Byline: MAM. Khan Understanding of Psychosis went through many developmental phases. Take for instance Schizophrenia. A breakaway came from the conventional thinking on Kraepilian after 100 years. Dementia Precox became to be known as schizophrenia and with further observations, four sub- types, Paranoid, Simple, Catatonic and Hebephrenia were described. Another promising land-mark study was known as Camberwel family study where three types of expressed emotions- Hostility, Critical and over-involvement were supposed to cause relapses in all psychiatric disorders. There was a study described in The Singapore Medical Journal way back in 1996 /37, 82-85 by Azhar M & Verma S.L entitled Relationship of Expressed Emotion with relapse of schizophrenia patients in Kelantan. In our culture , we know that in a joint family setting negative emotions can be very damaging. It seems to have lost its relevance in western culture. Now Expressed emotions do not find a place even in modern psychiatry text books. Through the study of expressed emotions, domain of negative symptoms emerged in full bloom. Initially it was thought that negative symptoms could be due to the use of anti-psychotics. Later came the development of good phenomenology by the revised versions of DSM. The use of measuring scales like PANSS and others, improved the understanding of the symptom domains. Negative state got further clarified into emotions and intellect. Finally Cognition has emerged as a fundamental process, heralding early psychosis. To-day, dysfunction of cognition is understood as a part of the disease process itself and forms a major component of Schizophrenic illness. This has now become a hall mark of Schizophrenia and many other symptoms are being understood in the context of cognitive impairment like disordered types of thinking, perception and insight. I feel that in Indian context , decline in cognitive faculties can be noticed in very early stages like complaints from the teachers. As diseases in general are getting recognized and clinically staged in early stages, there is a tendency in psychiatry too to stage them in terms of their progression. This has certainly been happening in the field of Schizophrenia. The pioneers in the field have been Australian Psychiatrists, who were advocating early treatment of Schizophrenia.. Tuck Schulz from Minnesota presented large data of teenager schizophrenics below the age of 18 who were put on anti-psychotics. He presented these findings in the American Psychiatric Association meeting in Washington in 2008. Such a study has been last done in 70s. There is convincing evidence that early intervention does halt the disease progression. From then on tremendous advancements have been taking place in the recognition of Early Psychosis particularly in Schizophrenia. More recently for the first time, early stages of Bi-polar disorder is also described.. Refer to RAP study by Barbara Cornblat in Long Island, New York (Paper presented in APA 2008). RAP stands for Recognition and Prevention. Against this background of massive Western experience and literature, I wish to understand it in the Indian context. Do our patients too behave in the same way and exhibit the same symptom profile? Patho-Physiology is universal but symptom profile do differ because of our culture. In this connection the seminal work of Patrick McGorry of University of Melbourne, cannot be underestimated and his work has certainly inspired me to take interest in this new area of development, which I feel is neglected in India. I must mention Hafner of Germany who in 2005 showed that the prodrome of Schizophrenia was indistinguishable from that of major depression in its early stages. Negative and Symptoms have also been described in prodromes. Way back in 1997, Kloster Kokker had mentioned that basic symptoms in early psychosis, refer to subjectively experienced abnormalities in the realms of cognition, attention, perception and movement and are thought by many to be important precursors of schizophrenia. …