̽��ֱ�� of Cambridge - psychosis

Collaboration Award 2024

zs332 — Mon, 03 Feb 2025 10:55:33 +0000

̽��ֱ��2024 Collaboration Award winner is Representing psychosis in video games: Communicating clinical science and tackling stigma, a project led by Prof Paul Fletcher Department of Psychiatry, School of Clinical Medicine, Clare College.

̽��ֱ��Pict warrior fighting her inner demons

cjb250 — Wed, 11 Sep 2019 14:46:53 +0000

How games developers, a Cambridge psychiatrist and people who live with hearing voices helped bring to life the psychoses experienced by the lead character in a BAFTA award-winning video game.

Psychotic disorders in minority groups: the high price of being an ‘outsider’

amb206 — Fri, 01 Apr 2016 12:00:00 +0000

In 1932 a psychiatrist called Ornulv Odegaard published a paper in which he reported that Norwegian immigrants in Minnesota had a much higher incidence of mental health problems than Norwegians back in their home country of Norway. ̽��ֱ��percentage of people in the Norwegian immigrant population experiencing such disorders was also much higher than it was among other minority groups in America.

“We’ve known for a long time that immigrant populations experience a greater frequency of psychotic disorders than the host population – and that it’s higher in immigrant groups than in the populations of the countries they have left,” says Hannah Jongsma, a PhD candidate in the Department of Psychiatry.

“Odegaard’s study is striking because he was the first researcher to carry out an academically robust study showing these variations. His findings were frequently interpreted to suggest a ‘selective migration’ hypothesis – and that those who migrated were somehow innately at a higher risk of developing psychotic disorders. This hypothesis has since been thoroughly tested and found to be false.”

Jongsma’s doctoral research draws on data gathered by an ambitious in-depth study of schizophrenia and other psychotic disorders in six countries. The data she uses was gathered by a project known as EU-GEI which sought to identify the interactive genetic, clinical and environmental determinants, involved in the development, severity and outcome of schizophrenia, right across the population of a number of countries.

Next week (2-6 April 2016) Jongsma will present her first findings from the EU-GEI study at the 5th Biennial Schizophrenia International Research Society Conference in Florence, Italy. Her presentation will give an overview of the incidence rates of psychotic disorders (the number of new cases per head of the population) and look at variations between the different study settings.

“My research looks specifically at the experiences of minority communities – for example British citizens with Trinidadian heritage,” says Jongsma. “ ̽��ֱ��data I’m using is from the case-control arm of the EU-GEI study and based on six-hour interviews and assessments with individuals who experienced a first episode of psychosis, their siblings and healthy controls. As far as I know, it is the most ambitious study of its kind to date, combining a rich set of socio-demographic, clinical and cognitive variables with a very large sample size – more than 2,000 people across the three groups.”

Although she has a background in public health, Jongsma’s undergraduate degree was in liberal arts and she holds a masters in philosophy. “As someone without a medical training, I was thrilled to be offered this PhD position in the Department of Psychiatry,” she says. “What I bring to my work on psychosis in minority communities is an ability to look at things from different points of view – a skill you develop when you study philosophy. I find the ability to think at different levels of abstraction has really helped my understanding of psychosis. I’m able to relate societal level variables, such as racial discrimination, to an individual’s chance of developing a psychotic disorder.”

It’s estimated that, in the UK, one in four people experience a mental health problem each year, and one in hundred will experience a psychotic disorder. Psychosis is a catch-all term that covers disorders of thought and perception that may have organic causes (such as a brain lesion or abuse of alcohol or other drugs) as well as a range of genetic components and environmental triggers. ̽��ֱ��World Health Organisation divides psychosis into affective and non-affective disorders. Affective disorders are dominated by their effects on mood and include depression and bipolar disorder. Non-affective disorders are not dominated by their effects on mood and include schizophrenia and delusional disorders.

“It’s likely that psychosis often develops as a consequence of a cluster of factors which have a cumulative effect and stack up to have a negative effect on psychological well-being. ̽��ֱ��factors that interest me most are the cultural and societal ones,” says Jongsma. “One of the great strengths of a university as broad as Cambridge is that it encourages dialogues between, for instance, neuroscientists, geneticists and epidemiologists. For the researcher, this provides valuable opportunities to exchange and develop ideas.”

̽��ֱ��EU-GEI data on which Jongsma is basing her research was gathered in Brazil, England, France, Italy, the Netherlands and Spain. It confirms that psychosis often presents in late adolescence and peaks in adulthood – and that men are more vulnerable. “Our data also shows that psychosis is more prevalent in urban compared to rural areas. Rural Spain showed the lowest incidence and south-east London the highest,” says Jongsma.

Research has shown that the high incidence of psychosis in minority communities is not limited to first-generation immigrants who might have experienced stress and upheaval in moving countries and finding their feet in a new culture.

“Second and subsequent generations are similarly vulnerable to higher levels of psychosis than the majority population around them. Second generation immigrants may struggle with finding a clear identity and experience a conflict in their affiliations and loyalties – on the one hand with the culture of their parents and on the other with the culture of the wider community,” suggests Jongsma. “Interestingly the density of an immigrant community sometimes seems to have a protective effect – in other words, the denser the immigrant community, the lower the level of psychosis – while sometimes the opposite is apparent.”

When a particular, and easily identifiable, community is seen to have raised levels of mental illness, there is a real danger of stereotyping. “In the UK, it is well known that psychotic disorders are particularly prevalent among Afro-Caribbeans who represent one of the largest groups of immigrants,” says Jongsma. “But, in the Netherlands, where I come from, psychosis is most common among Moroccan immigrants. To me, this suggests we need to look at the role these groups hold in society. Both minority groups suffer from deep-seated prejudices and discrimination.”

One possible reason for raised levels of psychotic disorders in minority groups is their lack of economic and social status. ‘Social defeat’ is a term coined by Professor Jean-Paul Selten (Maastricht ̽��ֱ��) and colleagues to describe the persistent negative experience of being excluded from the majority population. “This idea makes an interesting starting point for trying to understand the root causes of psychotic disorders,” says Jongsma. “Being at the lowest rung of the ladder has been shown to be stressful in primates and is likely to have the same effect on humans.”

̽��ֱ��freedom to express cultural identity is important to mental health. “Identities are formed and maintained on the basis of complex interactions with, and imitations of, those around us – and this social aspect of identity is crucial. Empathy with others and seeing them as fellow citizens, for example, comes from shared identity. It might be the case that minorities are excluded from the group of people regarded as fellow citizens,” says Jongsma.

With so many factors in the mix, unravelling the cause and effect of psychotic disorders will continue to present a challenge. For example, does an individual become mentally unwell as a consequence of being isolated – or does he or she withdraw as a result of being unwell? Genetic factors play a part as do environmental factors such as childhood trauma, cannabis use and deprivation.

“One of the arguments I find very interesting to explore is that psychosocial disempowerment could be seen as an explanatory framework. Over a long period, the feeling that you’re not in control of your life, and that you’re stuck in a hopeless situation that’s unlikely to improve, has been shown to increase mortality and the chance of developing physical illnesses such as heart attacks. I think it is important to look at this in the context of mental illness too,” says Jongsma.

“Poor health is strongly linked to deprivation and inequality – and all that comes with disadvantage. This is as true for heart disease and diabetes as it is for mental illness. In order to improve public mental health, we will have to look not just at the individuals who develop psychotic disorders, but at society more broadly.”

Hannah Jongsma is attending the 5th Biennial Schizophrenia International Research Society Conference with a travel grant awarded by the organisers.

Immigrant groups experience a high incidence of mental illness. Hannah Jongsma (Department of Psychiatry) is looking at data from an international study of the distribution of psychotic disorders. She suggests that ‘psychosocial disempowerment’ might be a powerful contributing factor to raised levels in minority communities.

Identities are formed and maintained on the basis of complex interactions with, and imitations of, those around us – and this social aspect of identity is crucial.

Hannah Jongsma

Robert Swier (Flickr Creative Commons)

Still, In a Crowd

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How hallucinations emerge from trying to make sense of an ambiguous world

cjb250 — Mon, 12 Oct 2015 19:00:41 +0000

Take a look at the black and white image. It probably looks like a meaningless pattern of black and white blotches. But now take a look at the image at the bottom of this article and then return to the black and white picture: it’s likely that you can now make sense of the black and white image. It is this ability that scientists at Cardiff ̽��ֱ�� and the ̽��ֱ�� of Cambridge believe could help explain why some people are prone to hallucinations.

A bewildering and often very frightening experience in some mental illnesses is psychosis – a loss of contact with external reality. This often results in a difficulty in making sense of the world, which can appear threatening, intrusive and confusing. Psychosis is sometimes accompanied by drastic changes in perception, to the extent that people may see, feel, smell and taste things that are not actually there – so-called hallucinations. These hallucinations may be accompanied by beliefs that others find irrational and impossible to comprehend.

In research published today in the journal Proceedings of National Academy of Sciences (PNAS), a team of researchers based at Cardiff ̽��ֱ�� and the ̽��ֱ�� of Cambridge explore the idea that hallucinations arise due to an enhancement of our normal tendency to interpret the world around us by making use of prior knowledge and predictions.

In order to make sense of and interact with our physical and social environment, we need appropriate information about the world around us, for example the size or location of a nearby object. However, we have no direct access to this information and are forced to interpret potentially ambiguous and incomplete information from our senses. This challenge is overcome in the brain – for example in our visual system – by combining ambiguous sensory information with our prior knowledge of the environment to generate a robust and unambiguous representation of the world around us. For example, when we enter our living room, we may have little difficulty discerning a fast-moving black shape as the cat, even though the visual input was little more than a blur that rapidly disappeared behind the sofa: the actual sensory input was minimal and our prior knowledge did all the creative work.

“Vision is a constructive process – in other words, our brain makes up the world that we ‘see’,” explains first author Dr Christoph Teufel from the School of Psychology at Cardiff ̽��ֱ��. “It fills in the blanks, ignoring the things that don’t quite fit, and presents to us an image of the world that has been edited and made to fit with what we expect.”

“Having a predictive brain is very useful – it makes us efficient and adept at creating a coherent picture of an ambiguous and complex world,” adds senior author Professor Paul Fletcher from the Department of Psychiatry at the ̽��ֱ�� of Cambridge. “But it also means that we are not very far away from perceiving things that aren’t actually there, which is the definition of a hallucination.

“In fact, in recent years we’ve come to realise that such altered perceptual experiences are by no means restricted to people with mental illness. They are relatively common, in a milder form, across the entire population. Many of us will have heard or seen things that aren’t there.”

In order to address the question of whether such predictive processes contribute to the emergence of psychosis, the researchers worked with 18 individuals who had been referred to a mental health service run by the NHS Cambridgeshire and Peterborough Foundation Trust, and led by Dr Jesus Perez, one of the co-authors on the study, and who suffered from very early signs of psychosis. They examined how these individuals, as well as a group of 16 healthy volunteers, were able to use predictions in order to make sense of ambiguous, incomplete black and white images, similar to the one shown above.

̽��ֱ��volunteers were asked to look at a series of these black and white images, some of which contained a person, and then to say for a given image whether or not it contained a person. Because of the ambiguous nature of the images, the task was very difficult at first. Participants were then shown a series of full colour original images, including those from which the black and white images had been derived: this information could be used to improve the brain’s ability to make sense of the ambiguous image. ̽��ֱ��researchers reasoned that, since hallucinations may come from a greater tendency to superimpose one’s predictions on the world, people who were prone to hallucinations would be better at using this information because, in this task, such a strategy would be an advantage.

̽��ֱ��researchers found a larger performance improvement in people with very early signs of psychosis in comparison to the healthy control group. This suggested that people from the clinical group were indeed relying more strongly on the information that they had been given to make sense of the ambiguous pictures.

When the researchers presented the same task to a larger group of 40 healthy people, they found a continuum in task performance that correlated with the participants’ scores on tests of psychosis-proneness. In other words, the shift in information processing that favours prior knowledge over sensory input during perception can be detected even before the onset of early psychotic symptoms.

“These findings are important because they tell us that the emergence of key symptoms of mental illness can be understood in terms of an altered balance in normal brain functions,” says Naresh Subramaniam from the Department of Psychiatry at the ̽��ֱ�� of Cambridge. “Importantly, they also suggest that these symptoms and experiences do not reflect a ‘broken’ brain but rather one that is striving – in a very natural way – to make sense of incoming data that are ambiguous.”

̽��ֱ��study was carried out in collaboration with Dr Veronika Dobler and Professor Ian Goodyer from the Department of Child and Adolescent Psychiatry at the ̽��ֱ�� of Cambridge. ̽��ֱ��research was funded by the Wellcome Trust and the Bernard Wolfe Health Neuroscience Fund. It was carried out within the Cambridge and Peterborough NHS Foundation Trust. Additional support for the Behavioural and Clinical Neuroscience Institute at the ̽��ֱ�� of Cambridge came from the Wellcome Trust and the Medical Research Council.

Reference
Teufel, C et al. Shift towards prior knowledge confers a perceptual advantage in early psychosis and psychosis-prone healthy individuals. PNAS; 12 Oct 2015

Why are some people prone to hallucinations? According to new research from the ̽��ֱ�� of Cambridge and Cardiff ̽��ֱ��, hallucinations may come from our attempts to make sense of the ambiguous and complex world around us.

August Natterer

Meine Augen zur Zeit der Erscheinungen

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Mind and body: Scientists identify immune system link to mental illness

cjb250 — Wed, 13 Aug 2014 20:00:00 +0000

̽��ֱ��study, published today in JAMA Psychiatry, indicates that mental illness and chronic physical illness such as coronary heart disease and type 2 diabetes may share common biological mechanisms.

When we are exposed to an infection, for example influenza or a stomach bug, our immune system fights back to control and remove the infection. During this process, immune cells flood the blood stream with proteins such as interleukin-6 (IL-6), a tell-tale marker of infection. However, even when we are healthy, our bodies carry trace levels of these proteins – known as ‘inflammatory markers’ – which rise exponentially in response to infection.

Now, researchers have carried out the first ever longitudinal study – a study that follows the same cohort of people over a long period of time – to examine the link between these markers in childhood and subsequent mental illness.

A team of scientists led by the ̽��ֱ�� of Cambridge studied a sample of 4,500 individuals from the Avon Longitudinal Study of Parents and Children – also known as Children of the 90s – taking blood samples at age 9 and following up at age 18 to see if they had experienced episodes of depression or psychosis. ̽��ֱ��team divided the individuals into three groups, depending on whether their everyday levels of IL-6 were low, medium or high. They found that those children in the ‘high’ group were nearly two times more likely to have experienced depression or psychosis than those in the ‘low’ group.

Dr Golam Khandaker from the Department of Psychiatry at the ̽��ֱ�� of Cambridge, who led the study, says: “Our immune system acts like a thermostat, turned down low most of the time, but cranked up when we have an infection. In some people, the thermostat is always set slightly higher, behaving as if they have a persistent low level infection – these people appear to be at a higher risk of developing depression and psychosis. It’s too early to say whether this association is causal, and we are carrying out additional studies to examine this association further.”

̽��ֱ��research indicates that chronic physical illness such as coronary heart disease and type 2 diabetes may share a common mechanism with mental illness. People with depression and schizophrenia are known to have a much higher risk of developing heart disease and diabetes, and elevated levels of IL-6 have previously been shown to increase the risk of heart disease and type 2 diabetes.

Professor Peter Jones, Head of the Department of Psychiatry and senior author of the study, says: “Inflammation may be a common mechanism that influences both our physical and mental health. It is possible that early life adversity and stress lead to persistent increase in levels of IL-6 and other inflammatory markers in our body, which, in turn, increase the risk of a number of chronic physical and mental illness.”

Indeed, low birth weight, a marker of impaired foetal development, is associated with increased everyday levels of inflammatory markers as well as greater risks of heart disease, diabetes, depression and schizophrenia in adults.

This potential common mechanism could help explain why physical exercise and diet, classic ways of reducing risk of heart disease, for example, are also thought to improve mood and help depression. ̽��ֱ��group is now planning additional studies to confirm whether inflammation is a common link between chronic physical and mental illness.

̽��ֱ��research also hints at interesting ways of potentially treating illnesses such as depression: anti-inflammatory drugs. Treatment with anti-inflammatory agents leads to levels of inflammatory markers falling to normal. Previous research has suggested that anti-inflammatory drugs such as aspirin used in conjunction with antipsychotic treatments may be more effective than just the antipsychotics themselves. A multicentre trial is currently underway, into whether the antibiotic minocycline, used for the treatment of acne, can be used to treat lack of enjoyment, social withdrawal, apathy and other so called negative symptoms in schizophrenia. Minocycline is able to penetrate the ‘blood-brain barrier’, a highly selective permeability barrier which protects the central nervous system from potentially harmful substances circulating in our blood.

̽��ֱ��‘blood-brain barrier’ is also at the centre of a potential puzzle raised by research such as today’s research: how can the immune system have an effect in the brain when many inflammatory markers and antibodies cannot penetrate this barrier? Studies in mice suggest that the answer may lie in the vagus nerve, which connects the brain to the abdomen. When activated by inflammatory markers in the gut, it sends a signal to the brain, where immune cells produce proteins such as IL-6, leading to increased metabolism (and hence decreased levels) of the ‘happiness hormone’ serotonin in the brain. Similarly, the signals trigger an increase in toxic chemicals such as nitric oxide, quinolonic acid, and kynurenic acid, which are bad for the functioning of nerve cells.

̽��ֱ��research was mainly funded by the Wellcome Trust, with further support from the National Institute for Health Research Cambridge Biomedical Research Centre and the Medical Research Council.

Children with high everyday levels of a protein released into the blood in response to infection are at greater risk of developing depression and psychosis in adulthood, according to new research which suggests a role for the immune system in mental illness.

Inflammation may be a common mechanism that influences both our physical and mental health

Peter Jones

Stu

Burnt out

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Antipsychotic drugs linked to slight decrease in brain volume

cjb250 — Fri, 18 Jul 2014 18:00:00 +0000

As we age, our brains naturally lose some of their volume – in other words, brain cells and connections. This process, known as atrophy, typically begins in our thirties and continues into old age. Researchers have known for some time that patients with schizophrenia lose brain volume at a faster rate than healthy individuals, though the reason why is unclear.

Now, in a study published in the open access journal PLOS ONE, a team of researchers from the ̽��ֱ�� of Oulu, Finland, and the ̽��ֱ�� of Cambridge has identified the rate of decrease in both healthy individuals and patients with schizophrenia. They also documented where in the brain schizophrenia patients have more atrophy, and have examined links between atrophy and antipsychotic medication.

By comparing brain scans of 33 patients with schizophrenia with 71 control subjects over a period of 9 years – from age 34 to 43 – the researchers were able to show that schizophrenia patients lost brain volume at a rate of 0.7% each year. ̽��ֱ��control participants lost brain volume at a rate of 0.5% per year.

Scientists have previously speculated that antipsychotic medication used to treat schizophrenia may be linked to this decrease in brain volume. Today’s research confirms this association, showing that the rate of decrease in volume was greater when the dose of medication was higher. However, the mechanisms behind this – and whether it was in fact the medication that was causing this greater loss of tissue – are not clear. Some researchers have previously argued that whilst older antipsychotic medications might cause brain volume decreases, newer antipsychotic medications may protect against these decreases. However, today’s research suggests that both classes of antipsychotic medication are associated with similar declines in brain volume.

̽��ֱ��researchers also looked at whether there was any link between the volume of brain lost and the severity of symptoms or loss of cognitive function, but found no effect.

Professor Juha Veijola from the Department of Psychiatry at the ̽��ֱ�� of Oulu, Finland says: “We all lose some brain tissue as we get older, but people with schizophrenia lose it at a faster rate. We’ve shown that this loss seems to be linked to the antipsychotic medication people are taking. Research like this where patients are studied for many years can help to develop guidelines about when clinicians can reduce the dosage of antipsychotic medication in the long term treatment of people with schizophrenia.”

“It’s important to stress that the loss of brain volume doesn’t appear to have any effect on people over the nine year follow-up we conducted, and patients should not stop their medication on the basis of this research, ” adds Dr Graham Murray from the Behavioural and Clinical Neuroscience Institute and the Department of Psychiatry at ̽��ֱ�� of Cambridge. “A key question in future will be to examine whether there is any effect of this loss of brain volume later in life. We need more research in larger studies with longer follow-ups to evaluate the significance of these brain changes.”

̽��ֱ��research was supported by the Academy of Finland, Medical Research Council, Sigrid Jusélius Foundation, and the Brain and Behavior Research Foundation.

A study published today has confirmed a link between antipsychotic medication and a slight, but measureable, decrease in brain volume in patients with schizophrenia. For the first time, researchers have been able to examine whether this decrease is harmful for patients’ cognitive function and symptoms, and noted that over a nine year follow-up, this decrease did not appear to have any effect.

̽��ֱ��loss of brain volume doesn’t appear to have any effect on people, and patients should not stop their medication on the basis of this research

Graham Murray

Adrian Cousins, Wellcome Images

Schizophrenia - hearing voices (Artist's illustration)

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