Early Signs of Psychosis in Youth Mental Health

Summary: A new study reveals that 50% of youth accessing mental health services exhibit Psychosis Spectrum Symptoms (PSS). This higher-than-expected prevalence highlights the need for early detection and intervention strategies.

The study, part of the larger Toronto Adolescent and Youth Cohort Study, aims to identify early predictors of psychosis spectrum disorder and improve intervention effectiveness.

By integrating research assessments into clinical practice and involving youth in a patient-facing dashboard, the study seeks to develop new strategies for early identification and better characterize the mental health needs of at-risk youth.

Key Facts:

  1. Half of the youth in the study, aged 11-24, displayed Psychosis Spectrum Symptoms, indicating a higher prevalence than anticipated.
  2. The study focuses on early indicators to predict psychosis risk and aims to improve the current 5% effectiveness rate in identifying at-risk children.
  3. This longitudinal study, involving patient and caregiver co-design, will follow 1500 youth over five years, integrating research into clinical practice for immediate application.

Source: University of Toronto

A new study co-led by Associate Professor Kristin Cleverley of the Lawrence Bloomberg Faculty of Nursing has found evidence that Psychosis Spectrum Symptoms (PSS) are often present in youth accessing mental health services.

From a profile of the initial 417 youth aged 11-24 participating in the study, 50 percent were shown to meet the threshold for Psychosis Spectrum Symptoms, a number Cleverley says was higher than expected, meaning there is a large number of children with these symptoms accessing mental health services.

This shows a young girl.
A novel aspect of the TAY Cohort Study is youth are given access to a patient-facing dashboard of their research results that is also integrated into their clinical record. Credit: Neuroscience News

Cleverley, who is also the CAMH Chair in Mental Health Nursing Research, says that what is novel about this study is that researchers are assessing early indicators that might predict whether someone is more at risk of developing Psychosis Spectrum Disorder, and examine whether there is a point at which earlier intervention for that youth could be more effective.

“Traditionally, early psychosis care starts when there is a serious presentation of psychotic symptoms, which usually occurs in the late teen years,” says Cleverley.

“The current approach to identifying children at risk of developing a psychotic disorder is only about 5 per cent effective, but with this study we can start to assess certain patterns or changes in function that can signal if an earlier intervention may be beneficial.”

Psychosis Spectrum Disorder can be extremely disabling, and is linked to cognitive impairment, long-term disability, and higher rates of death by suicide than other mental illnesses. Even without a diagnosis of psychosis, Psychosis Spectrum Symptoms can severely affect youth.

This study is one of three projects being led as part of the Toronto Adolescent and Youth (TAY) Cohort Study that is set to follow 1500 youth over the course of five years. The goal of the cohort study is to better understand the populations of youth seeking mental health treatment, how their mental health symptoms and functioning change over time, and whether early predictors of psychosis spectrum disorder can be determined.

This study was co-designed with patient and caregivers in addition to involving extensive engagement from clinicians. A novel aspect of the TAY Cohort Study is youth are given access to a patient-facing dashboard of their research results that is also integrated into their clinical record.

“We wanted to ensure that the study was embedded in the clinical program so that research assessments could be immediately utilized within clinical practice, including supporting decisions about  interventions or services,” says Cleverley.

This longitudinal study will include a follow-up every six months, and will provide researchers access to information about whether symptoms in these youth become chronic or episodic, and whether these changes are related to developmental milestones or environmental stressors, or changes to mental health services.

“Our goal with this research is really to characterize this population better so that we can identify new strategies that will complement existing strategies for early identification of youth at risk of psychosis,” says Cleverley. “It also creates an important opportunity for graduate students and researchers to develop sub-studies for this sample that will enable further research to improve youth mental health outcomes.”

About this psychosis and neurodevelopment research news

Author: Rebecca Biason
Source: University of Toronto
Contact: Rebecca Biason – University of Toronto
Image: The image is credited to Neuroscience News

Original Research: Open access.
The Toronto Adolescent and Youth Cohort Study: Study Design and Early Data Related to Psychosis Spectrum Symptoms, Functioning, and Suicidality” by Kristin Cleverley et al. Biological Psychiatry


The Toronto Adolescent and Youth Cohort Study: Study Design and Early Data Related to Psychosis Spectrum Symptoms, Functioning, and Suicidality


Psychosis spectrum symptoms (PSSs) occur in a sizable percentage of youth and are associated with poorer cognitive performance, poorer functioning, and suicidality (i.e., suicidal thoughts and behaviors). PSSs may occur more frequently in youths already experiencing another mental illness, but the antecedents are not well known. The Toronto Adolescent and Youth (TAY) Cohort Study aims to characterize developmental trajectories in youths with mental illness and understand associations with PSSs, functioning, and suicidality.


The TAY Cohort Study is a longitudinal cohort study that aims to assess 1500 youths (age 11–24 years) presenting to tertiary care. In this article, we describe the extensive diagnostic and clinical characterization of psychopathology, substance use, functioning, suicidality, and health service utilization in these youths, with follow-up every 6 months over 5 years, including early baseline data.


A total of 417 participants were enrolled between May 4, 2021, and February 2, 2023. Participants met diagnostic criteria for an average of 3.5 psychiatric diagnoses, most frequently anxiety and depressive disorders. Forty-nine percent of participants met a pre-established threshold for PSSs and exhibited higher rates of functional impairment, internalizing and externalizing symptoms, and suicidality than participants without PSSs.


Initial findings from the TAY Cohort Study demonstrate the feasibility of extensive clinical phenotyping in youths who are seeking help for mental health problems. PSS prevalence is much higher than in community-based studies. Our early data support the critical need to better understand longitudinal trajectories of clinical youth cohorts in relation to psychosis risk, functioning, and suicidality.

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  1. This is very interesting. Is there any research which investigates the link between the continued activity of the Moro Reflex; the primitive form of the Strauss/postural/adult fight or flight reflex; beyond the time of usual integration. As a neuro-developmental Practitioner I was taught, and a 35 year career in Special Needs teaching have found it so, that an active Moro Reflex , beyond the early months of life, puts the whole of the Central Nervous System on “Red alert” causing over-sensitivity in some or all senses without pause – causing a state of acute, “unexplained” anxiety. In this prolonged state the body becomes depleted in vital mineral elements, and is unable to function normally either physically or mentally with resulting cognitive ability and poor mental and physical health. A programme of developmental exercises and sound therapy have made a really significant difference. I would be very interested to hear other opinions.

  2. The growth spurts’ physical effects and imaginary audience (both mimicking psychosis)
    should be partialled out in groups of different ages 11-24.

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