SYSTEMATIC REVIEW: PREDICTIVE VALIDITY OF PRODROMAL SYMPTOMS OF EARLY PSYCHOSIS IN YOUTH

Abstract

Psychotic disorders such as schizophrenia often emerge in late adolescence or early adulthood, with a prodromal phase characterized by subtle but clinically significant symptoms. This systematic review synthesizes evidence from longitudinal and cohort studies published between 2000 and 2025 to evaluate the predictive validity of prodromal symptoms in youth at clinical high risk (CHR) for psychosis. Findings indicate that attenuated positive symptoms—particularly unusual thought content, suspiciousness, and perceptual abnormalities—remain the most reliable clinical predictors, though their specificity is limited. Converters are further distinguished by cognitive impairments (verbal memory, executive function), functional decline, and neurobiological changes such as prefrontal and temporal grey matter reductions. Transition rates across studies ranged from 20–35% over 2–3 years, supporting CHR assessments as clinically valuable yet insufficient as standalone predictors. Integrative models that combine symptom severity, cognitive performance, functional measures, and biological markers provide superior predictive accuracy. While early identification holds promise for preventive intervention, ethical concerns regarding stigma and false positives highlight the need for culturally sensitive, personalized approaches. This review underscores the importance of refining predictive frameworks to optimize early detection and improve outcomes in at-risk youth.