Fig. 1.

Onset of psychotic disorder. The core vulnerability underlying psychosis is portrayed as subtle alterations in the way individuals process environmental stimuli from moment to moment in the flow of daily life, giving rise to altered representations of the environment in the form of, for example, fluctuating paranoid feelings, negative affective states, or reduced incentive for environmental interactions (microphenotype). In some individuals, these states tend to persist from moment to moment, under the influence of interacting genetic and environmental factors (G × E), at some stage giving rise to noticeable psychotic experiences, for example in the form of habitual paranoid ideation (extended phenotype). Persistence of these psychotic experiences over months or even years, under the influences of interacting genetic and environmental factors (G ×E), and depending on the degree of copresence of affective dysregulation, motivational impairment, and cognitive alterations, increases the risk for onset of psychotic disorder (illness macrophenotype) with a high likelihood of disease expression over a period of many years.