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I read with interest the excellent study reported by Zipursky et al¹ in the June 1998 issue of the ARCHIVES. However, I would like to focus on one aspect that could be misinterpreted. The fact that they find reduced gray matter in "first episode psychosis" does not mean that this structural deviance is neurodevelopmental and due to a fixed lesion early in life. "First episode" does not mean "at the onset" but only that there has been no previous recovery and then subsequent exacerbation of symptoms. Illness duration prior to the magnetic resonance imaging scan in the Zipursky et al study is stated as being between 0.04 and 15 years. Thus, it could be that brain change has been occurring over time, reducing gray matter during the course of illness subsequent to its onset and prior to the scan. Some evidence for this now comes from many recent studies.^2-5

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