Rob’s World: Evolving Psychosis and the Transition to College

  • Daniel KirschEmail author
  • Ashley Holland


Schizophrenia spectrum disorders are serious, chronic mental disorders characterized by psychotic symptoms, cognitive decline, and social withdrawal. Onset of psychotic symptoms peaks in the college age youth, but attenuated symptoms often begin a decade earlier. Accurately identifying which at-risk youth will develop schizophrenia and knowing when to initiate early treatment remain vexing problems. Planning and orchestrating the transition to college for high school students who exhibit symptoms of the at-risk mental state (ARMS) but have not yet had full onset of the disorder can be extraordinarily complex. This chapter describes a young man who developed symptoms of anxiety when he transitioned from middle school to high school, had symptoms of the ARMS in high school, and developed schizophrenia in his second semester of college that required he leave college. It traces the development of his illness and his treatment from social anxiety to brief psychotic symptoms, to severe psychosis. It illustrates a treatment approach that emphasized shared decision making (SDM), engagement, and respect, and how this frame was extended to transition planning. This young man made the transition to college well, but had an acute psychotic episode in his second semester from which he has not fully recovered.


Schizophrenia in college Schizophrenia prodrome At-risk mental state Shared decision making Psychosis Evolving psychosis Cognition in schizophrenia Youth mental health Psychosis in transition age youth 


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of Massachusetts School of MedicineWorcesterUSA
  2. 2.Department of Child PsychiatryUniversity of Massachusetts Medical CenterWorcesterUSA

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