Since the introduction of antipsychotics like chlorpromazine in 1952, progress in improving the long-term outcomes for patients with schizophrenia has been limited. The focus on treating psychosis, which is not the core issue of schizophrenia according to early researchers like Kraepelin and Bleuler, has contributed to this stagnation. Both emphasized cognitive and social decline as more central to the disorder.

Recent research shows that schizophrenia begins with cognitive and brain development abnormalities well before psychosis appears. Studies reveal that cognitive decline, particularly in areas such as IQ and school performance, precedes psychosis by many years. Brain imaging studies also indicate that reduced brain volumes and abnormal brain maturation processes, including synaptic pruning during adolescence, are associated with schizophrenia risk. These findings suggest that the disorder may be better understood by focusing on early cognitive and brain development changes rather than psychosis. To improve outcomes, future research should prioritize large-scale, longitudinal studies examining cognitive, genetic, and brain development factors in early adolescence.

Reference: Kahn RS. On the Origins of Schizophrenia. Am J Psychiatry. 2020;177(4):291-297. doi: 10.1176/appi.ajp.2020.20020147.