The psychosis continuum: Systematic review on prodromal markers, symptom progression, and early intervention strategies.
Level 2 - randomized trial
Systematic review synthesizing mixed study designs (mostly prospective cohorts and RCTs)
PubMed 41109117 · doi:10.1016/j.ajp.2025.104725
What was done
A systematic review following PRISMA guidelines analyzing 60 studies (2000–2025) on prodromal psychosis markers, progression trajectories, and early interventions. The included literature consisted of 35 prospective cohort studies (58.3%), 9 randomized controlled trials (15.0%), 9 cross-sectional studies (15.0%), 5 case-control studies (8.3%), and 2 qualitative studies (3.3%).
What was found
Initial prodromal manifestations were predominantly non-specific: depression (52%), worry (41%), and anxiety (38%). Negative symptoms preceded positive symptoms by 12 months, showing persistent (35%), fluctuating (42%), or improving (23%) trajectories. Machine learning prediction achieved 77.6% accuracy for eye-tracking and AUC=0.84 for multimodal assessment. Childhood trauma affected 61% of ultra-high-risk individuals, while cannabis use conferred a 4-fold increase in transition risk (10-fold with genetic vulnerability). Cognitive-behavioral interventions demonstrated an NNT of 5, and omega-3 supplementation was associated with lower transition rates (4.9% vs. 27.5% in controls).
Why it matters
This review integrates phenomenological, neurobiological, and clinical trial data to support expanding clinical care from simple transition prevention toward stage-specific, multi-modal interventions that also address functioning and quality of life.
Limits
The review aggregates highly heterogeneous study designs ranging from qualitative research to randomized trials. The abstract does not provide total participant sample counts, confidence intervals, or formal risk-of-bias assessments.
Cited by
- supports Schizophrenia is typically preceded by mood disorders like depression and anxiety.