Observational studySocial psychiatry and psychiatric epidemiology2026
Early-Age onset of psychotic spectrum symptoms is highly prevalent and associated with greater illness severity in schizophrenia spectrum disorders that develop later in life.
Observational study in Social psychiatry and psychiatric epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsEarly identification of symptoms in schizophrenia spectrum disorders (SSD) may improve clinical outcomes, yet the temporal trajectory and prognostic relevance of initial symptom dimensions remain unclear. This study aimed to identify the earliest emerging symptoms among individuals with SSD and investigate their association with illness severity using a dimensional, data-driven approach.
methodsWe conducted a cross-sectional observational study including 160 adults with SSD, diagnosed using the via the Structured Clinical Interview for DSM-5 (SCID-5). Participants completed the Structured Clinical Interview for the Psychotic Spectrum - Self-Report (PSY-SR) PSY-SR questionnaire, which assesses lifetime psychotic spectrum symptoms across five domains: interpersonal sensitivity, paranoid traits, schizoid traits, misperceptions, and typical psychotic symptoms, with retrospective reporting of age at symptom onset. K-means clustering classified patients by severity based on total PSY-SR scores. Multinomial logistic regression identified factors linked to the more severe cluster.
resultsTwo clusters were identified: Cluster 1 (less severe; n = 91) and Cluster 2 (more severe; n = 69). Cluster 2 had higher PSY-SR scores (81.2 vs. 42.0) and earlier symptom onset, particularly for interpersonal sensitivity (15.7 vs. 18.8 years, p = 0.013) and typical psychotic symptoms, including hallucinations and delusions (22.0 vs. 26.5 years, p < 0.001). In contrast, age at onset of paranoid traits and misperceptions did not significantly differ between clusters. FGA use was associated with Cluster 2 membership, likely reflecting greater clinical severity. (OR = 5.10, p = 0.008). Later onset of interpersonal sensitivity and typical psychotic symptoms was associated with reduced severity, lowering the probability of Cluster 2 membership by around 50% per additional year.
conclusionsIn a cross-sectional sample of adults with SSD, earlier onset of interpersonal sensitivity and typical psychotic symptoms in SSD predicted worse outcomes. These findings support a dimensional understanding of symptom heterogeneity within SSD and suggest that systematic assessment of subthreshold and spectrum-level symptoms may contribute to improved early detection, risk stratification and more personalised interventions.
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