Papers by Andrew Thompson
Objective: Although studies suggest that erythrocyte concentrations of omega-3 and omega-6 fatty ... more Objective: Although studies suggest that erythrocyte concentrations of omega-3 and omega-6 fatty acids are lower in individuals with schizophrenia, evidence of beneficial effects of omega-3 fatty acid supplementation is limited. This study therefore aimed to determine whether omega-3 and omega-6 fatty acid levels are causally related to schizophrenia. Methods: Causality was evaluated using the inverse variance weighted (IVW) 2-sample Mendelian randomization (MR) method using fatty acid levels and schizophrenia genome-wide association study results. Weighted median, weighted mode, and MR Egger regression methods were used as sensitivity analyses. To address the mechanism, analyses were performed using instruments within the FADS and ELOVL2 genes. Multivariable MR (MVMR) was used to estimate direct effects of omega-3 fatty acids on schizophrenia, independent of omega-6 fatty acids, lipoproteins and triglycerides. Results: MR analyses indicated that long-chain omega-3 and omega-6 fatty...
The version presented here is a Working Paper (or 'pre-print') that may be later published elsewh... more The version presented here is a Working Paper (or 'pre-print') that may be later published elsewhere.
Society and risk of psychosis
Our understanding of the nature and aetiological architecture of psychotic mental disorders has a... more Our understanding of the nature and aetiological architecture of psychotic mental disorders has advanced notably in the past 20 years. It is now widely considered that psychotic disorders occur as consequence of a complex range of factors, spanning multiple domains and levels, that act on several psychological and biological mechanisms. In recent years, evidence has accumulated that exposure to, broadly, adverse social conditions and experiences over the course of development constitute part of this complex array of factors that influence onset. In this chapter, we will provide a critical overview of this evidence, including consideration of outstanding conceptual and methodological issues that limit the causal inferences that can be drawn from existing findings. From this, we will propose and sketch a sociodevelopmental pathway—as one of several pathways—to psychoses.
American Journal of Psychiatry, 2020
Objective: To investigate the incidence, course and outcome of psychotic experiences from childho... more Objective: To investigate the incidence, course and outcome of psychotic experiences from childhood through early adulthood in the general population, and prediction of psychotic disorder. Methods: A population-based cohort study using the semi-structured Psychosis-like Symptoms interview of psychotic experiences at ages 12, 18, and 24 (N=7900 with any data). Incidence rates were estimated using flexible parametric modelling, and positive predictive values (PPV), sensitivity, specificity, and area under the curve estimated for prediction. The incidence rate of psychotic experiences increased between ages 13-24 years, peaking during late adolescence. Of 3866 interviewed at age 24, 313 (8.1%, 95%CI 7.2%, 9.0%) had a definite psychotic experience since age 12. 109 individuals (2.8%) met criteria for a psychotic disorder up to age 24, of whom 70% had sought professional help. Prediction of current psychotic disorder at age 24 (N=47, 1.2%) by both self-report and interviewerrated measures of psychotic experiences at age 18 (PPVs 2.9% and 10.0% respectively) was improved by incorporating information on frequency and distress (PPVs 13.3% and 20.0% respectively), although sensitivities were low. The PPV of an at-risk mental state at age 18 predicting incident disorder ages 18-24 was 21.1% (95%CI 6.1%-45.6%; sensitivity 14.3%, 95%CI 4.0%-32.7%). Our study shows a peak in incidence of psychotic experience during late adolescence, and an unmet need for care in young people with psychotic disorders. Because of the low sensitivity, targeting individuals in non-help-seeking samples based only on more severe symptom cut-off thresholds will likely have little impact on population-levels of first-episode psychosis.
BJPsych open, 2018
Understanding the relative risks of maintenance treatment versus discontinuation of antipsychotic... more Understanding the relative risks of maintenance treatment versus discontinuation of antipsychotics following remission in first episode psychosis (FEP) is an important area of practice. A systematic review and meta-analysis. Prospective experimental studies including a parallel control group were identified to compare maintenance antipsychotic treatment with total discontinuation or medication discontinuation strategies following remission in FEP. Seven studies were included. Relapse rates were higher in the discontinuation group (53%; 95% CIs: 39%, 68%; = 290) compared with maintenance treatment group (19%; 95% CIs: 0.05%, 37%; = 230). In subgroup analyses, risk difference of relapse was lower in studies with a longer follow-up period, a targeted discontinuation strategy, a higher relapse threshold, a larger sample size, and samples with patients excluded for drug or alcohol dependency. Insufficient studies included psychosocial functioning outcomes for a meta-analysis. There is a ...
Schizophrenia research, Jan 10, 2016
Some childhood speech and language impairments precede psychosis but it is not clear whether they... more Some childhood speech and language impairments precede psychosis but it is not clear whether they also precede adolescent psychotic experiences and whether this association is specific to psychotic experiences. Pragmatic language and expressive speech and language (parent-assessed using the Children's Communication Checklist) at age 9 and psychotic experiences and depression at ages 12 and 18 were investigated in 7659 participants from the Avon Longitudinal Study of Parents and Children. Associations were investigated using multivariate modelling. Poorer pragmatic language at 9years was associated with psychotic experiences at both ages (12years OR 1.22, 95% CI 1.11, 1.34; 18years OR 1.25, 95% CI 1.10, 1.41) but only with depression at 18years (OR 1.10, 95% CI 1.00, 1.22). Poorer expressive speech and language ability was not associated with psychotic experiences or depression at either age. There was evidence that pragmatic language was specifically associated with psychotic ex...
Psychological Medicine, 2007
BackgroundClinical guidelines advise against prescribing more than one antipsychotic with limited... more BackgroundClinical guidelines advise against prescribing more than one antipsychotic with limited exceptions. Despite this, surveys continue to report high antipsychotic polypharmacy rates. The aim of the study was to investigate the effectiveness of a multi-faceted intervention in reducing prescribing of antipsychotic polypharmacy on general adult psychiatry wards, compared with guidelines alone.MethodA pragmatic cluster randomized controlled trial recruited 19 adult psychiatric units (clusters) from the South West of England. Participants were all ward doctors and nurses. The multi-faceted intervention comprised: an educational/CBT workbook; an educational visit to consultants; and a reminder system on medication charts.ResultsThe odds of being prescribed antipsychotic polypharmacy in those patients prescribed antipsychotic medication was significantly lower in the intervention than control group when adjusted for confounders (OR 0.43, 95% CI 0.21–0.90, p=0.028). There was conside...
Psychological Medicine, 2011
The version presented here may differ from the published version or, version of record, if you wi... more The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRAP URL' above for details on accessing the published version and note that access may require a subscription.
eLife, 2021
Causal interactions between specific psychiatric symptoms could contribute to the heterogenous cl... more Causal interactions between specific psychiatric symptoms could contribute to the heterogenous clinical trajectories observed in early psychopathology. Current diagnostic approaches merge clinical manifestations that co-occur across subjects and could significantly hinder our understanding of clinical pathways connecting individual symptoms. Network analysis techniques have emerged as alternative approaches that could help shed light on the complex dynamics of early psychopathology. The present study attempts to address the two main limitations that have in our opinion hindered the application of network approaches in the clinical setting. Firstly, we show that a multi-layer network analysis approach, can move beyond a static view of psychopathology, by providing an intuitive characterization of the role of specific symptoms in contributing to clinical trajectories over time. Secondly, we show that a Graph-Signal-Processing approach, can exploit knowledge of longitudinal interaction...
Psychiatry research. Neuroimaging, Jan 23, 2018
Theory of mind (ToM), the ability to infer one's own and others' mental states, is the so... more Theory of mind (ToM), the ability to infer one's own and others' mental states, is the social cognitive process shown to have the greatest impact on functional outcome in schizophrenia. It is not yet known if neural abnormalities underlying ToM present early, during the first episode of psychosis (FEP). Fourteen FEP participants and twenty-two healthy control participants, aged 15-25, were included in analyses. All participants had a 3T magnetic resonance imaging scan and completed a block-design picture-story attribution-of-intentions ToM fMRI task, and completed a battery of behavioral social cognitive measures including a ToM task. General linear model analyses were carried out. Post-hoc regression analyses were conducted to explore whether aberrant ToM-related activation in FEP participants was associated with symptomatology and global social and occupational functioning. FEP participants, when compared to healthy controls, had significantly less activity in the right te...
Psychotherapy and Psychosomatics, 2017
Background: Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ult... more Background: Cognitive-behavioural therapy (CBT) is the first-choice treatment in clients with ultra-high risk (UHR) for psychosis. However, CBT is an umbrella term for a plethora of different strategies, and little is known about the association between the intensity and content of CBT and the severity of symptomatic outcome. Methods: A sample of 268 UHR participants received 6 months of CBT with case management (CBCM) in the context of the multi-centre NEURAPRO trial with monthly assessments of attenuated psychotic symptoms (APS). Using multilevel regressions and controlling for the initial severity of APS, the associations between (1) number of CBCM sessions received and severity of APS and (2) specific CBCM components and severity of APS were investigated. Results: In month 1, a higher number of sessions and more assessment of symptoms predicted an increase in APS, while in month 3, a higher number of sessions and more monitoring predicted a decrease in the level of APS. More the...
Social cognition in clinical “at risk” for psychosis and first episode psychosis populations
Schizophrenia Research, 2012
Social cognitive deficits have been demonstrated in first episode psychosis (FEP) and groups at h... more Social cognitive deficits have been demonstrated in first episode psychosis (FEP) and groups at high risk for developing psychosis but the relative degree of deficit between these groups is unclear. Such knowledge may further our understanding of the importance of these deficits in the development of psychosis. The study aimed to compare the degree of impairment in social cognition in three groups: FEP, those at "ultra high risk" (UHR) for psychosis and healthy controls. UHR and FEP patients were recruited from an established youth mental health service in Melbourne. Three domains of social cognition were assessed: ToM (hinting task and interpretation of visual jokes); facial and vocal emotion recognition (Diagnostic Assessment of Non Verbal Accuracy); social perception (Mayer-Salovey-Caruso Emotional Intelligence Test - managing emotions branch). Group differences were analysed using Analysis of Covariance with age, gender and IQ as covariates. Data on 30 UHR, 40 FEP and 30 control participants were analysed. FEP patients performed significantly worse on all social cognition tasks compared to controls. For the UHR group, scores were intermediate between FEP and controls for all tasks, but only significantly different to controls for ToM tasks. Effects sizes were largest for the ToM tasks and the emotion recognition task for both patient groups. There were no significant differences between UHR and FEP patients in performance on any of the tasks. Social cognition is generally impaired in FEP patients but there are fewer deficits in a UHR group. Longitudinal research in larger samples is needed to investigate whether social cognition deficits, such as ToM are risk factors in UHR groups for subsequent transition to full-threshold psychosis.
Schizophrenia Research, 2012
Student travel awardees served as rapporteurs of each oral session and focused their summaries on... more Student travel awardees served as rapporteurs of each oral session and focused their summaries on the most significant findings that emerged from each session and the discussions that followed. The following report is a composite of these reviews. It is hoped that it will provide an overview for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.
Should a “Risk Syndrome for Psychosis” be included in the DSMV?
Schizophrenia Research, 2010
The proposed Risk Syndrome for Psychosis (RS) criteria are derived from the Ultra High Risk crite... more The proposed Risk Syndrome for Psychosis (RS) criteria are derived from the Ultra High Risk criteria (UHR) and prodromal or Clinical High Risk criteria (CHR), and consist of subthreshold or attenuated positive psychotic symptoms with operationalized recency and frequency criteria. The rationale behind the proposed inclusion of the RS in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSMV) is that several studies have found that the UHR/prodromal/CHR criteria predict onset of psychotic disorder, mainly schizophrenia, within a brief time period of a few years. Identifying individuals meeting these criteria thus affords the possibility of early intervention to prevent or delay onset of full blown psychotic disorder. However, the RS is yet to be properly validated. Additionally, there are potential dangerous unintended consequences of the reification of this syndrome as a formal diagnosis. Thus we feel it is premature to justify inclusion of the RS in the DSM.
Early Intervention in Psychiatry, 2012
Aims: There is clinical uncertainty as to whether borderline personality disorder (BPD) traits in... more Aims: There is clinical uncertainty as to whether borderline personality disorder (BPD) traits in those with an 'at risk mental state' have an effect on the risk of 'transition' to psychosis. We aimed to investigate the relationship between baseline BPD features, risk of transition and type of psychotic disorder experienced. Method: This is a case-control study of 'Ultra High Risk' (UHR) for psychosis patients treated at the clinic, between 2004 and 2007. 'Cases' were UHR individuals who made the 'transition' to full threshold psychotic disorder within 24 months; 'Control' group was a matched UHR sample who had not developed a psychotic disorder at 24 months. Individuals were matched on time of entry to the clinic, age and gender. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) BPD features were assessed from clinical assessments using a structured instrument (Structured Clinical Interview for DSM-IV Axis II Disorder for BPD (SCID-II BPD) ). Psychosis diagnosis following transition was rated from the clinical files using the operational criteria in studies of psychotic illness (OPCRIT) computer algorithm. The number of BPD traits and number with full threshold BPD were compared in those who developed psychosis and those who did not. We analysed data from 48 cases and 48 controls. There was no statistically significant difference in the rate of transition to psychosis for those with baseline full-threshold BPD, compared with those without BPD. The number of BPD traits or number with full threshold BPD did not differ by psychosis diagnosis grouping. Conclusions: Co-occurring BPD or BPD features does not appear to strongly influence the risk of shortterm transition to psychosis or the risk of developing a non-affective psychotic disorder in this population.
Acta Psychiatrica Scandinavica, 2010
Bechdolf A, Thompson A, Nelson B, Cotton S, Simmons MB, Amminger GP, Leicester S, Francey SM, McN... more Bechdolf A, Thompson A, Nelson B, Cotton S, Simmons MB, Amminger GP, Leicester S, Francey SM, McNab C, Krstev H, Sidis A, McGorry PD, Yung AR. Experience of trauma and conversion to psychosis in an ultra‐high‐risk (prodromal) group.Objective: We aimed to replicate a recent finding of high prevalence of trauma history in patients at ‘ultra‐high risk’ (UHR) of psychotic disorder and to investigate whether trauma predicts conversion to psychosis in this population.Method: A consecutive sample of UHR patients was assessed. History of trauma was accessed with the General Trauma Questionnaire. Cox regression models were used to explore relationship between conversion to psychosis and trauma.Results: Of 92 UHR patients nearly 70% had experienced a traumatic event and 21.7% developed psychosis during follow‐up (mean 615 days). Patients who had experienced a sexual trauma (36%) were significantly more likely to convert to first‐episode psychosis (OR 2.96) after controlling for meeting mul...
The British journal of psychiatry : the journal of mental science, Sep 1, 2016
Early intervention for psychosis (EIP) is a model of service delivery that aims to support young ... more Early intervention for psychosis (EIP) is a model of service delivery that aims to support young people with first-episode psychosis by providing the best available treatments, supporting recovery and preventing relapse. In this editorial, we review the evidence for EIP, how the model has developed since its inclusion in the NHS policy implementation guideline for mental health in 2001, challenges and areas of ongoing debate, and future development.
Psychiatric Bulletin, 2008
Health services research is vital in any medical specialty. In psychiatry, it has become more hig... more Health services research is vital in any medical specialty. In psychiatry, it has become more high-profile with the reconfiguration of different approaches to delivering care to patients. Research in this area often appeals to clinicians, who feel that the findings may be applicable to ‘real life’ clinical experience. However, many become disillusioned when faced with unexpected problems, not only with regulatory bodies such as ethics committees and funding organisations, but also by the practicalities of recruiting patients and involving fellow clinicians in their studies.
Childhood maltreatment and transition to psychotic disorder independently predict long-term functioning in young people at ultra-high risk for psychosis
Psychological Medicine, 2015
Background.Individuals identified as at ultra-high risk (UHR) for psychosis are at risk of poor f... more Background.Individuals identified as at ultra-high risk (UHR) for psychosis are at risk of poor functional outcome regardless of development of psychotic disorder. Studies examining longitudinal predictors of poor functioning have tended to be small and report only medium-term follow-up data. We sought to examine clinical predictors of functional outcome in a long-term longitudinal study.Method.Participants were 268 (152 females, 116 males) individuals identified as UHR 2–14 years previously. A range of clinical and sociodemographic variables were assessed at baseline. Functioning at follow-up was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS).Results.Baseline negative symptoms, impaired emotional functioning, disorders of thought content, low functioning, past substance use disorder and history of childhood maltreatment predicted poor functioning at follow-up in univariate analyses. Only childhood maltreatment remained significant in the multivariat...
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Papers by Andrew Thompson