Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Systematic Review
  • Published:

On the proportion of patients who experience a prodrome prior to psychosis onset: A systematic review and meta-analysis

Molecular Psychiatry (2024)Cite this article

Subjects

A Correction to this article was published on 14 February 2024

This article has been updated

Abstract

Background

Preventing or delaying the onset of psychosis requires identification of those at risk for developing psychosis. For predictive purposes, the prodrome – a constellation of symptoms which may occur before the onset of psychosis – has been increasingly recognized as having utility. However, it is unclear what proportion of patients experience a prodrome or how this varies based on the multiple definitions used.

Methods

We conducted a systematic review and meta-analysis of studies of patients with psychosis with the objective of determining the proportion of patients who experienced a prodrome prior to psychosis onset. Inclusion criteria included a consistent prodrome definition and reporting the proportion of patients who experienced a prodrome. We excluded studies of only patients with a prodrome or solely substance-induced psychosis, qualitative studies without prevalence data, conference abstracts, and case reports/case series. We searched Ovid MEDLINE, Embase (Ovid), APA PsycInfo (Ovid), Web of Science Core Collection (Clarivate), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, APA PsycBooks (Ovid), ProQuest Dissertation & Thesis, on March 3, 2021. Studies were assessed for quality using the Critical Appraisal Checklist for Prevalence Studies. Narrative synthesis and proportion meta-analysis were used to estimate prodrome prevalence. I2 and predictive interval were used to assess heterogeneity. Subgroup analyses were used to probe sources of heterogeneity. (PROSPERO ID: CRD42021239797).

Results

Seventy-one articles were included, representing 13,774 patients. Studies varied significantly in terms of methodology and prodrome definition used. The random effects proportion meta-analysis estimate for prodrome prevalence was 78.3% (95% CI = 72.8–83.2); heterogeneity was high (I2 97.98% [95% CI = 97.71–98.22]); and the prediction interval was wide (95% PI = 0.411–0.936). There were no meaningful differences in prevalence between grouped prodrome definitions, and subgroup analyses failed to reveal a consistent source of heterogeneity.

Conclusions

This is the first meta-analysis on the prevalence of a prodrome prior to the onset of first episode psychosis. The majority of patients (78.3%) were found to have experienced a prodrome prior to psychosis onset. However, findings are highly heterogenous across study and no definitive source of heterogeneity was found despite extensive subgroup analyses. As most studies were retrospective in nature, recall bias likely affects these results. While the large majority of patients with psychosis experience a prodrome in some form, it is unclear if the remainder of patients experience no prodrome, or if ascertainment methods employed in the studies were not sensitive to their experiences. Given widespread investment in indicated prevention of psychosis through prospective identification and intervention during the prodrome, a resolution of this question as well as a consensus definition of the prodrome is much needed in order to effectively direct and organize services, and may be accomplished through novel, densely sampled and phenotyped prospective cohort studies that aim for representative sampling across multiple settings.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Prisma diagram for the systematic review.
Fig. 2: Forest plot for all studies.
Fig. 3: Funnel plot for all studies.

Similar content being viewed by others

Data availability

Analyses were carried out using commercially available software. Data required to reproduce analyses are included in Tables 1 and 2.

Code availability

Analyses were carried out using commercially available software. Data required to reproduce analyses are included in Tables 1 and 2.

Change history

References (References marked with an asterisk indicate studies included in the meta-analysis)

  1. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2:e141 https://doi.org/10.1371/journal.pmed.0020141.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Salazar de Pablo G, Estrade Vaz A, Cutroni M, Andlauer O, Fusar-Poli P. Establishing a clinical service to prevent psychosis: What, how and when? Systematic review. Transl Psychiatry. 2021;11:43. https://doi.org/10.1038/s41398-020-01165-x.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Wu EQ, Shi L, Birnbaum H, Hudson T, Kessler R. Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach. Psychol Med. 2006;36:1535–40. https://doi.org/10.1017/S0033291706008191.

    Article  PubMed  Google Scholar 

  4. Desai PR, Lawson KA, Barner JC, Rascati KL. Estimating the direct and indirect costs for community-dwelling patients with schizophrenia. J Pharm Health Serv Res. 2013;4:187–94. https://doi.org/10.1111/jphs.12027/epdf.

    Article  Google Scholar 

  5. Kessler RC, Birnbaum H, Demler O, Falloon IR, Gagnon E, Guyer M. et al. The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). Biol Psychiatry. 2005;58:668–76. https://doi.org/10.1016/j.biopsych.2005.04.034.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Moreno-Küstner B, Martín C, Pastor L. Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PloS ONE. 2018;13:e0195687 https://doi.org/10.1371/journal.pone.0195687.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Häfner H. Prodrome, onset and early course of schizophrenia. In Murray RM, Jones PB, Susser E, van Os J, & Cannon M. editors. The epidemiology of schizophrenia. Cambridge University Press. 2003. pp. 124–47. https://doi.org/10.1002/9780470987353.ch8.

  8. Häfner H, Löffler W, Maurer K, Hambrecht M, an der Heiden W. Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatr Scand. 1999;100:105–18. https://doi.org/10.1111/j.1600-0447.1999.tb10831.x. *.

    Article  PubMed  Google Scholar 

  9. Gross G, Huber G, Klosterkötter J, & Linz M. Bonner Skala für die beurteilung von basissymptomen [BSABS; Bonn Scale for the Assessment of Basic Symptoms]. Berlin, Germany: Springer; 1987.

  10. McGlashan TH, Johannessen JO. Early detection and intervention with schizophrenia: rationale. Schizophr Bull. 1996;22:201–22. https://doi.org/10.1093/schbul/22.2.201.

    Article  CAS  PubMed  Google Scholar 

  11. Cupo L, McIlwaine SV, Daneault JG, Malla AK, Iyer SN, Joober R. et al. Timing, distribution, and relationship between nonpsychotic and subthreshold psychotic symptoms prior to emergence of a first episode of psychosis. Schizophr Bull. 2021;47:604–14. https://doi.org/10.1093/schbul/sbaa183. *.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Institute of Medicine (US) Committee on prevention of mental disorders. In Mrazek PJ, & Haggerty RJ. editors. Reducing risks for mental disorders: frontiers for preventive intervention research. National Academies Press (US). 1994. https://pubmed.ncbi.nlm.nih.gov/25144015/.

  13. Yung A, Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D. et al. Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust NZ J Psychiatry. 2005;39:964–71. https://doi.org/10.1111/j.1440-1614.2005.01714.x.

    Article  Google Scholar 

  14. McGlashan TH, Miller TJ, Woods SW, Hoffman RE, & Davidson L. Instrument for the assessment of prodromal symptoms and states. Early intervention in psychotic disorders, 2001. 135–9. https://link.springer.com/chapter/10.1007/978-94-010-0892-1_7.

  15. McGorry PD, Yung AR, Phillips LJ. The “close-in” or ultra high-risk model: a safe and effective strategy for research and clinical intervention in prepsychotic mental disorder. Schizophr Bull. 2003;29:771–90. https://doi.org/10.1093/oxfordjournals.schbul.a007046.

    Article  PubMed  Google Scholar 

  16. Salazar de Pablo G, Radua J, Pereira J, Bonoldi I, Arienti V, Besana F. et al. Probability of transition to psychosis in individuals at clinical high risk: an updated meta-analysis. JAMA Psychiatry. 2021;78:970–8. https://doi.org/10.1001/jamapsychiatry.2021.0830.

    Article  PubMed  Google Scholar 

  17. Fusar-Poli P, Bonoldi I, Yung AR, Borgwardt S, Kempton MJ, Valmaggia L. et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry. 2012;69:220–9. https://doi.org/10.1001/archgenpsychiatry.2011.1472.

    Article  PubMed  Google Scholar 

  18. Devoe DJ, Farris MS, Townes P, Addington J. Interventions and transition in youth at risk of psychosis: a systematic review and meta-analyses. J Clin Psychiatry. 2020;81:17r12053 https://doi.org/10.4088/JCP.17r12053.

    Article  PubMed  Google Scholar 

  19. Killackey E, Yung AR. Effectiveness of early intervention in psychosis. Curr Opin Psychiatry. 2007;20:121–5. https://doi.org/10.1097/YCO.0b013e328017f67d.

    Article  PubMed  Google Scholar 

  20. Worthington MA, Cannon TD. Prediction and prevention in the clinical high-risk for psychosis paradigm: a review of the current status and recommendations for future directions of inquiry. Front Psychiatry. 2021;12:770774 https://doi.org/10.3389/fpsyt.2021.770774.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Davies C, Radua J, Cipriani A, Stahl D, Provenzani U, McGuire P. et al. Efficacy and acceptability of interventions for attenuated positive psychotic symptoms in individuals at clinical high risk of psychosis: a network meta-analysis. Front Psychiatry. 2018;9:187 https://doi.org/10.3389/fpsyt.2018.00187.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Fusar-Poli P, Davies C, Solmi M, Brondino N, De Micheli A, Kotlicka-Antczak M. et al. Preventive treatments for psychosis: umbrella review (just the evidence). Front Psychiatry. 2019;10:764 https://doi.org/10.3389/fpsyt.2019.00764.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Addington J, Liu L, Buchy L, Cadenhead KS, Cannon TD, Cornblatt BA. et al. North American prodrome longitudinal study (NAPLS 2): the prodromal symptoms. J Nerv Ment Dis. 2015;203:328–35. https://doi.org/10.1097/NMD.0000000000000290. *.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Addington J, Piskulic D, Liu L, Lockwood J, Cadenhead KS, Cannon TD. et al. Comorbid diagnoses for youth at clinical high risk of psychosis. Schizophr Res. 2017;190:90–95. https://doi.org/10.1016/j.schres.2017.03.043.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gale C, Glue P, Gallagher S. Bayesian analysis of posttest predictive value of screening instruments for the psychosis high-risk state. JAMA Psychiatry. 2013;70:880–1. https://doi.org/10.1001/jamapsychiatry.2013.1320.

    Article  PubMed  Google Scholar 

  26. Simon AE, Ferrero FP, Merlo MCG. Prodromes of first-episode psychosis: how can we challenge neurospecificity. Compr Psychiatry. 2001;42:382–92. https://doi.org/10.1053/comp.2001.26272.

    Article  CAS  PubMed  Google Scholar 

  27. Woods SW, Powers AR,III, Taylor JH, Davidson CA, Johannesen JK, Addington J. et al. Lack of diagnostic pluripotentiality in patients at clinical high risk for psychosis: specificity of comorbidity persistence and search for pluripotential subgroups. Schizophr Bull. 2018;44:254–63. https://doi.org/10.1093/schbul/sbx138.

    Article  PubMed  Google Scholar 

  28. Lin A, Wood SJ, Nelson B, Beavan A, McGorry P, Yung AR. Outcomes of non-transitioned cases in a sample at ultra-high risk for psychosis. Am J Psychiatry. 2015;172:249–58.

    Article  PubMed  Google Scholar 

  29. Schultze-Lutter F, Rahman J, Ruhrmann S, Michel C, Schimmelmann BG. et al. Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients. Soc Psychiatry Psychiatr Epidemiol. 2015;50:1831–41. https://doi.org/10.1007/s00127-015-1093-3. *.

    Article  PubMed  Google Scholar 

  30. Shah JL, Crawford A, Mustafa SS, Iyer SN, Joober R. et al. Is the clinical high-risk state a valid concept? Retrospective examination in a first-episode psychosis sample. Psychiatr Serv. 2017;68:1046–52. https://doi.org/10.1176/appi.ps.201600304. *.

    Article  PubMed  Google Scholar 

  31. Brady LS, Larrauri CA.AMP SCZ Steering Committee. Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ): Developing tools to enable early intervention in the psychosis high risk state. World Psychiatry. 2023;22:42–43. https://doi.org/10.1002/wps.21038.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yung AR, Wood SJ, Malla A, Nelson B, McGorry P, Shah J. The reality of at risk mental state services: a response to recent criticisms. Psychol Med. 2021;51:212–8. https://doi.org/10.1017/S003329171900299X.

    Article  PubMed  Google Scholar 

  33. Ajnakina O, David AS, Murray RM. At risk mental state’ clinics for psychosis - an idea whose time has come - and gone!. Psychol Med. 2019;49:529–34. https://doi.org/10.1017/S0033291718003859.

    Article  PubMed  Google Scholar 

  34. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD. et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160 https://doi.org/10.1136/bmj.n160.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Barker TH, Migliavaca CB, Stein C, Colpani V, Falavigna M, Aromataris E. et al. Conducting proportional meta-analysis in different types of systematic reviews: a guide for synthesisers of evidence. BMC Med Res Methodol. 2021;21:189 https://doi.org/10.1186/s12874-021-01381-z.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Yale University. Reference Deduplicator. 2021. https://library.medicine.yale.edu/reference-deduplicator.

  37. Covidence systematic review software. Veritas Health Innovation Melbourne, Australia. 2023. Available at www.covidence.org.

  38. Varsamis J, Adamson JD. Early schizophrenia. Can Psychiatr Assoc J. 1971;16:487–97. https://journals.sagepub.com/doi/pdf/10.1177/070674377101600604.*.

    Article  CAS  PubMed  Google Scholar 

  39. Häfner H, Riecher A, Maurer K, Löffler W, Munk-Jørgensen P, Strömgren E. How does gender influence age at first hospitalization for schizophrenia? A transnational case register study. Psychol Med. 1989;19:903–18. https://doi.org/10.1017/S0033291700005626.

    Article  PubMed  Google Scholar 

  40. Huber G, Gross G, Schüttler R, Linz M. Longitudinal studies of schizophrenic patients. Schizophr Bull. 1980;6:592–605. https://doi.org/10.1093/schbul/6.4.592.

    Article  CAS  PubMed  Google Scholar 

  41. Ferrara M, Guloksuz S, Mathis WS, Li F, Lin IH, Syed S. et al. First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care. Soc Psychiatry Psychiatr Epidemiol. 2021;56:1359–69. https://doi.org/10.1007/s00127-021-02090-0. *.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Joanna Briggs Institute. (2017). Critical appraisal checklist for prevalence studies. https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Prevalence_Studies2017_0.pdf.

  43. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60. https://doi.org/10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Migliavaca CB, Stein C, Colpani V, Barker TH, Ziegelmann PK, Munn Z. et al. Meta-analysis of prevalence: I2 statistic and how to deal with heterogeneity. Res Synth Methods. 2022;13:363–7. https://doi.org/10.1002/jrsm.1547.

    Article  PubMed  Google Scholar 

  45. Spence JR, Stanley DJ. Prediction interval: what to expect when you’re expecting … a replication. PLoS ONE. 2016;11:e0162874 https://doi.org/10.1371/journal.pone.0162874.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Häfner H, Riecher-Rössler A, Hambrecht M, Maurer K, Meissner S, Schmidtke A. et al. IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophr Res. 1992;6:209–23. https://doi.org/10.1016/0920-9964(92)90004-o.

    Article  PubMed  Google Scholar 

  47. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders. 3rd ed. Arlington, VA: Author.

  48. Borenstein M, Hedges LE, Higgins JPT, & Rothstein HR. Comprehensive meta-analysis (Version 4). [Computer software]. 2022. www.Meta-Analysis.com.

  49. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101. https://doi.org/10.2307/2533446.

    Article  CAS  PubMed  Google Scholar 

  50. Tan HY, Ang YG. First-episode psychosis in the military: a comparative study of prodromal symptoms. Aust NZ J Psychiatry. 2001;35:512–9. https://doi.org/10.1046/j.1440-1614.2001.00912.x. *.

    Article  CAS  Google Scholar 

  51. Dominguez-Martinez T, Cristobal-Narvaez P, Kwapil TR, Barrantes-Vidal N. Clinical and psychosocial characterization of at-risk mental state and recent onset psychosis patients from an Early Psychosis Program in Barcelona (Spain). Actas Espanolas de Psiquiatria. 2017;45:145–56. https://pubmed.ncbi.nlm.nih.gov/28745387/.*.

    PubMed  Google Scholar 

  52. Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K. et al. Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatry. 2002;159:863–5.

    Article  PubMed  Google Scholar 

  53. Häfner H, Nowotny B. Epidemiology of early-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci. 1995;245:80–92. https://doi.org/10.1007/BF02190734.

    Article  PubMed  Google Scholar 

  54. Maki P, Koskela S, Murray GK, Nordstrom T, Miettunen J, Jaaskelainen E. et al. Difficulty in making contact with others and social withdrawal as early signs of psychosis in adolescents—The Northern Finland Birth Cohort 1986. Eur Psychiatry. 2014;29:345–51. https://doi.org/10.1016/j.eurpsy.2013.11.003. *.

    Article  CAS  PubMed  Google Scholar 

  55. Mustonen A, Niemela S, Nordstrom T, Murray GK, Maki P, Jaaskelainen E. et al. Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis. Br J Psychiatry. 2018;212:227–33. https://doi.org/10.1192/bjp.2017.52. *.

    Article  PubMed  Google Scholar 

  56. Jackson HJ, McGorry PD, Dudgeon P. Prodromal symptoms of schizophrenia in first-episode psychosis: prevalence and specificity. Compr Psychiatry. 1995;36:241–50. https://doi.org/10.1016/s0010-440x(95)90068-3. *.

    Article  CAS  PubMed  Google Scholar 

  57. Costello A. Mental health diagnoses during the year prior to schizophrenia, U.S. Armed Forces, 2001–10. MSMR. 2012;19:10–13. https://pubmed.ncbi.nlm.nih.gov/22452716/.*.

    PubMed  Google Scholar 

  58. Woodberry KA, Serur RA, Hallinan SB, Mesholam-Gately RI, Giuliano AJ, Wojcik JD. et al. Frequency and pattern of childhood symptom onset reported by first episode schizophrenia and clinical high risk youth. Schizophr Res. 2014;158:45–51. https://doi.org/10.1016/j.schres.2014.05.017. *.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Beiser M, Erickson D, Fleming JA, Iacono WG. Establishing the onset of psychotic illness. Am J Psychiatry. 1993;150:1349–54. https://doi.org/10.1176/ajp.150.9.1349.

    Article  CAS  PubMed  Google Scholar 

  60. Compton MT, Chien VH, Leiner AS, Goulding SM, Weiss PS. Mode of onset of psychosis and family involvement in help-seeking as determinants of duration of untreated psychosis. Soc Psychiatry Psychiatr Epidemiol. 2008;43:975–82. https://doi.org/10.1007/s00127-008-0397-y. *.

    Article  PubMed  Google Scholar 

  61. Ito S, Nemoto T, Tsujino N, Ohmuro N, Matsumoto K, Matsuoka H. et al. Differential impacts of duration of untreated psychosis (DUP) on cognitive function in first-episode schizophrenia according to mode of onset. Eur Psychiatry. 2015;30:995–1001. https://doi.org/10.1016/j.eurpsy.2015.08.004.

    Article  CAS  PubMed  Google Scholar 

  62. McGlashan TH. Premorbid adjustment, onset types, and prognostic scaling: still informative?. Schizophr Bull. 2008;34:801–5. https://doi.org/10.1093/schbul/sbn073.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Morgan C, Abdul-Al R, Lappin J, Jones P, Fearon P, Leese M. et al. Clinical and social determinants of duration of untreated psychosis in the ÆSOP first-episode psychosis study. Br J Psychiatry. 2006;189:446–52. https://doi.org/10.1192/bjp.bp.106.021303. *.

    Article  PubMed  Google Scholar 

  64. Kanahara N, Yoshida T, Oda Y, Yamanaka H, Moriyama T, Hayashi H. et al. Onset pattern and long-term prognosis in schizophrenia: 10-year longitudinal follow-up study. PLoS ONE. 2013;8:e67273 https://doi.org/10.1371/journal.pone.0067273. *.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  65. Shah JL, Jones N, van Os J, McGorry PD, Gülöksüz S. Early intervention service systems for youth mental health: integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis. Lancet Psychiatry. 2022;9:413–22. https://doi.org/10.1016/S2215-0366(21)00467-3.

    Article  PubMed  Google Scholar 

  66. Fusar-Poli P, Borgwardt S, Bechdolf A, Addington J, Riecher-Rössler A, Schultze-Lutter F. et al. The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry. 2013;70:107–20. https://doi.org/10.1001/jamapsychiatry.2013.269.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Solmi, Radua M, Olivola J, Croce M, Soardo E, Salazar de Pablo L. et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27:281–95. https://doi.org/10.1038/s41380-021-01161-7.

    Article  CAS  PubMed  Google Scholar 

  68. Shah JL, Scott J, McGorry PD, Cross SPM, Keshavan MS, Nelson B. et al. Transdiagnostic clinical staging in youth mental health: a first international consensus statement. World Psychiatry. 2020;19:233–42. https://doi.org/10.1002/wps.20745.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Carrión RE, Correll CU, Auther AM, Cornblatt BA. A severity-based clinical staging model for the psychosis prodrome: Longitudinal findings from the New York Recognition and Prevention Program. Schizophr Bull. 2017;43:64–74. https://doi.org/10.1093/schbul/sbw155.

    Article  PubMed  Google Scholar 

  70. Caspi A, Houts RM, Belsky DW, Goldman-Mellor SJ, Harrington H, Israel S. et al. The p factor: one general psychopathology factor in the structure of psychiatric disorders?. Clin Psychol Sci. 2014;2:119–37. https://doi.org/10.1177/2167702613497473.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby R. et al. The hierarchical taxonomy of psychopathology (HiTOP): a dimensional alternative to traditional nosologies. J Abnorm Psychol. 2017;126:454–77. https://doi.org/10.1037/abn0000258.

    Article  PubMed  Google Scholar 

  72. Riecher-Rössler A, Butler S, Kulkarni J. Sex and gender differences in schizophrenic psychoses-a critical review. Arch Women’s Ment Health. 2018;21:627–48. https://doi.org/10.1007/s00737-018-0847-9.

    Article  Google Scholar 

  73. Brand BA, de Boer JN, Dazzan P, Sommer IE. Towards better care for women with schizophrenia-spectrum disorders. Lancet Psychiatry. 2022;9:330–6. https://doi.org/10.1016/S2215-0366(21)00383-7.

    Article  PubMed  Google Scholar 

  74. Bunk D, Eggers C, Volberg G, Schebaum-Stein T. Dimensions of premorbid disorders in childhood-onset schizophrenia (COS). Neurol Psychiatry Brain Res. 2003;10:183–92. *.

    Google Scholar 

  75. Carter B, Wootten J, Archie S, Terry AL, Anderson KK. Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis. Arch Women’s Ment Health. 2022;25:679–91. https://doi.org/10.1007/s00737-022-01247-3.

    Article  Google Scholar 

  76. Ferrara M, Srihari VH. Early intervention for psychosis in the United States: tailoring services to improve care for women. Psychiatr Serv. 2021;72:5–6. https://doi.org/10.1176/appi.ps.202000205.

    Article  PubMed  Google Scholar 

  77. Srihari VH, Kane JM. Early intervention services 2.0: designing systems for the next generation of work. Biol Psychiat. 2020;88:291–3.

    Article  PubMed  Google Scholar 

  78. Shah JL, Allen NB, Avenevoli S, Correll CU, Fisher HL, Hickie IB, et al. A developmentally informed approach to characterizing, staging, and intervening in youth mental health problems. From the population to the clinic. In Uhlhaas PJ, & Wood SJ, editors. Youth mental health: a paradigm for prevention and early intervention. Cambridge, MA: The MIT Press. 2020.

  79. Benrimoh D, Fisher V, Mourgues C, Sheldon AD, Smith R, & Powers AR. Barriers and solutions to the adoption of clinical tools for computational psychiatry. 2022. https://doi.org/10.48550/arXiv.2301.04570.

  80. August SM, Kiwanuka JN, McMahon RP, Gold JM. The MATRICS consensus cognitive battery (MCCB): clinical and cognitive correlates. Schizophrenia Res. 2012;134:76–82. https://doi.org/10.1016/j.schres.2011.10.015.

    Article  Google Scholar 

  81. Powers AR, Mathys C, Corlett PR. Pavlovian conditioning-induced hallucinations result from overweighting of perceptual priors. Science. 2017;357:596–600. https://doi.org/10.1126/science.aan3458.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  82. Teufel C, Subramaniam N, Dobler V, Perez J, Finnemann J, Mehta PR. et al. Shift toward prior knowledge confers a perceptual advantage in early psychosis and psychosis-prone healthy individuals. Proc Natl Acad Sci USA. 2015;112:13401–6. https://doi.org/10.1073/pnas.1503916112.

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  83. Kafadar E, Fisher VL, Quagan B, Hammer A, Jaeger H, Mourgues C. et al. Conditioned hallucinations and prior overweighting are state-sensitive markers of hallucination susceptibility. Biol Psychiatry. 2022;92:772–80. https://doi.org/10.1016/j.biopsych.2022.05.007.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Vercammen A, Aleman A. Semantic expectations can induce false perceptions in hallucination-prone individuals. Schizophr Bull. 2010;36:151–6. https://doi.org/10.1093/schbul/sbn063.

    Article  PubMed  Google Scholar 

  85. Huckvale K, Venkatesh S, Christensen H. Toward clinical digital phenotyping: a timely opportunity to consider purpose, quality, and safety. NPJ Digital Med. 2019;2:1–11. https://doi.org/10.1038/s41746-019-0166-1.

    Article  Google Scholar 

  86. Trovão N, Prata J, VonDoellinger O, Santos S, Barbosa M, Coelho R. Peripheral biomarkers for first-episode psychosis-opportunities from the neuroinflammatory hypothesis of schizophrenia. Psychiatry Investig. 2019;16:177–84. https://doi.org/10.30773/pi.2018.12.19.1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Veronese M, Santangelo B, Jauhar S, D’Ambrosio E, Demjaha A, Salimbeni H. et al. A potential biomarker for treatment stratification in psychosis: evaluation of an [18F] FDOPA PET imaging approach. Neuropsychopharmacol. 2021;46:1122–32. https://doi.org/10.1038/s41386-020-00866-7.

    Article  CAS  Google Scholar 

  88. Fernandes BS, Karmakar C, Tamouza R, Tran T, Yearwood J, Hamdani N, et al. Precision psychiatry with immunological and cognitive biomarkers: a multi-domain prediction for the diagnosis of bipolar disorder or schizophrenia using machine learning. Transl Psychiatry. 2020;10:162 https://doi.org/10.1038/s41398-020-0836-4.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Mirzakhanian H, Singh F, Cadenhead KS. Biomarkers in psychosis: an approach to early identification and individualized treatment. Biomark Med. 2014;8:51–57. https://doi.org/10.2217/bmm.13.134.

    Article  CAS  PubMed  Google Scholar 

  90. Nieman DH, McGorry PD. Detection and treatment of at-risk mental state for developing a first psychosis: making up the balance. Lancet Psychiatry. 2015;2:825–34. https://doi.org/10.1016/S2215-0366(15)00221-7.

    Article  PubMed  Google Scholar 

  91. Keshavan MS, DeLisi LE, Seidman LJ. Early and broadly defined psychosis risk mental states. Schizophr Res. 2011;126:1–10. https://doi.org/10.1016/j.schres.2010.10.006.

    Article  PubMed  Google Scholar 

  92. Sandeep M. Characterisation of the prodrome to a first episode of psychotic mania: a retrospective study. 2012. (1815532270). 10153933, 178. *.

  93. Yung AR, McGorry PD. The initial prodrome in psychosis: descriptive and qualitative aspects. Aust NZ J Psychiatry. 1996;30:587–99. https://doi.org/10.3109/00048679609062654. *.

    Article  CAS  Google Scholar 

  94. Yıldızhan E, Türkcan A, İnan S, Erenkuş Z, Yalçın Ö, Erdoğan A. İlk Psikoz Atağı: Belirtiler, Tedavi Başlangıcı ve Klinik Yanıt İlişkisi [First episode psychosis: relationship of symptoms, initial treatment and clinical response]. Turk Psikiyatr Derg. 2015;26:77–86. https://pubmed.ncbi.nlm.nih.gov/26111283/.*.

    Google Scholar 

  95. Sullivan HS. The relation of onset to outcome in schizophrenia. Schizophrenia (Dementia Praecox). 1932. 111–8. *.

  96. Skokou M, Katrivanou A, Andriopoulos I, Gourzis P. Sintomatología de las fases activa y prodrómica de la esquizofrenia paranoide de inicio en el joven y de inicio tardío [Active and prodromal phase symptomatology of young-onset and late-onset paranoid schizophrenia]. Rev de Psiquiatria y Salud Ment. 2012;5:150–9. https://doi.org/10.1016/j.rpsm.2012.03.002. *.

    Article  Google Scholar 

  97. Shioiri T, Shinada K, Kuwabara H, Someya T. Early prodromal symptoms and diagnoses before first psychotic episode in 219 inpatients with schizophrenia. Psychiatry Clin Neurosci. 2007;61:348–54. https://doi.org/10.1111/j.1440-1819.2007.01685.x. *.

    Article  PubMed  Google Scholar 

  98. Schothorst PF, Emck C, van Engeland H. Characteristics of early psychosis. Compr Psychiatry. 2006;47:438–42. https://doi.org/10.1016/j.comppsych.2006.03.003. *.

    Article  PubMed  Google Scholar 

  99. Stepniak B, Papiol S, Hammer C, Ramin A, Everts S, Hennig L. et al. Accumulated environmental risk determining age at schizophrenia onset: a deep phenotyping-based study. Lancet Psychiatry. 2014;1:444–53. https://doi.org/10.1016/S2215-0366(14)70379-7. *.

    Article  PubMed  Google Scholar 

  100. Salvatore P, Khalsa HM, Hennen J, Tohen M, Yurgelun-Todd D, Casolari F. et al. Psychopathology factors in first-episode affective and non-affective psychotic disorders. J Psychiatr Res. 2007;41:724–36. https://doi.org/10.1016/j.jpsychires.2006.04.008. *.

    Article  CAS  PubMed  Google Scholar 

  101. Russell AT. The clinical presentation of childhood-onset schizophrenia. Schizophr Bull. 1994;20:631–46. https://doi.org/10.1093/schbul/20.4.631. *.

    Article  CAS  PubMed  Google Scholar 

  102. Röpcke B, Eggers C. Early-onset schizophrenia: a 15-year follow-up. Eur Child Adolesc Psychiatry. 2005;14:341–50. https://doi.org/10.1007/s00787-005-0483-6. *.

    Article  PubMed  Google Scholar 

  103. Renwick L, Lyne J, Donoghue BO, Owens L, Doyle R, Hill M. et al. Prodromal symptoms and remission following first episode psychosis. Schizophr Res. 2015;168:30–36. https://doi.org/10.1016/j.schres.2015.07.001. *.

    Article  PubMed  Google Scholar 

  104. Perkins DO, Leserman J, Jarskog LF, Graham K, Kazmer J. et al. Characterizing and dating the onset of symptoms in psychotic illness: the symptom onset in schizophrenia (SOS) inventory. Schizophr Res. 2000;44:1–10. https://doi.org/10.1016/s0920-9964(99)00161-9. *.

    Article  CAS  PubMed  Google Scholar 

  105. Rabe-Jabllonska J, Kotlicka-Antczak M, Gmitrowicz A. Clinical picture and duration of prodromal period of schizophrenia in adolescents. Arch Psychiatry Psychother. 2000;2:31–38. *.

    Google Scholar 

  106. Naqvi HA, Hussain S, Islam M, Huma S. Early psychosis symptoms. J Coll Physicians Surg Pak. 2014;24:198–202. https://www.jcpsp.pk/archive/2014/Mar2014/13.pdf.*.

    PubMed  Google Scholar 

  107. Møller P, Husby R. The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior. Schizophr Bull. 2000;26:217–32. https://doi.org/10.1093/oxfordjournals.schbul.a033442. *.

    Article  PubMed  Google Scholar 

  108. Meng H, Schimmelmann BG, Koch E, Bailey B, Parzer P, Gunter M. et al. Basic symptoms in the general population and in psychotic and non-psychotic psychiatric adolescents. Schizophr Res. 2009;111:32–38. https://doi.org/10.1016/j.schres.2009.03.001. *.

    Article  PubMed  Google Scholar 

  109. Kohn D, Niedersteberg A, Wieneke A, Bechdolf A, Pukrop R, Ruhrmann S. et al. Early course of illness in first episode schizophrenia with long duration of untreated illness—a comparative study. Fortschr Der Neurol Psychiatr. 2004;72:88–92. https://doi.org/10.1055/s-2003-812509. *.

    Article  CAS  Google Scholar 

  110. Kim Y, Lee JY, Yong SK, Jung HY, Lee KY. Reliability of the Korean Nottingham Onset Schedule (K-NOS) in Korean first-episode psychosis patients. Clin Psychopharmacol Neurosci. 2009;7:51–56. https://www.cpn.or.kr/journal/view.html?uid=69&vmd=Full.*.

    CAS  Google Scholar 

  111. Jackson HJ, McGorry PD, Dakis J, Harrigan S, Henry L, Mihalopoulos C. The inter-rater and test–retest reliabilities of prodromal symptoms in first-episode psychosis. Aust NZ J Psychiatry. 1996;30:498–504. https://doi.org/10.3109/00048679609065023. *.

    Article  CAS  Google Scholar 

  112. Iida J, Iwasaka H, Hirao F, Hashino K, Matsumura K, Tahara K. et al. Clinical features of childhood-onset schizophrenia with obsessive-compulsive symptoms during the prodromal phase. Psychiatry Clin Neurosci. 1995;49:201–7. https://doi.org/10.1111/j.1440-1819.1995.tb01885.x. *.

    Article  CAS  PubMed  Google Scholar 

  113. Huber G, Gross G, Schüttler R. A long-term follow-up study of schizophrenia: psychiatric course of illness and prognosis. Acta Psychiatr Scand. 1975;52:49–57. https://doi.org/10.1111/j.1600-0447.1975.tb00022.x. *.

    Article  CAS  PubMed  Google Scholar 

  114. Gourzis P, Katrivanou A, Beratis S. Symptomatology of the initial prodromal phase in schizophrenia. Schizophr Bull. 2002;28:415–29. https://doi.org/10.1093/oxfordjournals.schbul.a006950. *.

    Article  PubMed  Google Scholar 

  115. Gottlieb BS. Prognosis of hebephrenia; a study of onset and clinical manifestations. Psychiatr Q. 1941;15:54–63. https://doi.org/10.1007/BF01613954. *.

    Article  Google Scholar 

  116. Creel SM. Prodromal psychosocial behaviors in soldiers with schizophrenic and schizophreniform disorder. Mil Med. 1988;153:146–50. https://doi.org/10.1093/milmed/153.3.146. *.

    Article  CAS  PubMed  Google Scholar 

  117. Coryell W, Zimmerman M. Diagnosis and outcome in schizo-affective depression: a replication. J Affect Disord. 1988;15:21–27. https://doi.org/10.1016/0165-327(88)90005-5. *.

    Article  CAS  PubMed  Google Scholar 

  118. Conus P, Cotton S, Schimmelmann BG, McGorry PD, Lambert M. The first-episode psychosis outcome study: premorbid and baseline characteristics of an epidemiological cohort of 661 first-episode psychosis patients. Early Interv Psychiatry. 2007;1:191–200. https://doi.org/10.1111/j.1751-7893.2007.00026.x. *.

    Article  Google Scholar 

  119. Chen Y, Farooq S, Edwards J, Chew-Graham CA, Shiers D, Frisher M. et al. Patterns of symptoms before a diagnosis of first episode psychosis: a latent class analysis of UK primary care electronic health records. BMC Med. 2019;17:227 https://doi.org/10.1186/s12916-019-1462-y. *.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Chen EYH, Dunn ELW, Miao M, Yeung WS, Wong CK, Chan WF. et al. The impact of family experience on the duration of untreated psychosis (DUP) in Hong Kong. Soc Psychiatry Psychiatr Epidemiol. 2005;40:350–6. https://doi.org/10.1007/s00127-005-0908-z. *.

    Article  PubMed  Google Scholar 

  121. Day R, Nielsen JA, Korten A, Ernberg G, Dube KC, Gebhart J. et al. Stressful life events preceding the acute onset of schizophrenia: a cross-national study from the World Health Organization. Cult Med Psychiatry. 1987;11:123–205. https://doi.org/10.1007/BF00122563. *.

    Article  CAS  PubMed  Google Scholar 

  122. Bensi M, Armando M, Censi V, Aiello D, Fortes Lindau J, Cavaggioni G. et al. Segni e sintomi prodromici all’esordio psicotico. Uno studio sulla Duration of Untreated Illness (DUI) in un campione di pazienti con diagnosi di psicosi non affettiva [Early signs and symptoms before the psychotic onset. A study on the Duration of Untreated Illness (DUI) in a sample of patients with diagnosis of “non-affective psychotic disorders”]. La Clinica Terapeutica. 2011;162:11–18. https://pubmed.ncbi.nlm.nih.gov/21448540/. *.

    CAS  PubMed  Google Scholar 

  123. Bechdolf A, Halve S, Schultze-Lutter F, & Klosterkötter J. Selbst wahrnehmbare Vulnerabilität, Prodromalsymptome und Bewältigungsreaktionen vor schizophrenen und affektiven Episoden [Self-experienced vulnerability, prodromicsymptoms and coping strategies before schizophrenic and affective episodes]. Fortschr Neurol Psychiatr. 1998;66:378–86. https://doi.org/10.1055/s2007-995275.

    Article  CAS  PubMed  Google Scholar 

  124. Addington J, van Mastrigt S, Hutchinson J, Addington D. Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatr Scand. 2002;106:358–64. https://doi.org/10.1034/j.1600-0447.2002.02004.x.

    Article  CAS  PubMed  Google Scholar 

  125. Barajas A, Pelaez T, Gonzalez O, Usall J, Iniesta R, Arteaga M. et al. Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset. Early Intervent Psychiatry. 2019;13:414–24. https://doi.org/10.1111/eip.12498. *.

    Article  Google Scholar 

  126. Hafner H. Onset and early course as determinants of the further course of schizophrenia. Acta Psychiatr Scand Suppl. 2000;407:44–48. https://pubmed.ncbi.nlm.nih.gov/11261639/.*.

    Article  Google Scholar 

  127. Compton MT, Esterberg ML, Druss BG, Walker EF, Kaslow NJ. A descriptive study of pathways to care among hospitalized urban African American first-episode schizophrenia-spectrum patients. Soc Psychiatry Psychiatr Epidemiol. 2006;41:566–73. https://doi.org/10.1007/s00127-006-0065-z. *.

    Article  PubMed  Google Scholar 

  128. Compton MT, Broussard B, Ramsay CE, Stewart T. Pre-illness cannabis use and the early course of nonaffective psychotic disorders: associations with premorbid functioning, the prodrome, and mode of onset of psychosis. Schizophr Res. 2011;126:71–76. https://doi.org/10.1016/j.schres.2010.10.005. *.

    Article  PubMed  Google Scholar 

  129. Eggers C, Bunk D. Frühentwicklung kindlicher schizophrenien [Early development of childhood-onset schizophrenia]. Fortschr der Neurol Psychiatr. 2009;77:558–67. https://doi.org/10.1055/s-0028-1109737. *.

    Article  CAS  Google Scholar 

  130. Guloksuz S, Pries LK, Ten Have M, de Graaf R, van Dorsselaer S, Klingenberg B. et al. Association of preceding psychosis risk states and non-psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS-2 cohort. World Psychiatry. 2020;19:199–205. https://doi.org/10.1002/wps.20755. *.

    Article  PubMed  PubMed Central  Google Scholar 

  131. Schultze-Lutter F, Ruhrmann S, Berning J, Maier W, Klosterkotter J. Basic symptoms and ultrahigh risk criteria: symptom development in the initial prodromal state. Schizophr Bull. 2010;36:182–91. https://doi.org/10.1093/schbul/sbn072. *.

    Article  PubMed  Google Scholar 

  132. Emck C, Schothorst PF, Van Engeland H. Psychosen bij jeugdigen [Early onset psychosis]. Tijdschr Voor Psychiatr. 2001;43:757–65. https://research.vu.nl/en/publications/psychosen-bij-jeugdigen.*.

    Google Scholar 

  133. Pierre K. An Exploration of the harbingers that differentiate the schizophrenia prodrome from a “Bad Patch”. 2010. https://escholarship.mcgill.ca/concern/theses/x346d463j. *.

  134. Iyer SN, Boekestyn L, Cassidy CM, King S, Joober R, Malla AK. Signs and symptoms in the pre-psychotic phase: description and implications for diagnostic trajectories. Psychol Med. 2008;38:1147–56. https://doi.org/10.1017/S0033291708003152. *.

    Article  CAS  PubMed  Google Scholar 

  135. Hafner H. When, how and with what does schizophrenia begin?. J Brasileiro de Psiquiatria. 1996;45:7–21. *.

    Google Scholar 

  136. Maurer K, Konnecke R, Loffler W, Hafner H. Some new results from the ABC-study on early course and early recognition. Neurol Psychiatry Brain Res. 1998;6:9–18. *.

    Google Scholar 

  137. Häfner H, Nowotny B, Löffler W, an der Heiden W, Maurer K. When and how does schizophrenia produce social deficits?. Eur Arch Psychiatry Clin Neurosci. 1995;246:17–28. https://doi.org/10.1007/BF02191811. *.

    Article  PubMed  Google Scholar 

  138. Häfner H, Maurer K, Löffler W, an der Heiden W, Stein A, Könnecke R, et al. Onset and prodromal phase as determinants of the course. Search for the causes of schizophrenia: Vol. IV Balance of the century. Steinkopff. 1999. pp. 35–58. https://doi.org/10.1007/978-3-642-47076-9_3l. *.

  139. Hafner H. Onset and course of the first schizophrenic episode. Kaohsiung J Med Sci. 1998;14:413–31. https://pubmed.ncbi.nlm.nih.gov/9739575/.*.

    CAS  PubMed  Google Scholar 

  140. Compton MT, Kelley ME, Ramsay CE, Pringle M, Goulding SM, Esterberg ML. et al. Association of pre-onset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients. Am J Psychiatry. 2009;166:1251–7. https://doi.org/10.1176/appi.ajp.2009.09030311. *.

    Article  PubMed  PubMed Central  Google Scholar 

  141. Compton MT, Goulding SM, Walker EF. Characteristics of the retrospectively assessed prodromal period in hospitalized patients with first-episode nonaffective psychosis: findings from a socially disadvantaged, low-income, predominantly African American population. J Clin Psychiatry. 2010;71:1279–85. https://doi.org/10.4088/JCP.08m04678yel. *.

    Article  PubMed  Google Scholar 

  142. Eggers C, Bunk D. The long-term course of childhood-onset schizophrenia: a 42-year followup. Schizophr Bull. 1997;23:105–17. https://doi.org/10.1093/schbul/23.1.105. *.

    Article  CAS  PubMed  Google Scholar 

  143. Eggers C, Bunk D, Krause D. Schizophrenia with onset before the age of eleven: clinical characteristics of onset and course. J Autism Dev Disord. 2000;30:29–38. https://doi.org/10.1023/a:1005408010797. *.

    Article  CAS  PubMed  Google Scholar 

  144. Eggers C. The course of infantile and prepubertal schizophrenia. Monographien Aus Dem Gesamtgeb Der Psychiatr. 1973;9:250 https://doi.org/10.1007/978-3-662-13371-2. *.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to extend our sincere thanks to the library sciences department at Yale University for their significant contributions to the process of finding, requesting, and making available articles for this review. We would also like to thank all those authors who made a significant effort to provide us with data missing from their articles in support of this review. These included: Dr. Jackson, Dr. Riecher-Rossler, Dr. Yildizhan, Dr. Pelizza, Dr. Ehrenreich, Dr. Barrantes, Dr. Velthorst, Dr. Salvatore, Dr. Dazzan, Dr. Conus, Dr. McGorry, Dr. Skokou, Dr. Woodberry, Dr. Van Os, Dr. Sullivan, Dr. Mustonen, and Dr. Renwick.

Funding

No funding was received in connection to this review. D.B. is a shareholder, founder, and employee of Aifred Health, a digital mental health company which was not involved in any way with this review and whose work is not relevant to the aims of this review. D.B. did not receive funding from Aifred Health in connection to this review.

Author information

Authors and Affiliations

  1. PEPP-Montréal, Department of Psychiatry and Douglas Research Center, McGill University, Montreal, QC, Canada

    David Benrimoh & Jai Shah

  2. Department of Psychiatry, Stanford University, Stanford, CA, USA

    David Benrimoh

  3. Creedmoor Psychiatric Center, New York, NY, USA

    Viktor Dlugunovych

  4. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Abigail C. Wright

  5. Harvard Medical School, Boston, MA, USA

    Abigail C. Wright

  6. Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, MD, USA

    Peter Phalen

  7. Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA

    Melissa C. Funaro

  8. Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy

    Maria Ferrara

  9. Specialized Treatment Early in Psychosis Program (STEP), Yale School of Medicine, New Haven, CT, USA

    Maria Ferrara & Sinan Guloksuz

  10. Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA

    Albert R. Powers III, Scott W. Woods & Vinod Srihari

  11. Department of Psychiatry and Neuropsychology Maastricht University Medical Center, Maastricht, Netherlands

    Sinan Guloksuz

  12. Institute of Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Melbourne, Australia

    Alison R. Yung

Authors
  1. David Benrimoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Viktor Dlugunovych
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abigail C. Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Phalen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Melissa C. Funaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Ferrara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Albert R. Powers III
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Scott W. Woods
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sinan Guloksuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alison R. Yung
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vinod Srihari
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jai Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DB contributed to study conceptualization and the study protocol, data collection, conducted the data analysis, and led manuscript writing and revisions. VD, ACW, and PP contributed to study conceptualization and the study protocol, data collection, manuscript writing. MCF contributed to study conceptualization, prepared the search strategy, and contributed to manuscript writing. MF, ARP III, SWW, SG, ARY and VS contributed to study conceptualization, advised on analyses, and contributed to manuscript writing and revision. JS provided supervision, contributed to study conceptualization and the study protocol, advised on the data analysis, and contributed to manuscript writing and revisions.

Corresponding author

Correspondence to David Benrimoh.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: In this article the author’s name Sinan Guloksuz was incorrectly written as Sinahin Guloksuz.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Benrimoh, D., Dlugunovych, V., Wright, A.C. et al. On the proportion of patients who experience a prodrome prior to psychosis onset: A systematic review and meta-analysis. Mol Psychiatry (2024). https://doi.org/10.1038/s41380-024-02415-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41380-024-02415-w

Search

Advanced search

Quick links