Multimodal measures of inflammation in early-phase psychosis spectrum disorders

Growing evidence points to a causal role for immune dysfunction and oxidative stress in schizophrenia, with direct implications for diagnosis and treatment. This appears to be a transdiagnostic mechanism: similar inflammatory pathways, including elevated interleukin-6 (IL-6/IL6R), are implicated in depression as well as psychosis. This elevation is detectable before treatment begins, suggesting an early biomarker to identify patients across diagnoses who may benefit from immune-targeted therapies. Chronic inflammation also drives the metabolic dysfunction common in schizophrenia, and affects neuronal development, astrocytic function, and grey matter volume, making it a tractable target for interventions addressing psychiatric and physical health.

Translating this biology into clinical benefit requires a clear, reproducible signature of chronic low-level inflammation that clinicians can use to stratify patients and guide treatment choice across diagnoses. The Psychosis Immune Mechanism Stratified Medicine Study (PIMS) is building this evidence base, combining findings across multiple methods, including large real-world datasets, to define who is most likely to respond to immune-based approaches and to chart a path from mechanistic discovery to precision medicine: identifying inflammatory subtypes, validating clinically usable biomarkers, and embedding these into everyday transdiagnostic care.

This presentation outlines recent PIMS evidence, together with early, complementary findings from the Early Psychosis Informatics into Care (EPICare) programme, with a focus on concrete next steps toward clinical implementation.