My research focuses on subtle psychopathological changes and states that may mark the development of major mental illnesses in adolescents and young adults.

This research is part of the wider 'early intervention' paradigm where the goal is to both predict the onset of illness and detect disorder at the earliest stage to provide a window for therapeutic intervention. This may improve outcome, but also provides a means to prevent the disorder developing.  Studying subtle changes in experiences, prior to diagnosis, also enables an understanding of pathophysiology and of how disorders develop over time.

My work to date has largely focused on the 'at risk mental state' for psychosis, a collection of unusual experiences that may suggest an individual is at risk of developing a psychotic disorder such as schizophrenia.  We have used functional and structural neuroimaging, together with cognitive neuropsychology, to examine what makes such individuals at risk for psychosis, to improve prediction of who may go on to develop the disorder, and to gain a better understanding of psychological and brain changes that may underpin the onset of the disorder.  I am also particularly interested in delusions and their formation and maintenance. More recently, I have been developing research into changes in mood regulation and stability, changes that may be early markers of mood or personality disorders, and which may be important in the genesis of psychosis.

Research into the early detection of mental illness brings clear benefits as not only may new cases be prevented, but those who do develop the disorder yet are able to receive appropriate early treatment may have better clinical outcomes, including lower rates of admission and suicide, as well as greater function.  Such an approach is not only clinically advantageous, but economically brings cost benefits to the NHS.

Current ongoing work involves collaborations with colleagues  using multi-modal imaging techniques to examine those at risk of developing psychosis.  This includes a MRC-funded study with Stephen Wood in Birmingham, looking at structural brain changes serially over time.  Together with Steven Marwaha, we are beginning to pilot measures of mood instability in clinical populations with different diagnoses to try and determine whether the experience is the same in different disorders and continue our work examining mood instability in the Adult Psychiatric Morbidity Survey.

Until 2012, I was Chair of the Philosophy Special Interest Group of the Royal College of Psychiatrists.  I recently co-edited The Maudsley Reader in Phenomenological Psychiatry and have an ongoing programme of work examining delusions as well as responsibility in mental illness with Lisa Bortolotti at the University of Birmingham.  I am one of the series editors for International Perspectives in Philosophy and Psychiatry and am on the editorial board for the British Journal of Psychiatry.

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