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Vadym Terelyuk/Getty Images The earliest signs of schizophrenia aren’t subtle. People may start hearing voices in their head, or becoming suspicious of others. They may feel like they’re being followed or wonder if a chip has been implanted in their brain. These symptoms are troubling, but on their own, they don’t necessarily mean someone has schizophrenia. Not yet. Advertisement Article continues below this ad Now teams of doctors around the world, including a squadron at UCSF, are studying individuals with these early signs of illness to determine who will go on to develop schizophrenia, and if there may be ways to intervene early and lessen the severity of disease or stop it entirely. “We know people don’t generally wake up in full psychosis having no symptoms the day before,” said Dr. Daniel Mathalon, a psychiatrist who runs the UCSF Path Program for Early Psychosis. “If we can identify people before psychosis develops, that could help us alter the course of disease or even prevent it.” Mathalon studies people with what’s known as high-risk syndrome for schizophrenia. These are individuals who may be hearing voices or feeling like someone is watching them, but they don’t yet believe those voices or feelings. In other words, a voice may be telling them that the government is out to get them, but they aren’t convinced it’s true. San Francisco Chronicle Logo ### See more S.F. Chronicle on Google Make us a Preferred Source to get more of our news when you search. [Add Preferred Source](https://www.google.com/preferences/source?q=sfchronicle.com) In many cases, individuals experiencing these symptoms are scared and confused. Some may be fearful of developing full-blown psychosis, in which they can’t tell what’s real and what’s not. Advertisement Article continues below this ad Schizophrenia has long been perceived as a devastating mental illness that can ruin young lives and cause decades of heartache. It is a brain disorder marked by delusions, hallucinations and disorganized speech and thinking. With medication, those symptoms can be well managed, but some people with schizophrenia struggle to access or stay on treatment and have trouble holding a job or managing personal relationships. They may face repeated episodes of homelessness and psychiatric hospitalizations. About 1% of the total population will develop schizophrenia, but that rate is much higher for those experiencing the high-risk syndrome. Among the high-risk group, about 25% will develop schizophrenia, most of them in the first year or two after reporting symptoms. But 75% of people with those concerning symptoms will not develop schizophrenia or full-blown psychosis. And for all individuals in the high-risk category, early treatment — including therapy and anti-anxiety or anti-depressant drugs — can improve symptoms. Doctors don’t give anti-psychotic drugs to patients in the high-risk category because they can have bad side effects and there is no evidence that those medications prevent schizophrenia. But for patients who do develop schizophrenia, getting them started right away on anti-psychotics can improve their long-term outcome. That’s another reason for them to seek care before psychosis develops, so patients already are connected to all the services they will need. Advertisement Article continues below this ad “Visually what we all typically see day to day, as far as schizophrenia, are the people struggling the most, on the street,” said Dr. Jacob Ballon, a psychiatrist who is co-director of Stanford’s INSPIRE Clinic for people experiencing psychosis. But he has patients who work full time and are married in addition to those with major lifestyle struggles. “I’m often cognizant of the fact that when I tell too many positive stories, that’s not everyone’s experience. I want to face the wide range of outcomes,” Ballon said. “But there’s room for optimism. There are things that can be done and there are positive outcomes. I think operating from a place of hope offers that possibility.” Research into the high-risk syndrome began in Australia, Mathalon said, where care providers began interviewing people with schizophrenia about what was going on in their lives in the period just before their first psychotic episode. Those patients described hearing voices or having unsettling beliefs, but also feeling confused or mistrustful of what they were experiencing. In many cases, they also had started having trouble in school or holding a job, or begun to withdraw from friends and family and isolate themselves. More recently, scientists have started to look for biomarkers, biological cues such as something in the blood or on a brain scan, that are associated with schizophrenia. Just this month, Northwestern University [announced it had found a new biomarker](https://news.northwestern.edu/stories/2026/03/schizophrenia-study-finds-new-biomarker-drug-candidate-to-treat-cognitive-symptoms) in the spinal fluid of people with schizophrenia. Advertisement Article continues below this ad Mathalon has identified abnormal brain activity related to schizophrenia. He found that when most people hear a certain sound over headphones, a specific brain wave will appear 300 milliseconds later. High-risk patients who will develop schizophrenia tend to have less electrical activity when hearing this sound than those patients who will not develop schizophrenia. Studying those patients and the biomarkers is important for two reasons: It could help doctors determine which high-risk patients will develop schizophrenia and allow them to start antipsychotic medications earlier. It also could help scientists study other potential drugs for treatment of schizophrenia. One of the main battles care providers still face in treating schizophrenia is the shame and fear associated with the condition. Many people believe that having schizophrenia will ruin their chances at a fulfilling and successful life. Patty Evans developed schizophrenia in her 20s, though she recalls having some symptoms in her teens, when she began hearing voices. She was too afraid to tell her parents, so she went off to school and even studied abroad before the psychosis fully hit. For a year or two it felt like her life derailed, Evans said. She was depressed and suicidal. She couldn’t hold a job. The voices were so loud in her head that she would sometimes just stop what she was doing to listen. At night, she would write long essays to herself that made no sense. Advertisement Article continues below this ad But eventually she got on medication and it helped her stabilize. Evans went back to school and became a computer programmer, a job she held for 40 years. She’s 73 now and essentially symptom-free. Though schizophrenia was not an easy condition to manage, she wants people to know that it doesn’t have to be the end of their world. She regularly shares her story on behalf of NAMI San Francisco — the National Alliance on Mental Illness — to help challenge the stigma of schizophrenia. “I’m really doing well,” she said recently, taking a break from gardening in her San Francisco yard. “I had some ups and downs. It was hard, but I managed to get through my whole career and retire. Now I’m on one psychoactive drug, and that’s all I need.” She added that even people who still struggle with their psychosis can have full lives. One woman she knows well is studying to become a therapist. Another man takes care of his elderly mother full-time. “He still hears voices, but he is the most kind, kind person,” she said. “He’s absolutely joyful when he’s with people that like him.” March 22, 2026 ![Photo of Erin Allday]() [Erin Allday](https://www.sfchronicle.com/author/erin-allday/) Staff Writer Erin Allday covers gender and sexuality for the Chronicle. Previously, she was a longtime health writer with a focus on covering infectious diseases, including HIV/AIDS and the COVID pandemic. A Southern California native, Erin has lived in the Bay Area since graduating UC Berkeley. She joined the Chronicle in 2006. Most Popular 1\. 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![Scientists studying schizophrenia have started to look for biomarkers — biological cues such as something in the blood or on a brain scan — that are associated with the disorder.]() Scientists studying schizophrenia have started to look for biomarkers — biological cues such as something in the blood or on a brain scan — that are associated with the disorder. Vadym Terelyuk/Getty Images The earliest signs of schizophrenia aren’t subtle. People may start hearing voices in their head, or becoming suspicious of others. They may feel like they’re being followed or wonder if a chip has been implanted in their brain. These symptoms are troubling, but on their own, they don’t necessarily mean someone has schizophrenia. Not yet. Article continues below this ad Now teams of doctors around the world, including a squadron at UCSF, are studying individuals with these early signs of illness to determine who will go on to develop schizophrenia, and if there may be ways to intervene early and lessen the severity of disease or stop it entirely. “We know people don’t generally wake up in full psychosis having no symptoms the day before,” said Dr. Daniel Mathalon, a psychiatrist who runs the UCSF Path Program for Early Psychosis. “If we can identify people before psychosis develops, that could help us alter the course of disease or even prevent it.” Mathalon studies people with what’s known as high-risk syndrome for schizophrenia. These are individuals who may be hearing voices or feeling like someone is watching them, but they don’t yet believe those voices or feelings. In other words, a voice may be telling them that the government is out to get them, but they aren’t convinced it’s true. San Francisco Chronicle Logo Make us a Preferred Source to get more of our news when you search. [Add Preferred Source](https://www.google.com/preferences/source?q=sfchronicle.com) In many cases, individuals experiencing these symptoms are scared and confused. Some may be fearful of developing full-blown psychosis, in which they can’t tell what’s real and what’s not. Article continues below this ad Schizophrenia has long been perceived as a devastating mental illness that can ruin young lives and cause decades of heartache. It is a brain disorder marked by delusions, hallucinations and disorganized speech and thinking. With medication, those symptoms can be well managed, but some people with schizophrenia struggle to access or stay on treatment and have trouble holding a job or managing personal relationships. They may face repeated episodes of homelessness and psychiatric hospitalizations. About 1% of the total population will develop schizophrenia, but that rate is much higher for those experiencing the high-risk syndrome. Among the high-risk group, about 25% will develop schizophrenia, most of them in the first year or two after reporting symptoms. But 75% of people with those concerning symptoms will not develop schizophrenia or full-blown psychosis. And for all individuals in the high-risk category, early treatment — including therapy and anti-anxiety or anti-depressant drugs — can improve symptoms. Doctors don’t give anti-psychotic drugs to patients in the high-risk category because they can have bad side effects and there is no evidence that those medications prevent schizophrenia. But for patients who do develop schizophrenia, getting them started right away on anti-psychotics can improve their long-term outcome. That’s another reason for them to seek care before psychosis develops, so patients already are connected to all the services they will need. Article continues below this ad “Visually what we all typically see day to day, as far as schizophrenia, are the people struggling the most, on the street,” said Dr. Jacob Ballon, a psychiatrist who is co-director of Stanford’s INSPIRE Clinic for people experiencing psychosis. But he has patients who work full time and are married in addition to those with major lifestyle struggles. “I’m often cognizant of the fact that when I tell too many positive stories, that’s not everyone’s experience. I want to face the wide range of outcomes,” Ballon said. “But there’s room for optimism. There are things that can be done and there are positive outcomes. I think operating from a place of hope offers that possibility.” Research into the high-risk syndrome began in Australia, Mathalon said, where care providers began interviewing people with schizophrenia about what was going on in their lives in the period just before their first psychotic episode. Those patients described hearing voices or having unsettling beliefs, but also feeling confused or mistrustful of what they were experiencing. In many cases, they also had started having trouble in school or holding a job, or begun to withdraw from friends and family and isolate themselves. More recently, scientists have started to look for biomarkers, biological cues such as something in the blood or on a brain scan, that are associated with schizophrenia. Just this month, Northwestern University [announced it had found a new biomarker](https://news.northwestern.edu/stories/2026/03/schizophrenia-study-finds-new-biomarker-drug-candidate-to-treat-cognitive-symptoms) in the spinal fluid of people with schizophrenia. Article continues below this ad Mathalon has identified abnormal brain activity related to schizophrenia. He found that when most people hear a certain sound over headphones, a specific brain wave will appear 300 milliseconds later. High-risk patients who will develop schizophrenia tend to have less electrical activity when hearing this sound than those patients who will not develop schizophrenia. Studying those patients and the biomarkers is important for two reasons: It could help doctors determine which high-risk patients will develop schizophrenia and allow them to start antipsychotic medications earlier. It also could help scientists study other potential drugs for treatment of schizophrenia. One of the main battles care providers still face in treating schizophrenia is the shame and fear associated with the condition. Many people believe that having schizophrenia will ruin their chances at a fulfilling and successful life. Patty Evans developed schizophrenia in her 20s, though she recalls having some symptoms in her teens, when she began hearing voices. She was too afraid to tell her parents, so she went off to school and even studied abroad before the psychosis fully hit. For a year or two it felt like her life derailed, Evans said. She was depressed and suicidal. She couldn’t hold a job. The voices were so loud in her head that she would sometimes just stop what she was doing to listen. At night, she would write long essays to herself that made no sense. Article continues below this ad But eventually she got on medication and it helped her stabilize. Evans went back to school and became a computer programmer, a job she held for 40 years. She’s 73 now and essentially symptom-free. Though schizophrenia was not an easy condition to manage, she wants people to know that it doesn’t have to be the end of their world. She regularly shares her story on behalf of NAMI San Francisco — the National Alliance on Mental Illness — to help challenge the stigma of schizophrenia. “I’m really doing well,” she said recently, taking a break from gardening in her San Francisco yard. “I had some ups and downs. It was hard, but I managed to get through my whole career and retire. Now I’m on one psychoactive drug, and that’s all I need.” She added that even people who still struggle with their psychosis can have full lives. One woman she knows well is studying to become a therapist. Another man takes care of his elderly mother full-time. “He still hears voices, but he is the most kind, kind person,” she said. “He’s absolutely joyful when he’s with people that like him.” March 22, 2026 ![Photo of Erin Allday]() Staff Writer Erin Allday covers gender and sexuality for the Chronicle. Previously, she was a longtime health writer with a focus on covering infectious diseases, including HIV/AIDS and the COVID pandemic. A Southern California native, Erin has lived in the Bay Area since graduating UC Berkeley. She joined the Chronicle in 2006.