Study reveals struggles precede psychosis risk by years, suggesting prevention opportunities

A groundbreaking international study of over 1,000 adolescents and young adults at risk for psychosis has found that social and academic difficulties emerge years before clinical symptoms appear, offering a critical window for early intervention.

Psychosis, a symptom of mental illness, refers to a mental state when one loses touch with reality and can involve hallucinations, delusions or difficulty deciphering reality.

This study is one of the first papers to analyze data from the Accelerating Medicines Partnership Schizophrenia project, which was the largest and most diverse international study of psychosis risk to date.

Led by Assistant Professor Henry Cowan, Michigan State University researchers worked closely with an international consortium at 43 international sites to recruit participants from 13 countries. Researchers completed clinical interviews, cognitive testing and symptom assessments.

The study found that functional decline and negative symptoms appear to develop well before psychosis-risk syndromes are identified. Early-life social and academic struggles strongly predicted later negative symptoms and cognitive impairment.

Negative symptoms, especially deficits in motivation and pleasure, were the clearest markers of longstanding functional problems, even when controlling for depression and anxiety. These patterns were consistent across early- and late-symptom onset.

However, researchers also found that reduced attenuated psychotic symptoms — low-level hallucinations or delusions that appear prior to a first true psychotic episode — had no relationship to functioning levels before psychosis-risk symptoms emerged.

“Psychotic disorders are highly disabling, and outcomes remain poor for many individuals. This study shows that by the time psychosis-risk symptoms appear, years of functional deterioration may already have occurred,” said Cowan, co-author of the study and a professor at MSU’s Department of Psychology. “Early social and academic problems are an important developmental signal appearing in critical developmental periods, years before actual clinical symptoms emerge.”

This study underscores the need for clinicians to recognize and address social and academic challenges during critical developmental periods.

“We hope this work encourages clinicians and researchers to look earlier and broader when identifying risk for serious mental illness,” Cowan said. “Rather than focusing narrowly on psychotic symptoms, the findings support early intervention strategies targeting developmental issues with motivation, social engagement and cognitive functioning, which may be more closely tied to long-term outcomes.”