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This patient had 2 episodes of Bipolar 1 mania, followed by a 20\u2010year period of psychotic depression. From ages 35\u201048, she manifested severe, paranoid schizophrenia with marked functional decline. She became refractory to antipsychotic drugs, including oral risperidone and clozapine. At age 48, while participating in a double\u2010blind, 6\u2010month clinical trial of long\u2010acting injectable risperidone (Consta\u00ae, 100\u00a0mg <jats:styled-content style=\"fixed-case\">IM<\/jats:styled-content> biweekly) for treatment\u2010resistant schizophrenia, at week 23, upon awakening, complete disappearance of psychosis and marked improvement in function was noted, which persisted until the present (approximately 7\u00a0years). Remarkably, cognitive test performance in most domains improved beginning at 6\u00a0weeks and reached normal levels in executive function, despite minimal improvement in psychosis until week 23. <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> studies before and after remission revealed unique and substantial increases in gray matter of the cingulate and parietal cortex, and subthalamic nucleus, not seen in other patients in this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The 3 discrete periods of psychopathology support the diagnosis of <jats:styled-content style=\"fixed-case\">PSD<\/jats:styled-content>. The unusual course and outcome, including remarkable improvement, in executive function and enhanced cortical gray matter in selective brain regions may have been the result of unique endogenous genetic and epigenetic factors and effect of medication.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cns.12986","type":"journal-article","created":{"date-parts":[[2018,6,15]],"date-time":"2018-06-15T16:22:32Z","timestamp":1529079752000},"page":"641-651","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A within\u2010subject consideration of the psychotic spectrum disorder concept in a patient in remission associated with cortical gray matter recovery"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4901-8845","authenticated-orcid":false,"given":"Herbert Y.","family":"Meltzer","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Northwestern University 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