=format) Long-acting injectables and generations of antipsychotics are among the choices a patient with schizophrenia may be presented.1 But even before treatment is needed, screening is essential. Psychiatric Times sat down with Richard Miller, MD, a psychiatrist specializing in community treatment and schizophrenia, to discuss the importance of early psychosis and schizophrenia screening in younger individuals. **Psychiatric Times: We know schizophrenia tends to develop earlier in life; can you share why early screening is so important for schizophrenia and psychosis?2 Richard W. Miller, MD: We meet individuals with undiagnosed schizophrenia in many environments. We see them in the emergency room, we see them in the inpatient units, and I treat them in the outpatient world. And what we are seeing is individuals come in and some are maybe college students having a break, or young adults who have been undiagnosed for a period of time. So, the earlier you screen, the better, because we know that morphologically the brain is going to change. Treatment resistance can happen in as little as 1 or 2 possible stays. And that means, to be effective but cost-effective, you need to have higher doses. And the reality of the situation is the patients wind up spending more time in the hospital. There are times with higher doses of medication, and not to mention the negative outcomes cognitively, financially—you re simply spending more time in the hospital. So the goal is to screen patients, assess them, and treat them. We have a lot of good options for treatment, and we can provide one of those options that is best for that patient. PT: When working with that variety of patients with schizophrenia, is there an aspect of the diagnosis or treatment that you see is often overlooked? Dr Miller: Definitely. There are 3 spectrums—3 symptoms. You have your positive symptoms, which unfortunately get most of the attention: hallucinations, delusions, paranoia. For example, when I go to court and I’m testifying, it is usually because patients are hearing auditory hallucinations about violence, or they had a psychotic episode. That usually means we are seeing paranoia, which can get law enforcement involved or becomes more prominent in terms of getting picked up by police. Negative symptoms are just as significant, but sometimes do not get as much attention. These are symptoms where the patient might not be showering, not eating, demotivated, depressed, maybe with some cognitive functioning delays, which could be due to depression and lack of motivation. Then you have general psychopathology, which is more generalized difficulty functioning, and you see some cognitive problems there as well. Historically, our medications have treated the positive symptoms quite well, and I get that because those are what most commonly get attention in courts and hospitals. But the other symptom clusters, which are just as important, have not been addressed as adequately as we would like over the course of history. So you must treat the whole patient, but understand that positive symptoms are usually what bring them to the hospital. PT: You mentioned treating the whole patient, is there something you find unique about patients with schizophrenia who might have other psychiatric comorbidities? Dr Miller: One of the big problems is the type of patients come in and say, “Well, I can’t concentrate. It’s my ADHD.” That happened to me just yesterday. And I said, “Well, let’s look at this. You have schizophrenia. You’ve been using marijuana to self-medicate anxiety for a period of time.” It has been a constant struggle where the patient has been self-medicating to help anxiety, yet at the same time potentially causing worsening anxiety. So they are having concentration issues, which they are attributing to ADHD, which is not really there. It is more a cognitive processing issue due to schizophrenia. I think trying to explain to the patient that they do not need 3 different psych medications—you need 1 medication to treat the entire cluster of symptoms (inattention, anxiety, and disorganization), which is at the core of your illness. That is sometimes a hard discussion to have. My patient in this examples has decent insight, understands he is ill, and he has done well on medication, but still has residual symptoms and thinks he can go without it. But the reality is these are symptoms consistent with schizophrenia. PT: Similarly, is there a different strategy necessary for working with patients with schizophrenia compared to other disorders? Dr Miller: What I love about this population is the specific challenges we can help them face. This type of illness typically hits between ages 18 and 24, which are formative years; individuals are leaving high school, going to the military, starting serious relationships, getting jobs, living independently. And then they get what I call a gut punch and are essentially unable to move forward. They are paralyzed because their illness has given them an all-stop. Schizophrenia affects development, the ability to work, to go to school. It’s a heartbreaking illness, and you see it percolate into other aspects of their life. Some folks become homeless, they turn to drugs, they get into legal issues. We have great treatment options, and if we screened better and knew who was more likely to develop schizophrenia, patients might have a better chance. If they started treatment earlier, they would have a great chance. When I trained at the University of Michigan, we had a program called MP3, where we screened high school students to see who was more likely at risk. That is a great idea—realizing who is more likely to become ill and creating systems to help them get treatment. If you don’t start treatment early, it does not turn out well. PT: If you could highlight one element, what is most important for clinicians to keep in mind when evaluating patients with psychosis or schizophrenia? Dr Miller: I think this comes back to insight. Some patients with schizophrenia have insight, some do not, and that makes it really hard. If you do not treat the problem, it’s going to get worse, like a snowball, and percolate into other aspects of their lives—socially, legally, financially. Second, we have great treatments out there that are underutilized—long-acting injectables like aripiprazole (Aristada). Only about 10% of patients with schizophrenia are on an LAI, and I’ve been in this field for 15 to 20 years. That’s ridiculously low, when these are great treatments. A colleague once asked me, “Why is it so hard for people with schizophrenia to take their medication?” And I said, “You’ve got to realize, a lot of these individuals don’t believe they’re ill.” It’s based on paranoia, delusions, hallucinations. Someone with diabetes usually knows they have diabetes and what happens if they do not take their insulin. But people with schizophrenia often do not believe they are ill. Understanding that insight is compromised makes a lot of things make sense. The illness spirals if you do not treat it, and it hits at such an early age that it can disrupt a life pretty aggressively. PT: Is there something particular from your community work that has changed the way you view schizophrenia treatment? Dr Miller: Absolutely. LAIs are underutilized. Ten percent of the population is on them, and we have to be more aggressive about getting that number up. LAIs like Aristada are a great option—it’s a monthly or every-2-month maintenance medication to decrease the burden of illness. > Patients can be getting meds 6 times a year instead of 365 times a year. That’s incredible. It can be hard to take pills every day, but easier to get an injection a few times a year. It takes 5 or 10 minutes—about an hour a year total. These medications work, and they are underutilized. We have great tools—we just have to use them. And one last thing: when you walk into a hardware store, there’s a reason they sell 50 types of screws, not 1. In the same way, we have many tools to help individuals with schizophrenia. It is not one-size-fits-all. Different medications, different options. LAIs are one of those tools, and they are still underutilized. So again, not one-size-fits-all—we have multiple modalities to give treatment. Dr Miller** is the owner of his private practice, Bloom Wellness, a psychiatrist at Elwyn Adult Behavioral Health, and works in inpatient practice in Rhode Island. References 1\. Schizophrenia. Mayo Clinic. October 16, 2024. Accessed February 18, 2026. <https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449> 2\. Schizophrenia. National Alliance on Mental Illness. December 2025. Accessed February 18, 2026. <https://www.nami.org/types-of-conditions/schizophrenia/> ### Newsletter Receive trusted psychiatric news, expert analysis, and clinical insights — subscribe today to support your practice and your patients. 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Readable Markdown	Early psychosis screening in teens and young adults helps catch overlooked symptoms sooner. ![schizophrenia early screening](https://cdn.sanity.io/images/0vv8moc6/psychtimes/5442de3094aaf91ab8653a740b8e08dd5a6a6da1-10940x6132.jpg?w=10940&max-h=6132&fit=crop&auto=format) James/Adobe Stock ![](https://cdn.sanity.io/images/0vv8moc6/psychtimes/5442de3094aaf91ab8653a740b8e08dd5a6a6da1-10940x6132.jpg?fit=crop&auto=format) Long-acting injectables and generations of antipsychotics are among the choices a patient with schizophrenia may be presented.1 But even before treatment is needed, screening is essential. Psychiatric Times sat down with Richard Miller, MD, a psychiatrist specializing in community treatment and schizophrenia, to discuss the importance of early psychosis and schizophrenia screening in younger individuals. **Psychiatric Times: We know schizophrenia tends to develop earlier in life; can you share why early screening is so important for schizophrenia and psychosis?2 Richard W. Miller, MD: We meet individuals with undiagnosed schizophrenia in many environments. We see them in the emergency room, we see them in the inpatient units, and I treat them in the outpatient world. And what we are seeing is individuals come in and some are maybe college students having a break, or young adults who have been undiagnosed for a period of time. So, the earlier you screen, the better, because we know that morphologically the brain is going to change. Treatment resistance can happen in as little as 1 or 2 possible stays. And that means, to be effective but cost-effective, you need to have higher doses. And the reality of the situation is the patients wind up spending more time in the hospital. There are times with higher doses of medication, and not to mention the negative outcomes cognitively, financially—you re simply spending more time in the hospital. So the goal is to screen patients, assess them, and treat them. We have a lot of good options for treatment, and we can provide one of those options that is best for that patient. PT: When working with that variety of patients with schizophrenia, is there an aspect of the diagnosis or treatment that you see is often overlooked? Dr Miller: Definitely. There are 3 spectrums—3 symptoms. You have your positive symptoms, which unfortunately get most of the attention: hallucinations, delusions, paranoia. For example, when I go to court and I’m testifying, it is usually because patients are hearing auditory hallucinations about violence, or they had a psychotic episode. That usually means we are seeing paranoia, which can get law enforcement involved or becomes more prominent in terms of getting picked up by police. Negative symptoms are just as significant, but sometimes do not get as much attention. These are symptoms where the patient might not be showering, not eating, demotivated, depressed, maybe with some cognitive functioning delays, which could be due to depression and lack of motivation. Then you have general psychopathology, which is more generalized difficulty functioning, and you see some cognitive problems there as well. Historically, our medications have treated the positive symptoms quite well, and I get that because those are what most commonly get attention in courts and hospitals. But the other symptom clusters, which are just as important, have not been addressed as adequately as we would like over the course of history. So you must treat the whole patient, but understand that positive symptoms are usually what bring them to the hospital. PT: You mentioned treating the whole patient, is there something you find unique about patients with schizophrenia who might have other psychiatric comorbidities? Dr Miller: One of the big problems is the type of patients come in and say, “Well, I can’t concentrate. It’s my ADHD.” That happened to me just yesterday. And I said, “Well, let’s look at this. You have schizophrenia. You’ve been using marijuana to self-medicate anxiety for a period of time.” It has been a constant struggle where the patient has been self-medicating to help anxiety, yet at the same time potentially causing worsening anxiety. So they are having concentration issues, which they are attributing to ADHD, which is not really there. It is more a cognitive processing issue due to schizophrenia. I think trying to explain to the patient that they do not need 3 different psych medications—you need 1 medication to treat the entire cluster of symptoms (inattention, anxiety, and disorganization), which is at the core of your illness. That is sometimes a hard discussion to have. My patient in this examples has decent insight, understands he is ill, and he has done well on medication, but still has residual symptoms and thinks he can go without it. But the reality is these are symptoms consistent with schizophrenia. PT: Similarly, is there a different strategy necessary for working with patients with schizophrenia compared to other disorders? Dr Miller: What I love about this population is the specific challenges we can help them face. This type of illness typically hits between ages 18 and 24, which are formative years; individuals are leaving high school, going to the military, starting serious relationships, getting jobs, living independently. And then they get what I call a gut punch and are essentially unable to move forward. They are paralyzed because their illness has given them an all-stop. Schizophrenia affects development, the ability to work, to go to school. It’s a heartbreaking illness, and you see it percolate into other aspects of their life. Some folks become homeless, they turn to drugs, they get into legal issues. We have great treatment options, and if we screened better and knew who was more likely to develop schizophrenia, patients might have a better chance. If they started treatment earlier, they would have a great chance. When I trained at the University of Michigan, we had a program called MP3, where we screened high school students to see who was more likely at risk. That is a great idea—realizing who is more likely to become ill and creating systems to help them get treatment. If you don’t start treatment early, it does not turn out well. PT: If you could highlight one element, what is most important for clinicians to keep in mind when evaluating patients with psychosis or schizophrenia? Dr Miller: I think this comes back to insight. Some patients with schizophrenia have insight, some do not, and that makes it really hard. If you do not treat the problem, it’s going to get worse, like a snowball, and percolate into other aspects of their lives—socially, legally, financially. Second, we have great treatments out there that are underutilized—long-acting injectables like aripiprazole (Aristada). Only about 10% of patients with schizophrenia are on an LAI, and I’ve been in this field for 15 to 20 years. That’s ridiculously low, when these are great treatments. A colleague once asked me, “Why is it so hard for people with schizophrenia to take their medication?” And I said, “You’ve got to realize, a lot of these individuals don’t believe they’re ill.” It’s based on paranoia, delusions, hallucinations. Someone with diabetes usually knows they have diabetes and what happens if they do not take their insulin. But people with schizophrenia often do not believe they are ill. Understanding that insight is compromised makes a lot of things make sense. The illness spirals if you do not treat it, and it hits at such an early age that it can disrupt a life pretty aggressively. PT: Is there something particular from your community work that has changed the way you view schizophrenia treatment? Dr Miller: Absolutely. LAIs are underutilized. Ten percent of the population is on them, and we have to be more aggressive about getting that number up. LAIs like Aristada are a great option—it’s a monthly or every-2-month maintenance medication to decrease the burden of illness. > Patients can be getting meds 6 times a year instead of 365 times a year. That’s incredible. It can be hard to take pills every day, but easier to get an injection a few times a year. It takes 5 or 10 minutes—about an hour a year total. These medications work, and they are underutilized. We have great tools—we just have to use them. And one last thing: when you walk into a hardware store, there’s a reason they sell 50 types of screws, not 1. In the same way, we have many tools to help individuals with schizophrenia. It is not one-size-fits-all. Different medications, different options. LAIs are one of those tools, and they are still underutilized. So again, not one-size-fits-all—we have multiple modalities to give treatment. Dr Miller** is the owner of his private practice, Bloom Wellness, a psychiatrist at Elwyn Adult Behavioral Health, and works in inpatient practice in Rhode Island. References 1\. Schizophrenia. Mayo Clinic. October 16, 2024. Accessed February 18, 2026. <https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449> 2\. Schizophrenia. National Alliance on Mental Illness. December 2025. Accessed February 18, 2026. <https://www.nami.org/types-of-conditions/schizophrenia/> ### Newsletter Receive trusted psychiatric news, expert analysis, and clinical insights — subscribe today to support your practice and your patients.
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