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This dissertation summarizes the early illness course of schizophrenia patients who experienced their first psychosis and were followed for a year while treated as usual in clinical practice.

Individual differences in the course of psychotic symptoms and overall functioning were found, demonstrating various trajectories in both outcomes. In general, patients showed stable functional brain network connectivity patterns comparable to that of healthy controls, which were unrelated to cognitive performance. Cognitive impairments were present in various domains and relatively stable over twelve months, but the trajectories from childhood to illness onset as well as the severity of cognitive impairment after the first psychosis differed considerably between patients.

Our findings confirm the importance of making patient-level predictions rather than predicting prognosis on group level, but also demonstrate that, currently, personalized treatment decisions remain challenging, due to e.g. the variability in patient characteristics and outcome measures between studies. We showed the value of advanced statistical methods to increase our understanding of the variable illness courses, e.g., providing the opportunity to investigate multiple predictors of outcome simultaneously, or to identify patient subgroups with similar clinical profiles. Future research using these techniques, as well as efforts to reach greater consensus on outcome definitions across studies, may help identify high-risk groups, such as those at risk of relapse, cognitive or functional impairment. Ultimately, these groups may offer relevant insights for clinical practice by guiding treatment choices, for example, determining who are most likely to benefit from cognitive training or require additional support in daily functioning.