Brain Circuitry in Psychosis Risk: Implications for Early Detection, Referral, and Emerging Treatments

Young people experiencing subtle changes in thinking, perception, mood, or functioning often first present in outpatient, school, pediatric, or primary care settings. Early identification of these warning signs can profoundly alter the trajectory of psychotic disorders, making clinicians and community providers critical partners in prevention and early intervention. In this timely presentation, Dr. William Stone will explore the latest advances in understanding the neurobiology of Clinical High Risk for Psychosis (CHR-P), a state associated with elevated risk for developing psychosis. Drawing on decades of research, Dr. Stone will review how alterations in brain circuitry—including networks involved in cognition, self-referential thinking, and psychotic experiences—may contribute to symptom development and functional decline. Attendees will learn about emerging neuroscience approaches, including recent findings demonstrating that real-time fMRI neurofeedback can alter brain connectivity in youth at CHR-P by strengthening adaptive frontal networks while reducing activity in the brain's default mode network, a system implicated in schizophrenia and related conditions. These findings offer a glimpse into future intervention strategies aimed at modifying risk before the onset of psychosis. The session will also introduce a newly launched research study examining how brain, behavioral, and biological markers change when individuals at high risk for psychosis receive an experimental medication. Although this study is not designed to test treatment efficacy, it represents an important step toward identifying biomarkers that may eventually guide personalized prevention and treatment approaches. A special focus will be placed on cognitive challenges in CHR-P—including difficulties with attention, memory, processing speed, and executive functioning—which are common, highly impactful, and often underrecognized in clinical practice. Dr. Stone will discuss how these cognitive changes affect academic, occupational, and social functioning and how clinicians can better identify and address them. Most importantly, this session will provide practical guidance for clinicians and referral sources: How do we recognize early signs of psychosis risk? When should we refer for specialized assessment? What emerging treatments are on the horizon, and how should we discuss them with patients and families? This presentation is especially relevant for outpatient mental health clinicians, school-based providers, pediatricians, primary care clinicians, social workers, counselors, and others who work with adolescents and young adults experiencing early changes in mental health or functioning. Early recognition can change lives. Join us to learn how advances in neuroscience are shaping the future of psychosis prevention—and what clinicians can do today.