Synergistic pathways to psychosis: understanding developmental risk and resilience factors

Psychotic disorders are complex and debilitating conditions that arise from the interplay of genetic and environmental factors. A wealth of research has identified various factors that confer risk for psychosis, while comparatively less work has focused on identifying protective or resilience-promoting factors that contribute to positive outcomes in the context of psychosis risk. Given the significant heterogeneity of outcomes for individuals at risk for psychosis, it is clear that both risk and resilience factors should be considered. In this narrative review, we synthesize current research on early adversity occurring across pre-/perinatal periods, childhood, and early adolescence, which confer risk for psychosis. We also discuss several protective factors and interventions that may buffer against the effects of early adversity, thus mitigating risk and promoting improved outcomes. By integrating findings across these domains, we underscore the importance of a developmental and multidimensional approach to understanding pathways to psychosis, which may inform future directions for prevention and intervention efforts.