There are two key approaches for identifying people with early signs that may suggest a high risk of developing psychosis or schizophrenia. The first approach is based on Huber’s Basic Symptoms, which focuses on a detailed way of describing phenomenological (subjective) disturbances. Because the basic symptoms refer only to subtle subjectively experienced abnormalities, they may reflect an earlier phase in the disease process than the second approach, which identifies at-risk mental states as a combination of; a family history of psychosis (familial risk) plus non-specific symptoms and recent decline in functioning; recent onset Attenuated Psychotic Symptoms with decline in functioning; and Brief Limited Intermittent Psychotic Symptoms.

What is the evidence for cognitive functioning in high-risk groups?

Moderate to high quality evidence found medium-sized effects of poorer verbal learning, reasoning and problem-solving, visual memory, verbal memory, working memory, olfaction, visual learning, and executive functioning in people at clinical high-risk for psychosis compared to controls. There were also small effects of poorer general intelligence, processing speed, attention/vigilance, premorbid intelligence, visuospatial ability, social cognition, and motor functioning in people at clinical high risk for psychosis.

High quality evidence shows people at clinical high risk of psychosis and familial high risk of psychosis are similarly impaired on processing speed, verbal and visual memory, attention and language fluency when compared with controls. People at familial high risk were more impaired on premorbid and current IQ than those at clinical high risk, and those at clinical high risk were more impaired on visuospatial working memory than those at familial high risk.

Moderate quality evidence found medium-sized effects of poorer verbal learning, visual memory, and executive functioning in people at high-risk of psychosis who made the transition to psychosis compared to people at high-risk of psychosis who did not make the transition to psychosis. There were small effects of poorer processing speed, attention/vigilance, and general intelligence in those who transitioned to psychosis, with no differences in working memory, premorbid intelligence, olfaction, or motor functioning.

Moderate quality evidence finds medium-sized effects of better verbal learning, general intelligence, and executive functioning in people at high-risk of psychosis compared to people with first-episode psychosis. There were no differences in premorbid intelligence or processing speed.

High quality evidence finds small improvements in cognition over time in people at ultra-high risk of psychosis and in people with first-episode psychosis.

March 2022

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