Psychotic disorders, including schizophrenia and affective psychosis, affect ~3% of the population and typically emerge in early adulthood. Cardiometabolic disease accounts for much of the 20-year life-expectancy gap in psychosis. Evidence indicates potentially causal processes, often seen in aging, act within and beyond the brain, and before the onset of treatment; these include inflammation, metabolic and mitochondrial dysfunction. Here we synthesize evidence and propose a framework that proposes psychosis as a multisystem disorder of accelerated aging, and outline implications for aging-targeted interventions.