In Conversation… Psychosis with Dr. Helen Fisher

In this podcast, Dr. Helen Fisher talks about psychosis in young people. The discussion includes the development of psychosis in young people, the risk factors, and how Helen is playing a part to increase the awareness of psychosis to the general public.

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You can find Dr. Helen Fisher on Twitter @HelenLFisher.

Transcript

Intro Speaker:  This podcast is brought to you by the Association for Child and Adolescent Mental Health, ACAMH for short. You can find more podcasts and other resources on our website, www.ACAMH.org and follow us on social media by searching ACAMH.

Interviewer: Hello, and welcome to the ‘In Conversation’ podcast series for The Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a freelance journalist with a specialism in psychology. Today, I’m interviewing Dr. Helen Fisher, reader in developmental psychopathology at The Institute of Psychiatry, Psychology and Neuroscience at King’s College London. Helen has spent nearly two decades researching the aetiology and treatment of psychosis in young people. Welcome, Helen. Hi, thanks for joining me.

Dr. Helen Fisher: Thank you for having me.

Interviewer: Can you start with an instruction about what you do?

Dr. Helen Fisher: Yeah. So, I always consider myself to be an interdisciplinary scientist. So, I have a background originally, in psychology but my PhD is actually in social epidemiology and psychiatric genetics. Then, from that point, I’ve really embraced the idea of interdisciplinarity and have brought lots of different strands. So, things like epigenetics, environmental science, and the arts into the work I do, to really help me understand why young people develop psychosis. So, what puts them at risk but also, what we can do to actually prevent them from developing those problems.

Interviewer: You specialize in the ateoligy and treatment of psychosis in young people and I’m wondering what prompted your initial interest in that area?

Dr. Helen Fisher: Yeah. So, I think two things. The first was that, during my psychology degree, I did a four-year degree where I did a placement with a mental health team to actually understand what that was like, with the idea that I might do clinical psychology, which I didn’t. During that, I had the opportunity to sit in a psychiatric ward round, which is kind of unusual for a 19-year-old to have that opportunity unless you’re actually admitted. It was really fascinating that the first person that came into the world round who sat next to where I was, was a young guy of about the same age as me but huge. So, he was about seven foot tall, about five foot wide, very imposing and had been admitted for psychosis. What was fascinating about it was that he was quivering, sitting next to me because he was completely convinced that I was going to hurt him, which completely, from my point of view was completely the opposite of what I expected. So, for me really, what that made me think about was I really wanted to understand. How could someone get to a point of believing something that was so clearly not true that it really had a physical and emotional effect on them? So, that really led me to wanting to understand how people develop these symptoms, particularly in adolescence where it’s very common.

I think the second thing is that I had an uncle who had chronic schizophrenia, and that’s not actually why I originally was interested in the area. But I guess, this is related. The problem was, at the point at which he was diagnosed, really the only treatment available at that point, other than hospitalization, was he basically stayed at home and took a really strong antipsychotic, which was important to control the symptoms he was experiencing, but meant that he really did nothing else. So, from the age of 15 to 65, he literally sat at home, took his medication, smoked and did nothing with his whole life. He was a lovely guy but it just, to me, was just really upsetting that he just didn’t have the opportunity to live his life or contribute in any way to society. I think that really underlies my real enthusiasm for early intervention. So, really early on when an individual develops psychosis, really going in with a whole range of services to really help them get back on track. Even if they continue to experience symptoms, actually find a way to increase the quality of life, get back into university or a job rather than just a waste, I think.

Interviewer: You described this powerful image of the large patient that you saw very early on in your career. I was wondering what psychosis looks like in young people.

Dr. Helen Fisher: I guess the first thing to say is that actually, I tend to look at psychosis across a full spectrum. So, normally, when we think about psychosis, we think about people who have a full-blown psychotic disorder, so they’re hearing voices. They’re very paranoid. It dominates their whole life, their thinking. It’s having a huge impact on them. It’s incredibly distressing. That kind of psychotic disorder in adolescence, the peak incidence of that is around 17 to 25. So, in late adolescence, early adulthood. From that point on, it is similar. Obviously, in very old age, it is often quite different and so, the kind of symptoms and experiences are the same. I guess, the content of them is sometimes different because it more reflects what’s happening to the person at the time. What is increasingly interesting is that spectrum. There is the lower end. Later in childhood and during early adolescence and also, into adulthood, people having much lower-end spectrum experiences. They may be occasionally hearing a voice or just hearing whisperings or sounds and they’re not quite sure what they are. They’re a little bit more paranoid or jealous. Things are just not quite right. Those experiences tend to occur in late childhood, early adolescence. They continue often, into adulthood but those are the experiences I’m really interested in because I think it’s a good opportunity for us to get in and perhaps, intervene before someone gets to that full-blown state.

Interviewer: And do they get that picked up or do people try and hide those?

Dr. Helen Fisher: Yeah, I think people do hide them. I think in late childhood, early adolescence, people often don’t know what’s going on and I think those kind of experiences are considered really, very taboo, still, in our society. People feel very comfortable talking, maybe wrongly, but talking about feeling depressed and feeling anxious, but they certainly don’t say, I feel psychotic, very often. We all feel like we want to distance ourselves from that. So, I think people do but I think also we never ask. I think until fairly recently, we never knew that children actually, and adolescents, had these kind of experiences because no one actually asked them. I think in large general population studies, a decade or so ago, people started to actually ask. They actually started to ask children in their studies about this, and actually realised that actually, they are much more common than we had expected. And for many kids, they’ll just disappear but for others they will continue and almost regardless of that, they do indicate that those kids will have a lot of problems later, potentially.

Interviewer: What is the prevalence of psychosis in adolescents in the UK?

Dr. Helen Fisher: For psychotic disorder at that full end of the spectrum, it’s around 3%, but it really depends. It’s very socially and geographically patterned. So, it depends on a variety of things. Your ethnic group and in relation to minority status and other things you’re experiencing, whether you live in a city, whether you live in the country. Even within the UK, it does actually fluctuate quite a bit. At the lower end of the spectrum, really attenuated experiences can occur in up to about 30% of the adolescent population. For more strictly defined symptoms, really hearing a voice but without having all the other problems that lead to a disorder, that’s around 5%, 6% and dissipates a little bit through adolescence.

Interviewer: Going back to that interplay of psychosis and childhood maltreatment and victimization. I know a lot of your research centers around that. Can you say a bit more about that, the interplay between those two?

Dr. Helen Fisher: Yeah. So, there’s been a growing area of research over the last decade or so and lots of different people involved, really showing that several different types of victimization… Ones that study abuse but also, neglect and bullying and witnessing violence within the home, all seem to be associated, with around a two-fold increased risk of having these symptoms in childhood and adolescence. Certainly also, with them persisting over time and we think that’s for a variety of reasons. It may be that actually, it’s associated with other things that we’re not taking to account but it’s probably to do with what that means for the person, psychologically and biologically. Some of those things, not all of them, things like sexual abuse and bullying, can be very stressful. We know that stress has a biological reaction. We can feel it when we feel stressed and we know that the inflammation and other things that that causes can alter how the brain works and that can lead to changes that may actually trigger these symptoms. We also know that if you experience those things, particularly pervasive, so particularly multiple types. At home, you’re getting abused, you go to school, someone’s victimizing you online, someone’s bullying you. It becomes a pervasive thing, that your view of the world as you’re growing up, starts to change.

It isn’t uncommon for people in those situations to start, as a way of protecting themselves, attribute hostility to everybody that they start to meet because they’re trying to protect themselves. They might begin to think that other people are likely to hurt them, as a protective thing to keep themselves away, which would be sensible in that situation. It doesn’t take much then, for that idea to develop into something more like paranoia or a more persecutory type of delusion.

Also, if you’ve been victimised, you might also be struggling to relate to other people. You might not have as much support as you might have, otherwise. It may be that if you have anomalous experiences, by which I mean you might hear something and you don’t know what that is. You haven’t got someone perhaps, to talk that through with and normalize that. We all hear random things that are probably just something else and dismiss it. You might get more interested in that and think more about it and worry about it more and that then, might develop more into something like an auditory hallucination, a voice that you begin to hear.

Interviewer: Is that ever a comfort, a retreat?

Dr. Helen Fisher: Yeah, absolutely and I think it’s really important, particularly when we think about hearing voices, that we tend to generally think about those as being unpleasant, distressing. But actually, a lot of them are actually very pleasant or they’re quite benign and actually, are just there. Those experiences are actually fairly common in the general population because actually, they’re not always distressing. They can be supportive. It can be a friend if you haven’t got any other friends, if you’re very lonely.

Interviewer: You’re British Academy mid-career fellow at King’s. Your work has explored the social, psychological and epigenetic factors that increase and decrease the risk of psychotic experiences developing and persisting during adolescents amongst victimised children. You’ve touched on some of these. I think it would be helpful to explore each in turn. So, starting with social factors that might put a young person at risk.

Dr. Helen Fisher: I think obviously, the main one I look at is their relationships with other people in terms of particularly being victimised by other people, is the key thing I look at, socially but related to that really, as well, is the broader social world. We don’t operate in a bubble. We have interaction with people in our family but also, the wider environment and certainly, some of the work we’ve done when we’ve looked at living in a city, for instance. What we find actually, explains why we might see symptoms more in that sphere is because actually, people living in areas where actually, there isn’t much what we call social cohesion, so there’s not much trust between neighbours, there’s no one really, to turn to for support. There’s a lot of crime and general disorder in the area. So, people don’t feel very safe. I think those factors in the social tend to be problematic.

On the flipside, what’s protected, not surprisingly, is likely the opposite of that. So, living in a much more supportive, broader environment where people feel comfortable and safe. But also, growing up, even despite experiencing things like bullying and other types of victimization, if you actually live in a family which is nurturing and supportive and someone actually cares, actually that makes a huge difference and is very protective even in the context of really, quite severe victimization.

Interviewer: What about the psychological factors?

Dr. Helen Fisher: There are a range of things that are likely. The ones that I’ve looked at are really in the context of children and adolescents who have been exposed to victimization and what we see there, is two things that seem to increase their risk. One is that actually, if they’re victimised, if they become what we call an effective pathway, if they become more depressed or anxious, actually those initial mental health symptoms can trigger moving towards psychosis. The other one really, is what we call having an externalizing locus of control. So what I mean by that, is that actually, someone begins to think that if they’ve been victimised, that actually they don’t have any personal control over what’s happening to them. That everything is out of their hands. It’s all about other people influencing what’s happening to them or fate or something bigger picture.

Interviewer: Right. Things are done to them.

Dr. Helen Fisher: Yeah, and they begin to feel helpless and they don’t really feel that they can have any agency in the world and that seems to be important, to a degree, to paranoia, but also with things like hearing voices were actually, they don’t… If they hear something, instead of thinking it’s just me generating that sound or thought, they think it must be something else. So, they begin to have that belief that other things are actually generating what’s happening and therefore, are more likely to attribute things to voices or other factors. The other one is low self-esteem and again, that’s not really surprising in the context of victimization. Again, a slightly different thing which is blaming yourself for everything.

Interviewer: What about the epigenetic factors? What role do they have?

Dr. Helen Fisher: When looking at epigenetics, one thing we’re talking about is something that regulates how our genes work. So, we all know we’ve got DNA and that’s pretty fixed across the life course, but there’s a whole chemical layer above it and things that happen to it that can influence how those genes actually work. So, we’re not going to change the gene, but you can actually change how much it’s working or not. We think, as well as the internal kind environment in the cell in the body, that actually, external things can come in and influence that. Particularly things that are stressful, which as I say, have in themselves, a biological reaction. That biological reaction, a change in how our hormones are working, can influence potentially, how our genes change. That might be one thing that’s happening and that change in how the genes are working may influence how the brain develops, how it functions and again, that might lead onto psychotic phenomena being triggered.

What we’ve seen is that we certainly see some of these changes in gene regulation occurring prior to the development of psychotic symptoms in kids and we see differences if they persist over time. If they stop during adolescence, we see the epigenetic changes also changing but what we don’t see really, is with victimization, there’s a really mixed field. Certainly in our work, we don’t see particularly strong associations between victimization and these changes. We see something for sexual abuse but it’s not really very clear and it’s not clear for the others, which is surprising, given how stressful those are and that we see similar things in animal models. See these changes, but we don’t see them as much in humans. They’re much more complicated. So, the idea that something like victimization or some kind of stress might change how our genes are working and then lead to psychosis is a nice theory, but we don’t really have the evidence to show that that’s really happening.

So, at the moment it’s very theoretical. As I say, what we can see are changes occur prior to the onset of the symptoms. We just don’t know why they’re occuring. If you were to replicate that work a lot and think about it very carefully, technically, a long way in the future, you could think about potentially doing a blood test to see these changes or a cheek swab to see the changes. You could potentially predict that someone might develop these symptoms. That could be a way of screening people to intervene. I would suggest probably, with psychological therapy rather than biological agents, but I think we’re a long way from that, still.

Interviewer: Talking about prediction and on predicting which victimised children will go on to develop psychopathology in late adolescence and given the factors that you described, how can this knowledge be utilized?

Dr. Helen Fisher: The thing with victimization is we know victimization increases risk for a huge number of mental health and physical health problems. So, we now know, from the work I’ve done and many other people, that it also increases your risk of having so psychotic symptoms and psychotic disorders. So, I think it’s a fairly no-brainer that we should do something about victimization. I don’t think that many people disagree with that. It’s just very hard to do. It’s very hard to eradicate. There are various intervention programs, particularly around bullying that have shown some effectiveness and people are trying to implement those. It’s much harder to prevent sexual abuse, physical abuse in the home. There are parenting programs, but things like sexual abuse tend to occur outside. So, preventing it is really important, but it’s hard. Sometimes it’s more going to be about tackling it if we’re aware of it. In terms of the other factors, what we really need to do and we haven’t done is really look at if we pool them together, what kind of constellation of those factors? It’s really important to have the best predictions. People are starting to do some of that work and there’s some very fancy statistics that could be done to try and do that.

Interviewer: You mentioned this earlier but your current research program examines the role of the wider environment, including neighbourhood social factors and air pollution in the emergence of psychotic phenomena. Can you share a bit more about this work?

Dr. Helen Fisher: Yeah. So, one of my team, Joanne Newbury, did her PhD trying to understand whether the really common association we see between living in a city and having a psychotic disorder, whether we see that also, at this lower end of the spectrum and we do. We see that living in a city, at least in the UK, means you’re much more likely to have these low-level psychotic phenomena and psychotic symptoms in both late childhood and later in adolescence, than if you live in a rural area or just a town in the UK. Her work has really looked, firstly, at the social factors.

What she found was that, because even within a city, there’s variation and she really found that it was people who lived in the city but the area they lived in had this really low trust between neighbours and lack of support and much higher levels of crime and disorder. They explained about half of the association between living in the city and having those psychotic experiences. But then, we’re like, well it’s only half of them. So, some of the other half is error and other things but there must be something else. Well, actually one of the big things in cities, certainly in terms of physical health, is air pollution. We know that some of the very fine particles in air pollution, you inhale them but they can actually also pass the blood-brain barrier. We know they affect the lungs and other organs, but they can actually get into the brain and so, there’s a little bit of work suggesting that actually, if that happens in childhood and adolescence, the brain is developing, that actually you can stunt the development of parts of the brain or it can change how it’s actually working. We thought well actually, that seems feasible in terms of then, having a potential impact on psychosis as well and other mental health problems.

So, within a large general population study that we work on called E-Risk, Environmental Risk study across the UK, we were able to work with environmental scientists to actually model their pollution exposure in these kids earlier on and at different points in adolescence. And what we find is that adolescents who are exposed to the highest levels of air pollution, particularly nitrogen oxides and nitrogen dioxides which tend to be mainly from transport, they had much higher rates of these psychotic experiences than kids exposed to lower levels. This explained about 60% of the association between living in the city and having these experiences. So, for us, that’s really fascinating and we’re starting to think a bit more about why that might be and trying to get a little better at those mechanisms. So, we also know air pollution can cause inflammation in the brain and inflammation could also affect things like the dopamine system and other things that have been linked to psychotic phenomena. So, we’re really trying to pull apart a bit, those mechanisms.

Just to say, though, one of the things that is really important with this work is that what we certainly can’t say at this point, is that it definitely causes it. We can’t say that about any of it. We know they’re associated but it could easily be something else. So, in the case of air pollution, one of the things it could be is noise because a lot of it, in the UK, is generated by traffic and traffic is noisy and noise is stressful. It could also, depending on where you live, it can disrupt your sleep, struggling in sleep and both that stress and the problems with sleeping are both also things that we’ve previously associated with development of psychosis and psychotic phenomena. So, it’s very difficult to model noise exposure. So, at this point we can’t control for the noise when we’re looking at the air pollution, if you see what I mean. So, it’s difficult to know can what it is. It may be that the eventual common pathways, the impact on the brain is actually the same thing. It might be inflammation and changing the way it’s working but how it gets there might be different.

Interviewer: Okay. What other research project projects are currently live that excite you?

Dr. Helen Fisher: I think one of the other biggest ones that I work on at the moment is actually something which is more in the global mental health field. A lot of my previous work is very UK focused and working with UK cohorts, but I had an opportunity, a couple of years ago, to go to an event where we got together with lots of different people around the world. We developed a project called the Idea Projects. That’s Identifying Depression Early in Adolescence. It was moving me away from psychosis, moving to depression and really, it’s a collaboration between academics and clinicians in different parts of the world to really understand if we can identify adolescents who are at risk of developing depression much earlier than we can at this point. So, depression itself, actually is probably a bigger global mental health problem. It affects a much larger number of people. It mainly has its incidence onset in adolescence and it’s the leading cause of illness and disability in the world amongst the adolescent population. Actually, 90% of the world’s adolescents live in low and middle-income countries, they don’t live in high-income countries. So, actually, those countries have the greatest burden of depression and the most opportunities to do something about it. So, we’re working with colleagues in Brazil, Nepal and Nigeria.

So, both low and middle-income countries to really see can we identify, in this early adolescent period, which adolescents are most at risk of having depression by the time they get to 18, so that we could then develop interventions. A little bit like we were talking earlier. We’re actually using quite sophisticated statistical techniques, using existing large population studies to see what combination of factors might be most risky for somebody, with the idea that if you could look at those, you could actually develop a really clear screening tool that could be used in schools or other places. There’s a lot of ethical issues around that but you could potentially identify kids and do something about it.

Interviewer: I’ve read you’re working on a program that aims to improve public understanding of psychosis through immersive art experiences, which sounds fascinating. What is it about?

Dr. Helen Fisher: Yeah. I think, as we touched on earlier, I do feel that psychosis and psychotic symptoms such as hearing voices, really are the last taboo area of mental health in the UK. We talk a lot about mental health in the UK, which is great and lots of people are talking about it, but don’t really feel comfortable still with psychosis. I think a lot of that is because they don’t understand what it feels like, what those phenomena are. They’re quite different. Although I say that. They’re on a spectrum. It’s difficult to identify where you’ve had a similar experience.

So, although you can get people to talk about it and people can write stuff about it, I felt that actually, what’s really important is probably to give people their own personal experience of some of these symptoms so they understand what it feels like. Then, they can begin to think about it, be aware of it and start to perhaps, help people feel more comfortable talking about it with other people and maybe people can get help a bit earlier.

What we did, we’ve done a variety of things but the key thing we did a few years ago was actually, with young people who have these experiences and a range of artists, actually develop an immersive experience. So we, in the middle of Peckham, set up an art gallery. We borrowed some lovely art from a guy called Toby Brown who has a diagnosis of schizophrenia and paints some amazing pictures. We actually gave people headsets, like you would normally if you went into an art gallery, and they listened to the normal audio tour about the pictures and mental health, but what we had, in a concealed room, was actors who actually provided voices, individual voices to each person with the headphones. They were watching them on CCTV, so the person didn’t know they were there and as they were listening to the audio guide, we overlaid voices in it. So as you’re listening to the guide and I’m walking towards particular picture, I’m suddenly getting a voice through these headphones as well, saying no, don’t stand too close to that.

Interviewer: Did they know that was…?

Dr. Helen Fisher: No, they didn’t know. They knew they were gonna have something immersive but we didn’t tell them exactly what that was. We did obviously, tell them before that it might be distressing or it might not be. You can take the headphones off at any time and it would stop, kind of thing, for ethical reasons. We had someone watching to make sure everyone was okay. What we tried to do is give people a range of different experiences. Some of the voices were more negative. We were very careful not to do anything too distressing for them. The young people were really clear they didn’t want anyone to feel as distressed as they often did and that was really important.

But some of them were more negative. Some of them were more just commenting. So kind of benign, you’re doing this. I see you walking. Some of them were really playful and fun and supportive. Flick that person’s ear. Something childish, to really give a range, an idea of the spectrum of things that people experience. So, we did that.

We also had a part which people entered into a tube simulation where they also got the idea, the feeling of what it feels like, on a visual level, to have a lot of visual overstimulation as well. The important thing was that, after the experience, we got people to sit in a group because everyone had a slightly different voice, as I say, across the spectrum, to talk about what it felt like for them and to also realise that not everyone’s experience was the same and what that mean. Really for us, started that conversation and people, from the feedback we got, just found it really insightful. It seemed to increase their level of empathy and understanding of this and make them think about something they didn’t before.

Interviewer: What an incredible project.

Dr. Helen Fisher: Yeah, and so off the back of that, we’re doing a variety of things like that. And actually, the project I’m working on right now is a bit broader than that, around awareness. I’m actually working with the National Gallery and we’re developing a mental health themed audio tour of the gallery. I guess the thing with the immersive experiences, it’s very expensive. It’s very time-consuming and you can only really give it to a few people. It’s quite difficult to do, on scale. So we really want to think about we still want to do that kind of work but also, can you do something that’s really accessible to millions of people and millions of people visit the National Gallery from all over the world, every year.

So, we’re actually creating a tour, with young people with lived experience, so that if you go to the gallery, you can choose to put on the normal audio tour thing and actually hear about mental health problems and things that you might not have heard before. Take the tour as if you were a young person with mental health problems, going through the gallery. So we’re going to launch that on the 10th October for World Mental Health Day and no doubt, advertise that more, nearer the time.

Interviewer: What else can be done to improve public understanding of psychosis?

Dr. Helen Fisher: I think a lot of different things. Other things that I’ve been involved in are working with theatre companies. If they’re portraying it, to portray it authentically and then, have discussions with audiences. As I say, there are a range of immersive things. There’s online opportunities through social media. A lot of people have YouTube channels. There’s obviously celebrities who talk about things and other people who talk and I think it’s one of those things where people are going to relate to different things. So, some people will go to the theatre and some people might go to the National Gallery and get an experience there. Some people might go to a particular event or listen to a particular celebrity or prominent person or read something.

So, I think there are going to be different things that appeal to different people, so we probably need different things. I think it’s also really important to think about how we bring that into the mental health education that’s starting in schools. And certainly, one of the people I’ve worked with a lot is a guy called Jonny Benjamin, who has a diagnosis of schizoaffective disorder and does a lot of work, both on TV, but also actually going into schools and talking about what it feels like for him, with adolescents so that they feel more comfortable about it. They understand that other people experience these things. So, I think through all these different mediums, we can start to get people to feel more comfortable about it and talk about it and that should start to dispel some of the stigma and hopefully, people, particularly adolescents, can feel more comfortable talking about it if they have early experiences and some later ones. If they can start to feel more comfortable talking about it, they might not continue or at least, if they need help, they might be able to get that a bit sooner.

Interviewer: What else is in the pipeline that you’d like to mention?

Dr. Helen Fisher: I think at the moment. one of the areas I’m really keen to work on is to extend the work on pollution. We are currently applying for money to really actually understand the links between air pollution and psychosis but also particularly, depression, which has also shown a strong association, but in different parts of the world. So, although we have relatively high rates of pollution in the UK, they’re nowhere near as high as they are in other parts of the world. I think if you really want to understand a phenomenon, you’ve got to look at that more extreme case. So, we’re starting to build some collaborations with people in Nepal, which is one of the places with the worst air quality in the world because it’s landlocked by India and China. So, all their pollution comes in and no one lives on the lovely mountain. They all live in the belly of the whale, so it gets stuck. So, we’re doing some work to try and see if we can really assess air pollution exposure properly in that country in different ways. Then, see if we can link it to our prediction models of depression and psychosis. So. we’re doing some work on that, particularly. And as I say, extending our understanding of what the mechanisms are in relation to psychosis and depression. So, is it that actually, it’s to do with the brain becoming inflamed? Is it more to do with actually, the stress of noise and other factors? So, we’re trying to move that forward.

Interviewer: Helen, you recently joined the editorial board of the Journal of Child Psychology and Psychiatry, the JCPP. What do you hope to bring to the role?

Dr. Helen Fisher: So I’m hoping to bring enthusiasm and a real opportunity to encourage people to submit methologically robust research, where they look at helping us understand more about about the etiology and also, how we might prevent and intervene with adolescents in terms of psychotic phenomena across the spectrum. So, from these very early experiences, through to psychotic disorder.

Interviewer: Finally, Helen. What is your takeaway message for those listening or watching our conversation?

Dr. Helen Fisher: So, I think, as I say, the important thing really, is it would be great if people could think about psychosis as much more of a spectrum and not just focus on severe end of the spectrum, but also think about, particularly in adolescents, that children and adolescents are quite likely to be having these types of experiences. Then, if we could conduct research to really help us understand which children are most at risk of having these types of lower-level experiences and other mental health problems and what might protect them from going on and having more severe mental illnesses later. We really could develop interventions to help the most vulnerable children as early as possible and that would really give us hope that we might actually prevent severe mental illness from ever occurring at all

Interviewer: Brilliant. Thank you ever so much. To read more about Dr. Helen Fisher, on her work on psychosis, visit the ACAMH website, www.ACAMH.org and Twitter at ACAMH. ACAMH is spelt A-C-A-M-H.

Close: This podcast was brought to you by The Association for Child and Adolescent Mental Health, ACAMH for short.

ENDS

Dr Helen Fisher is a Reader in Developmental Psychopathology, a Chartered Research Psychologist, and a British Academy Mid-Career Fellow within the Social, Genetic and Developmental Psychiatry Centre, at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK. She has a strong interdisciplinary background in psychology, social psychiatry, genetics, and epidemiology, funded through pre- and post-doctoral fellowships from the MRC and ESRC.

Helen has spent 18 years researching the aetiology and treatment of psychosis in young people. Her initial research involved evaluating Early Intervention Services for young people with psychosis, and then focused on the role of childhood maltreatment in the development and course of psychosis. During her MQ Fellows award she extended this work to explore the social, psychological and epigenetic factors that increase and decrease the risk of psychotic experiences developing and persisting during adolescence amongst victimised children. Currently, her research programme examines the role of the wider environment (neighbourhood social factors and air pollution) in the emergence of psychotic phenomena and other mental health problems during adolescence; epigenetic signatures of victimisation and psychosis; the phenomenology of childhood psychotic symptoms; predicting which victimised children will have poor functioning and develop psychopathology in late adolescence; improving public understanding of psychosis through immersive art experiences; and early identification of adolescents at risk for depression around the globe. She is also a co-investigator of the Environmental Risk (E-Risk) Longitudinal Twin Study and a Research Consultant for the NSPCC.