Risk Stratification in the Schizophrenia Prodrome: Psychotic Symptoms, Cannabis Use, and Stress

Cheryl Corcoran, MD, recipient of the Alexander Gralnick Award from the American Psychiatric Association, described her upcoming presentation on analyzing schizophrenia risk with computational phenotyping.

Corcoran explained that approximately 80% of individuals who develop schizophrenia experience a prodromal period characterized by attenuated or subthreshold psychotic symptoms, and that among those identified as clinically at risk for psychosis, 10 to 25% ultimately progress to a full psychotic disorder.^1,2 She described the phenomenology of this prodromal state: rather than frank hallucinations or fixed delusions, affected individuals (typically teenagers and young adults) experience perceptual distortions such as hearing their name in ambient sounds, altered color perception, or unusual bodily sensations, as well as compelling but not fully formed delusional beliefs. A key differentiating feature, Corcoran noted, is that prodromal individuals retain insight and actively grapple with these experiences, uncertain whether they are real.

Corcoran outlined her multimodal research program, which has combined qualitative open-ended interviews to characterize the subjective experience of psychosis risk with collaborative neuroimaging, electroencephalography, and fluid biomarker studies—including blood, saliva, and cerebrospinal fluid—to identify biological correlates of the emerging psychosis risk state.

She also addressed modifiable risk factors, identifying stress and cannabis use as primary targets for intervention. She noted that for individuals with a biological liability for psychosis, cannabis use meaningfully increases the probability of progression to a psychotic disorder, framing both stress management and cannabis reduction as clinically actionable strategies during the prodromal window.

Dr Corcoran is a professor of psychiatry at the Icahn School of Medicine at Mount Sinai.

References

1. Tandon N, Shah J, Keshavan MS, et al. Attenuated psychosis and the schizophrenia prodrome: current status of risk identification and psychosis prevention. Neuropsychiatry (London). 2012;2(4):345-353.

2. Hijazi H, Moukaddam N. Prodromal symptoms of schizophrenia: understanding and addressing challenges. Psychiatric Times. June 18, 2025. https://www.psychiatrictimes.com/view/prodromal-symptoms-of-schizophrenia-understanding-and-addressing-challenges