Research to investigate the most challenging symptom of psychosis

Psychotic disorders affect around 1% of the population worldwide. They are amongst the most severe and disabling of all mental disorders and have a disproportionately high social and economic cost [PDF 1519KB].

Finding ways to intervene as early as possible is one of the most effective ways we can reduce the burden of psychosis. That’s where our funding comes in.

While psychosis is commonly associated with hallucinations and delusions, one of the most challenging symptoms for people experiencing psychotic disorders is the impact it can have on cognition. This can range from difficulty in identifying emotions in other people to memory loss or challenges with decision-making. 

These symptoms often appear well before the first psychotic episode and continue as the condition develops. This can have a severe and disabling impact on someone’s life, impacting their relationships, employment and ability to carry out day-to-day tasks. 

However, very few options exist to predict, assess or treat cognitive impairments. That’s why we’re funding research that both tests new treatments and explores future opportunities for interventions.

Our cognition Mental Health Award is providing £16.8 million in funding. 

The teams will work closely with people with lived experience of psychosis to develop and evaluate interventions to improve cognitive outcomes in people experiencing, or at risk of, psychosis, and increase our understanding of potential markers of cognitive functioning. 

Find out more about the projects we're funding:

Can immersive virtual reality be used to improve social cognition in young people with early psychosis?

Professor Andrew Thompson and Dr Roos Pot-Kolder
University of Melbourne, Australia

Psychotic disorders first start to emerge in adolescence. One of the symptoms that has the biggest impact on quality of life is impaired social cognition, which is the ability to process and use social information. Immersive virtual reality (VR) has been identified as an innovative tool because it addresses many of the current treatment challenges and is especially engaging for young people. However, no VR treatment has been designed specifically for improving social cognition in early psychosis. Professor Thompson and Dr Pot-Kolder will lead a team to co-design and evaluate a VR therapy for improving social cognition impairments and social functioning in young people with early psychosis.

Does sleep therapy improve cognitive functioning for people at the early stages of psychosis?

Professor Daniel Freeman 
University of Oxford, UK

Sleep disturbances are highly common in patients with psychosis but rarely treated. Professor Freeman and his team have developed an eight-session therapy for sleep problems in psychosis – ranging from stimulus control to methods for desensitising to the bedroom when it has been associated with past trauma. In the largest study of its kind, the team will investigate whether treating sleep problems also brings other benefits, such as in cognitive functioning and psychiatric symptoms, for people at the early stages of psychosis. 

Can new pharmacological treatment pathways impact cognitive symptoms in early psychosis?

Professor Belinda Lennox 
University of Oxford, UK

All licensed pharmacological treatments for psychosis act by blocking dopamine signalling. These drugs do not lead to improvements in cognition, which is a core symptom associated with early psychosis. Independent lines of research have recently identified several molecules with therapeutic potential that instead act on muscarinic, endocannabinoid and glutamatergic signalling. Professor Lennox and her team will examine these non-dopaminergic interventions for cognitive symptoms and investigate how improving cognition may translate into changes in quality of life for people experiencing early psychosis.

Can transcranial magnetic stimulation improve social cognition?

Dr Anil Malhotra 
Feinstein Institutes for Medical Research, USA 

Previous research has shown that social cognitive performance is made up of several components that include basic emotion detection skills and higher social cognitive functions, referred to as the ‘mentalizing’ factor. In this study, Dr Malhotra and his team will examine if repetitive transcranial magnetic stimulation (a non-invasive procedure that uses magnetic fields to influence brain activity) in an area of the brain associated with the mentalizing factor improves social cognitive performance in young people with psychosis who are early in the course of their illness.

How can sleep measurements inform interventions for children and young people at high risk of psychosis?

Professor Matt Jones 
University of Bristol, UK

Evidence links sleep to both cognitive function and psychosis risk. However, the details of when and how sleep impacts them remain unclear. In this study, Professor Jones and his multidisciplinary team will evaluate if sleep can be used to determine personalised care for children and young people at a genetically high risk of psychosis. To do this, they will use longitudinal measures of sleep behaviour and neurophysiology, as well as cognitive and clinical assessments, to co-design, test and validate graded measures of sleep and cognition using wearable technology and app-based metrics.

Can a smartphone app be used to measure cognition in early psychosis?

Dr John Torous 
Beth Israel Deaconess Medical Centre, US and India

For people experiencing psychosis, there are no clinically available methods for rapidly assessing or monitoring cognition in real-time. This lack of measurement has limited our understanding and effective treatment of these symptoms. Dr Torous and his team have already developed and piloted the open-source mindLAMP app which can offer smartphone-based assessments of processing speed and working memory. In this study, they will assess if an expanded battery of tests can be used to capture cognitive data for people experiencing early psychosis.

Could changes in glutamate predict treatment outcomes in psychosis?

Dr Claudia Danielmeier 
University of Nottingham, UK 

Current interventions aiming to improve cognitive functioning in psychosis are beneficial for some individuals but not others. Differences in treatment outcomes could be linked to underlying neurotransmitters, like glutamate. Dr Danielmeier will lead a team investigating if changes in glutamate levels could act as a new marker for cognitive treatment outcomes in individuals with first-episode psychosis. They will measure alterations in brain glutamate levels while participants complete a cognitive task and examine if it can predict changes in cognition.

Can machine learning help to predict the progression of psychosis?

Professor Andre Marquand 
Radboud University Medical Centre, The Netherlands

Cognitive impairments are common in early psychosis and they have a substantial impact on quality of life. Professor Marquand and his team will model cognitive data from tens of thousands of people with and without psychosis to determine early risk factors of psychosis. They will develop deep learning technology to aggregate large amounts of cognitive data, map variation across the lifespan and cognitive areas, and identify methods for predicting the onset and progression of psychosis.

By improving our understanding of cognition impairment, and the ways that we can identify, predict and intervene as early as possible, we hope to address an unmet need for people experiencing, or at risk of, psychosis. 

But we won’t stop there. We want to create transformative change in mental health research so that people experiencing mental health challenges can thrive. 

To do this, we will be launching more collaborative and transdisciplinary funding calls, inviting research teams from a diverse range of backgrounds and disciplines, and people with lived experience, to help improve understanding and intervention across depression, anxiety and psychosis.