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Markers of Psychosis Risk in the General Population

  • Author Footnotes
    1 JHT and MEC contributed equally to this work.
    Jerome H. Taylor
    Footnotes
    1 JHT and MEC contributed equally to this work.
    Affiliations
    Lifespan Brain Institute, Penn Medicine and Children’s Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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  • Author Footnotes
    1 JHT and MEC contributed equally to this work.
    Monica E. Calkins
    Footnotes
    1 JHT and MEC contributed equally to this work.
    Affiliations
    Lifespan Brain Institute, Penn Medicine and Children’s Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
    Search for articles by this author
  • Raquel E. Gur
    Correspondence
    Address correspondence to Raquel E. Gur, M.D., Ph.D., 10th Floor, Gates Building, Hospital of the University of Pennsylvania, 34th and Spruce Street, Philadelphia, PA 19104.
    Affiliations
    Lifespan Brain Institute, Penn Medicine and Children’s Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
    Search for articles by this author
  • Author Footnotes
    1 JHT and MEC contributed equally to this work.
Published:February 12, 2020DOI:https://doi.org/10.1016/j.biopsych.2020.02.002

      Abstract

      The categorical approach to defining schizophrenia spectrum disorders requires meeting established criteria. To advance early identification and intervention in young people, the field has progressed to studying help-seeking individuals who are at clinical high risk based on subthreshold psychosis spectrum symptoms, and criteria have been articulated for qualifying individuals as at risk. A broader dimensional examination of psychosis has been applied to population-based studies on non–help seekers. This review highlights the ascertainment and assessment approaches to such population-based studies. Most studies are cross-sectional and rely on questionnaires with limited overlap of tools. However, several consistent findings emerge on symptoms, neurocognitive deficits, and neuroimaging parameters and other biomarkers associated with emergence and persistence of psychotic features. The findings are consistent with the literature on abnormalities associated with schizophrenia, including the presence of neurocognitive deficits; abnormalities in brain structure, function, and connectivity that are related to distress; impairment; and functional outcome. These findings support the validity of studying psychosis experiences during development in a way that can chart the emergence of psychosis in the context of general psychopathology. Such studies are necessary for establishing developmental trajectories that characterize this emergence and for identifying risk and resilience biomarkers moderating or modulating the full range of schizophrenia-related manifestations. More community-based studies are needed, with better standardization and harmonization of measures and incorporating longitudinal follow-up, to establish mechanistic links between cellular–molecular aberrations and specific manifestations of psychosis as envisioned by the precision medicine agenda.

      Keywords

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