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medRxiv PreprintsInternational1 November 2026

Ultra-rare coding variants in schizophrenia risk genes are associated with longitudinal phenotypic differences across psychotic disorders

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Background: The Schizophrenia Exome Meta-Analysis (SCHEMA) Consortium has recently identified 40 genes at a false discovery rate <0.05 in which ultra-rare damaging variants substantially increase schizophrenia (SZ) risk. However, the impact of these variants on clinical trajectories across the psychosis spectrum is not yet known. Methods: We screened 9,821 sequenced participants with psychotic disorders who passed genomic quality control from the SUPER-Finland psychosis study for ultra-rare variants predicted to be damaging in these 40 SZ-associated genes, identifying 163 variant carriers. To
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