An international study into why some young people suffer from severe episodes of losing touch with reality – or psychosis – may help health professionals to tailor treatments more effectively.
There is an urgent need to find new treatments for psychosis, an umbrella term that describes a range of conditions that cause someone to sense and believe things that only exist in their mind. Psychosis affects about one person in every hundred per year. It is estimated that 3 in 100 individuals experience psychosis in their lifetime.
Psychosis is a very disruptive and severe mental health state/condition, usually affecting young people in their 20s to early 30s. It typically starts with changes in the way they perceive themselves and the world around them and can go on to result in distressing hallucinations and delusions.
Dr Liliana Galindo, Medical Leader in Psychosis and lead consultant psychiatrist for the CAMEO early intervention service at Cambridgeshire and Peterborough NHS Foundation Trust (CPFT)
“A psychotic episode is an intense and scary experience. Frequently people can’t sleep or eat and endure a lot of distress. They struggle simply to ask for help,” she continues.
The study – called ProNET (Psychosis Risk Outcomes Network) – is being carried out across 26 sites around the world and CPFT was chosen as a centre of excellence to be the UK partner. It aims to find out why certain individuals will develop psychosis as well as improving the treatments – including drugs and psychological therapies – that are available to them.
More than 1000 people aged between 12 and 30 years with clinical high risk of having a psychotic episode, but who have not yet experienced one, are being followed throughout the study. They are assessed using a range of cognitive, psychological, and genetic tests and closely monitored every month for two years. During this time, researchers gather information to help them understand why some develop psychosis, while others do not and can recover.
Globally, we don’t have enough information to understand this. Because current treatment options are very limited, we need to try and find new approaches.
Dr Liliana Galindo
Some 40 young people at high clinical risk from Cambridgeshire and Peterborough are being recruited, as well as 15 healthy controls. All study participants give saliva and blood samples as well as details about mental health within their families. Many of these young people would not meet the current threshold to receive support as their symptoms are not considered sufficiently severe.
The study has already yielded results: “In many cases, we’ve found that just monitoring the intensity of an individual’s symptoms reduces their risk of progressing to psychosis. At the same time, we can detect those people that will transition to psychosis at an earlier point in time,” explains Lili.
She believes that offering people the opportunity to discuss their challenges within a safe space with trained staff contributes to preventing further development of psychosis. There is evidence that clinical monitoring reduces the transition to psychosis in people with clinical high risk.
The researchers are using a new assessment tool: PSYCHS – a semi-structured interview that measures changes in areas like perception, contentment, thoughts, and feelings to diagnose those at clinical high risk.
Psychosis is one of the most misunderstood mental health conditions with many different possible causes, such as trauma, hormonal changes, brain disease or external factors like drugs: “We want to try and identify the triggers for that individual and then tailor their treatment. Starting the right treatment early can help someone at high risk.”
Lili believes that partnerships between organisations across Cambridgeshire create unique research opportunities: “People are curious and challenge themselves. Instead of accepting things as they are, let’s question our models and understand better.”
For example, she is currently working with CPFT, Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge to look into the use of psychedelic drugs to treat patients with serious mental illness. “This is the first trial of its kind in Cambridge; it shows how we can work together to deliver a research intervention that neither organisation could do by itself.”
Originally from Colombia, Lili dreamed of being able to combine her medical training with research. She urges young women, particularly those in developing countries, to pursue their dreams: “I was the first member of my close family to visit Europe. It was a lot of hard work and very challenging.
Believe in yourself. It’s possible to achieve your goals. Find great mentors and surround yourself with people who share the same values.
Dr Liliana Galindo