Answered by E. Fuller Torrey, M.D.:
For someone who has had schizophrenia for many years, an MRI is not indicated unless the person develops new neurological symptoms. However, for a person being diagnosed with schizophrenia for the first time, I believe that an MRI should be done to rule out other diseases that may cause symptoms similar to those of schizophrenia. Diseases that mimic schizophrenia and that may be detected by MRI scans include brain tumors, Huntington's disease, Wilson's disease, metachromatic leukodystrophy, sarcoidosis, subdural hematomas, Kuf's disease, viral encephalitis, and aqueductal stenosis.
Regarding the treatment of hallucinations and delusions, we now have a wide variety of less expensive, first-generation (e.g., fluphenzaine, thiothixene, haloperidol) and more expensive second-generation (e.g., clozapine, olanzapine, risperidone) anti-psychotic medication. For most people, these medications will markedly reduce or even abolish hallucinations and delusions. Unfortunately, we do not yet have any way of predicting which individual will respond to which medication, so we medicate by trial and error. A detailed description of these medications, including their side effects, can be found in my book, Surviving Schizophrenia, 4th edition.