Sleep disturbances as an early indicator of psychotic disorders in adolescents and young adults

Sleep disturbances are increasingly recognized as clinically relevant markers in the early detection of psychotic disorders among adolescents and young adults. These disturbances, including insomnia, circadian rhythm disruptions, parasomnias, and fragmented sleep, affect up to 70% of individuals at clinical high risk for psychosis, rising to 80% in fully developed schizophrenia. This review synthesizes current evidence on the relationship between sleep problems and early psychotic symptoms, emphasizing their potential as observable and possibly modifiable indicators of illness onset. Neurobiological mechanisms suggest overlapping pathways for both sleep problems and the development of psychotic symptoms involving dopaminergic, serotonergic, and hormonal dysregulation, which are additionally exacerbated by psychological factors such as stress, substance use, and poor sleep hygiene. Screening methods, such as self-report questionnaires, actigraphy, and polysomnography, have demonstrated utility in identifying individuals at risk. Furthermore, sleep-focused interventions, particularly cognitive behavioral therapy, show promise in alleviating both sleep and psychiatric symptoms. Despite methodological limitations of available research, including heterogeneous study designs and short follow-ups, sleep assessment can represent a low-cost, scalable tool for early intervention. Future research should prioritize longitudinal, multimodal studies and explore personalized, sleep-centered preventive strategies. Furthermore, sleep disorders could be considered not only as early signs of developing psychosis but also as a potential therapeutic target in psychosis prevention.