What is it about?

Psychosis involves losing touch with reality, for example hearing voices or holding unusual beliefs. About 1 in 8 people with psychosis first experience symptoms before age 18; this is called early-onset psychosis (EOP). Adults with psychosis often have problems with cognitive abilities, the mental processes we use to learn, remember, pay attention, and solve problems. Much less is known about children and teenagers with psychosis, especially those whose psychosis is related to mood symptoms. We tested cognitive abilities in over 2,200 youth in Mexico: 1,000 with early-onset psychosis, 150 of their siblings, and compared them to 1,000 with other mental health disorders (e.g., depression, anxiety; i.e., not psychosis ). Youth with schizophrenia-spectrum psychosis had moderate deficits across all cognitive abilities, while youth with mood-related psychosis (psychotic mood disorders and schizoaffective disorder) had smaller deficits across most, but not all, abilities. Siblings performed similarly to the comparison group. We also compared youth with early-onset psychosis and their siblings to the comparison group across different ages. In all groups, cognitive gaps relative to the comparison group were smallest in children and largest in young adults. However, gaps first appeared at different ages: in children for schizophrenia-spectrum psychosis, in adolescents for mood-related psychosis, and in young adults for siblings. This suggests that youth with psychosis, and possibly their siblings, may show reduced or delayed cognitive development compared to their peers. Because we measured each person only once, we cannot confirm that youth with psychosis fall further behind their peers over time. Following the same young people over several years is needed to test this.

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Why is it important?

This is the largest and most diagnostically varied study of cognition in young people with early-onset psychosis to date. Most previous research has focused on schizophrenia. We show that young people with mood-related psychosis, a large but understudied group, also have cognitive deficits, though smaller ones. The schizophrenia-spectrum and mood-related psychosis groups also differed in terms of age and abilities in which gaps appeared compared to the comparison group. Working memory differences appeared in both groups, and verbal memory differences appeared only in schizophrenia-spectrum psychosis. In the schizophrenia-spectrum psychosis group, gaps appeared in childhood, but appeared later in mood-related psychosis. If confirmed in longitudinal studies, this points to support targeted at specific abilities during specific stages of development, focused on helping young people keep pace rather than preventing decline. The study also includes Mexican children and teenagers, a group underrepresented in psychiatric research. Two cautions: the age patterns weakened when we accounted for years of schooling, so disrupted education may be part of the story, and the sibling findings come from a smaller group and need to be replicated.

Perspectives

This paper reflects years of work by the EPIMex team, including study staff, researchers, clinicians, and the young people and families who took part, all of whom made it possible to recruit such a large and diverse group of young people. What stood out to me most was that young people with mood-related psychosis, who are often left out of research on early-onset psychosis, also showed cognitive difficulties, and that these appeared to emerge at different ages than in schizophrenia-spectrum psychosis. I was also intrigued by the siblings. Although they performed similarly to the comparison group overall, younger siblings did slightly better than their peers, while young adult siblings showed larger gaps. The sibling group was smaller, so this needs to be repeated, but it raises the possibility that cognitive differences linked to family risk for psychosis only become apparent later in development. For me, the most important next step is to follow these young people over time to see whether the age differences we found reflect real developmental change, and ultimately, which abilities and developmental periods would benefit most from early intervention and cognitive remediation.

Josephine Mollon
Children's Hospital Boston

Read the Original

This page is a summary of: Age-Associated Cognitive Deviations in Early-Onset Psychosis Patients and Their Siblings, American Journal of Psychiatry, September 2026, American Psychiatric Association,
DOI: 10.1176/appi.ajp.20251082.
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