Publication: Patterns 3: 100506.

Soumya Banerjee, Phil Alsop, Linda Jones, Rudolf N. Cardinal

10 June 2022


Artificial intelligence (AI) is increasingly taking on a greater role in healthcare. However, hype and negative news reports about AI abound. Integrating patient and public involvement (PPI) in healthcare AI projects may help in adoption and acceptance of these technologies. Researchers argue that AI algorithms should also be co-designed with patients and healthcare workers. They specifically suggest (1) including patients with lived experience of the disease, and (2) creating a research advisory group (RAG) and using these group meetings to walk patients through the process of AI model building, starting with simple (e.g., linear) models.

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Publication: BMJ Open

Linda A Jones, Jenny R Nelder, Joseph M Fryer, Philip H Alsop, Michael R Geary, Mark Prince, Rudolf N Cardinal

13 April 2022


Researchers have published results from a national survey of public opinion on sharing health data to support clinical care and research. Nearly 30,000 people took part in the anonymous survey online from February to September 2020, which was open to all UK residents to measure people’s opinions on health data and consent.

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Publication: Nature

R. A. I. Bethlehem, J. Seidlitz, S. R. White, J. W. Vogel, K. M. Anderson, C. Adamson, S. Adler, G. S. Alexopoulos, E. Anagnostou, A. Areces-Gonzalez, D. E. Astle, B. Auyeung, M. Ayub, J. Bae, G. Ball, S. Baron-Cohen, R. Beare, S. A. Bedford, V. Benegal, F. Beyer, J. Blangero, M. Blesa Cábez, J. P. Boardman, M. Borzage, J. F. Bosch-Bayard, N. Bourke, V. D. Calhoun, M. M. Chakravarty, C. Chen, C. Chertavian, G. Chetelat, Y. S. Chong, J. H. Cole, A. Corvin, M. Costantino, E. Courchesne, F. Crivello, V. L. Cropley, J. Crosbie, N. Crossley, M. Delarue, R. Delorme, S. Desrivieres, G. A. Devenyi, M. A. Di Biase, R. Dolan, K. A. Donald, G. Donohoe, K. Dunlop, A. D. Edwards, J. T. Elison, C. T. Ellis, J. A. Elman, L. Eyler, D. A. Fair, E. Feczko, P. C. Fletcher, P. Fonagy, C. E. Franz, L. Galan-Garcia, A. Gholipour, J. Giedd, J. H. Gilmore, D. C. Glahn, I. M. Goodyer, P. E. Grant, N. A. Groenewold, F. M. Gunning, R. E. Gur, R. C. Gur, C. F. Hammill, O. Hansson, T. Hedden, A. Heinz, R. N. Henson, K. Heuer, J. Hoare, B. Holla, A. J. Holmes, R. Holt, H. Huang, K. Im, J. Ipser, C. R. Jack Jr, A. P. Jackowski, T. Jia, K. A. Johnson, P. B. Jones, D. T. Jones, R. S. Kahn, H. Karlsson, L. Karlsson, R. Kawashima, E. A. Kelley, S. Kern, K. W. Kim, M. G. Kitzbichler, W. S. Kremen, F. Lalonde, B. Landeau, S. Lee, J. Lerch, J. D. Lewis, J. Li, W. Liao, C. Liston, M. V. Lombardo, J. Lv, C. Lynch, T. T. Mallard, M. Marcelis, R. D. Markello, S. R. Mathias, B. Mazoyer, P. McGuire, M. J. Meaney, A. Mechelli, N. Medic, B. Misic, S. E. Morgan, D. Mothersill, J. Nigg, M. Q. W. Ong, C. Ortinau, R. Ossenkoppele, M. Ouyang, L. Palaniyappan, L. Paly, P. M. Pan, C. Pantelis, M. M. Park, T. Paus, Z. Pausova, D. Paz-Linares, A. Pichet Binette, K. Pierce, X. Qian, J. Qiu, A. Qiu, A. Raznahan, T. Rittman, A. Rodrigue, C. K. Rollins, R. Romero-Garcia, L. Ronan, M. D. Rosenberg, D. H. Rowitch, G. A. Salum, T. D. Satterthwaite, H. L. Schaare, R. J. Schachar, A. P. Schultz, G. Schumann, M. Schöll, D. Sharp, R. T. Shinohara, I. Skoog, C. D. Smyser, R. A. Sperling, D. J. Stein, A. Stolicyn, J. Suckling, G. Sullivan, Y. Taki, B. Thyreau, R. Toro, N. Traut, K. A. Tsvetanov, N. B. Turk-Browne, J. J. Tuulari, C. Tzourio, É. Vachon-Presseau, M. J. Valdes-Sosa, P. A. Valdes-Sosa, S. L. Valk, T. van Amelsvoort, S. N. Vandekar, L. Vasung, L. W. Victoria, S. Villeneuve, A. Villringer, P. E. Vértes, K. Wagstyl, Y. S. Wang, S. K. Warfield, V. Warrier, E. Westman, M. L. Westwater, H. C. Whalley, A. V. Witte, N. Yang, B. Yeo, H. Yun, A. Zalesky, H. J. Zar, A. Zettergren, J. H. Zhou, H. Ziauddeen, A. Zugman, X. N. Zuo, E. T. Bullmore & A. F. Alexander-Bloch

6 April 2022


An international team of researchers has created a series of brain charts spanning our entire lifespan – from a 15 week old fetus to 100 year old adult – that show how our brains expand rapidly in early life and slowly shrink as we age. Read the full story.

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Publication: The Lancet Regional Health

Shanquan Chena, Tamsin J.Ford, Peter B.Jones, Rudolf N.Cardinal

29 March 2022


Public data from two surveys (Health Survey for England, UK; Survey of Health, Ageing and Retirement in Europe) covered 19 European countries across EMHAP phases one (2011–2015) and two (2015–2018). People screening positive for depressive symptoms by self-report were included. The primary outcome was antidepressant use: using country-specific weighted regression models, researchers estimated temporal trends and subgroup disparities in antidepressant receipt, with secondary analysis by country-level measures including healthcare expenditure.

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Publication: PLOS Medicine

Shanquan Chen, Benjamin R Underwood , Peter B Jones, Jonathan R Lewis, Rudolf N Cardinal

18 March 2022


Among patients over 50 using mental health services at Cambridgeshire and Peterborough NHS Foundation Trust, researchers observed an association between lithium use and a decreased risk of developing dementia.

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Publication: Psychological Medicine

Katherine Parkin; Shanquan Chen; Marjan Biria; Helen Beckwith; Isaac Jarratt-Barnham; Naomi A Fineberg; Rudolf N Cardinal; Trevor W Robbins; Emilio Fernandez-Egea

13 January 2022

The paper explores the impact of obsessive-compulsive symptoms (OCS) on the wellbeing of people who take clozapine to manage symptoms of schizophrenia. It highlights that clozapine-associated OCS occur frequently in this group of patients and that these symptoms have a negative impact on people’s wellbeing over time.

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Publication: npj Schizophrenia

Banerjee S, Liò P, Jones PB, Cardinal RN

8 December 2021


Machine learning (ML), one aspect of artificial intelligence (AI), involves computer algorithms that train themselves. They have been widely applied in the healthcare domain. However, many trained ML algorithms operate as ‘black boxes’, producing a prediction from input data without a clear explanation of their workings.

Researchers apply class-contrastive counterfactual reasoning to ML to demonstrate how specific changes in inputs lead to different predictions of mortality in people with severe mental illness (SMI).

Researchers produce predictions accompanied by visual and textual explanations as to how the prediction would have differed given specific changes to the input.

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Publication: Journal of Affective Disorders

Shanquan Chen, Athina R.Aruldass, Rudolf N.Cardinal

11 November 2021


In the first half of 2021, people in the USA who had had the COVID-19 vaccine were in general less likely to have anxiety and depressive symptoms (which might be a cause or a consequence). This effect varied with age, marital status, level of education, ethnicity, and income, but not gender.

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Publication: BJPsych Open

Shanquan Chen, Emilio Fernandez-Egea, Peter B. Jones, Jonathan R. Lewis and Rudolf N. Cardinal

2 November 2021


In people with severe mental illness such as schizophrenia, an elevated risk of death after COVID-19 infection persists to about 60 days.

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Publication: Journal of Clinical Psychopharmacology

Fernandez-Egea, Emilio; Chen, Shanquan; Jenkins, Christopher; Turrion, Concha; Mitchell, Simon P.; Dodwell, David J. F.; Mann, Louisa M.; Deakin, Julia B.; Syed, Zahoor H.; Hafizi, Sepehr; Zimbron, Jorge; Praseedom, Asha S.; Cardinal, Rudolf N.

17 June 2021


Factors associated with sedation and its pharmacological management remain poorly studied.  Researchers conducted a retrospective cohort study based on deidentified electronic clinical records of clozapine-treated patients from the secondary mental health care provider for Cambridgeshire and Peterborough, United Kingdom.

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Publication: International Journal of Geriatric Psychiatry

Chen S, Jones PB, Underwood BR, Fernández-Egea E, Qin P, Lewis JR, Cardinal RN

11 August 2021


Researchers studied patients over 65 known to CPFT mental health services during the early COVID-19 pandemic, and historical control groups (people known to have acquired COVID-19 itself did not take part). During lockdown, people with dementia or severe mental illness had a higher risk of death without confirmed COVID-19.

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Publication: Science Direct

Setareh Alabaf, Brian Kirkpatrick, Shanquan Chenc, Rudolf N. Cardinal, Emilio Fernandez-Egea

28 June 2021


Researchers examined whether timing of known risk factors for schizophrenia may influence the development of schizophrenia with primary negative symptoms.

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Publication: Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

Kanen JW, Arntz FE, Yellowlees R, Price A, Christmas DM, Apergis-Schoute AM, Sahakian BJ, Cardinal RN, Robbins TW

12 January 2021


Responding emotionally to danger is critical for survival. Normal functioning also requires flexible alteration of emotional responses when a threat becomes safe. Aberrant threat and safety learning occur in many psychiatric disorders, including posttraumatic stress disorder, obsessive-compulsive disorder, and schizophrenia, in which emotional responses can persist pathologically. While there is evidence that threat and safety learning can be modulated by the serotonin systems, there have been few studies in humans. Researchers addressed a critical clinically relevant question: How does lowering serotonin affect memory retention of conditioned threat and safety memory?

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Publication: BMJ Open

Ioannis Bakolis Robert Stewart,David Baldwin, Jane Beenstock, Paul Bibby, Matthew Broadbent, Rudolf CardinalShanquan Chen, Karthik Chinnasamy, Andrea Cipriani, Simon Douglas, Philip Horner, Caroline A Jackson, Ann John, Dan W Joyce, Sze Chim Lee, Jonathan Lewis, Andrew McIntosh, Neil Nixon, David Osborn, Peter Phiri, Shanaya Rathod, Tanya Smith, Rachel Sokal, Rob Waller, Sabine Landau

26 May 21


To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020. Data was reviewed looking at lockdown policy, changes and admissions, with findings of sizeable changes during the first national lockdown, but still unclear what the effect is.


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Publication: BJPsych Open

Bhardwaj A, Moore A, Cardinal RN, Bradley C, Cross L, Ford TJ

13 January 2021

The Covid-19 crisis necessitated rapid adoption of remote consultations across National Health Service (NHS) child and adolescent mental health services (CAMHS).

This study aimed to understand practitioners’ experiences of rapid implementation of remote consultations across CAMHS in one NHS trust in the east of England.

Data were collected through a brief questionnaire documenting clinicians’ experiences following remote delivery of services. The questionnaire began before ‘lockdown’ and focused on 102 assessment consultations as part of a planned move to virtual assessment.

As the roll-out of remote consultations was extended at lockdown, the researchers extended the questionnaire to include all remote clinical contacts (n = 202).

Despite high levels of initial concern, clinicians’ reports were positive overall; importantly, however, their experiences varied by team. When restrictions on face-to-face working are lifted, a blended approach of remote and face-to-face service delivery is recommended to optimise access and capacity while retaining effective and safe care.

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Publication: BMJ Open Diabetes Research & Care

Fernández-Egea E, Walker R, Ziauddeen H, Cardinal RN, Bullmore ET

28 January 2020

The prevalence of diabetes in schizophrenia is twice that in the general population, but there are few reliable predictors of which individuals will develop glucose dysregulation.

This research tested if abnormal birth weight (either too low or too high) and parental diabetes, both variables that can be ascertained in the clinic, can predict diabetes onset in patients with schizophrenia.

Researchers looked at electronic records of a cohort of 190 clozapine-treated patients (37% treated for more than 20 years) and Cox regression survival analysis (with any type of glucose dysregulation as the event) to account for differences in length of treatment before the event and age at clozapine treatment initiation.

Age at clozapine initiation, family history of diabetes and birth weight were significant predictors of glucose dysregulation onset, while gender was not.

Among individuals with 10 years of follow-up, 80% of those with both abnormal birth weight and a family history of diabetes developed diabetes compared with 56% with only abnormal birth weight, 40% with only a family history of diabetes and 20% in those with neither.

Since 48% of cases had at least one risk factor and 6% had both risk factors, there is a substantial proportion of patients for whom preventive strategies could be implemented.

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Margaret L. WestwaterFlavia ManciniAdam X. GorkaJane ShapleskeJaco SerfonteinChristian GrillonMonique Ernst Hisham Ziauddeen  and Paul C. Fletcher

12 April 2021


Stress does not trigger binge eating in people with eating disorders Cambridge researchers found. Researchers invited women with anorexia nervosa,  bulimia nervosa and healthy controls – to attend a two-day stay at Wellcome-MRC Institute of Metabolic Science Translational Research Facility (TRF) where they performed tasks while their brain activity was monitored using a functional MRI scanner.

Read the full story

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Publication: Revista de Psiquiatría y Salud Mental

Alabaf S, Kirkpatrick B, Chen S, Cardinal RN, Fernández-Egea E

10 April 2021

Schizophrenia typically involves so-called “positive” or psychotic symptoms (symptoms that are present but are unwanted), but sometimes also so-called “negative” or deficit symptoms (aspects of normal behaviour that are absent).

In a group of 167 patients with schizophrenia and being treated with clozapine, those patients with “non-deficit” schizophrenia were more likely than those with “deficit” schizophrenia to have reported cannabis use by the time of their first-episode psychosis, or trauma (related to crime or abuse) prior to that first episode of psychosis.

Patients with “deficit” schizophrenia were more likely to have been born in summer months. The timing of stressors during brain development may influence the pattern of symptoms that emerge.

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Publication: Frontiers in Psychiatry

Rudolf N. Cardinal, Caroline E. Meiser-Stedman,  David M. Christmas,  Annabel C. Price,  Chess Denman,  Benjamin R. Underwood,  Shanquan Chen,  Soumya Banerjee,  Simon R. White,  Li Su,  Tamsin J. Ford,  Samuel R. Chamberlain and  Catherine M. Walsh

25 February 2021


Simulated transmission of a COVID-19-like disease in a hypothetical community care team under different conditions.

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Publication: Translational Psychiatry

Kanen JW, Arntz FE, Yellowlees R, Cardinal RN, Price A, Christmas DM, Apergis-Schoute AM, Sahakian BJ, Robbins TW

1 February 2021

Serotonin is involved in a wide range of mental capacities essential for navigating the social world, including emotion and impulse control. Much recent work on serotonin and social functioning has focused on decision-making. Here researchers investigated the influence of serotonin on human emotional reactions to social conflict. They used a novel computerised task that required mentally simulating social situations involving unjust harm and found that depleting the serotonin precursor tryptophan-in a double-blind randomised placebo-controlled design-enhanced emotional responses to the scenarios in a large sample of 73 healthy volunteers, and interacted with individual differences in trait personality to produce distinctive human emotions.

Whereas guilt was preferentially elevated in highly empathic participants, annoyance was potentiated in those high in trait psychopathy, with medium to large effect sizes. The findings show how individual differences in personality, when combined with fluctuations of serotonin, may produce diverse emotional phenotypes. This has implications for understanding vulnerability to psychopathology, determining who may be more sensitive to serotonin-modulating treatments, and casts new light on the functions of serotonin in emotional processing.

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Publication: PLOS Medicine

Julieta Galante, Claire Friedrich, Anna F Dawson, Marta Modrego-Alarcón, Pia Gebbing, Irene Delgado-Suárez, Radhika Gupta, Lydia Dean, Tim Dalgleish, Ian R White, Peter B Jones 

11 January 2021


Many randomised controlled trials (RCTs) have been conducted around the world to assess whether in-person mindfulness training can improve mental health and wellbeing, but the results are often varied.

Researchers led a systematic review and meta-analysis to examine the published data from the RCTs. This approach allows them to bring together existing – and often contradictory or under-powered – studies to provide more robust conclusions.

The team identified 136 RCTs on mindfulness training for mental health promotion in community settings. These trials included 11,605 participants aged 18 to 73 years from 29 countries, more than three-quarters (77%) of whom were women.

The researchers found that in most community settings, compared with doing nothing, mindfulness reduces anxiety, depression and stress, and increases wellbeing. However, the data suggested that in more than one in 20 trials settings, mindfulness-based programmes may not improve anxiety and depression. Read the full press release

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Publication: Current Biology

Camilla L. Nord, Edwin S. Dalmaijer, Thomas Armstrong, Kate Baker, Tim Dalgleish

24 November 2020


Disgust is a natural response to unpleasant sights, but for some people, disgust can become pathological, affecting their mental health and quality of life.

Researchers have shown that domperidone, a commonly-prescribed anti-nausea medicine, can help significantly reduce how much volunteers look away from disgusting images. Read the full news story.

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Publication: Frontiers in Psychiatry

Chen S, She R, Qin P, Kershenbaum A, Fernández-Egea E, Nelder JR, Ma C, Lewis JR, Wang C, Cardinal RN

26 November 2020

To date, there is a paucity of information regarding the effect of COVID-19 or lockdown on mental disorders.

In this study researchers aimed to quantify the medium-term impact of lockdown on referrals to secondary care mental health clinical services.

They conducted a controlled interrupted time series study using data from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment population ~0.86 million).

The UK lockdown resulted in an instantaneous drop in mental health referrals but then a longer-term acceleration in the referral rate. This acceleration was primarily for urgent or emergency referrals, including referrals to liaison psychiatry and mental health crisis teams. The acceleration was significant for females, males, working-age adults, people of White ethnicity, those living alone, and those who had pre-existing depression, severe mental illness, hypertension / cardiovascular / cerebrovascular disease, personality disorders, asthma / chronic obstructive pulmonary disease, dyslipidemia, anxiety, substance misuse or reactions to severe stress.

No significant post-lockdown acceleration was observed for children / adolescents, older adults, people of ethnic minorities, married / cohabiting people, and those who had previous / pre-existing dementia, diabetes, cancer, eating disorder, a history of self-harm or intellectual disability. This evidence may help service planning and policy-making, including preparation for any future lockdown in response to outbreaks.

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Publication: European Neuropsychopharmacology

J.R. Breedon, H. Ziauddeen, J. Stochl, K.D. Ersche

24 November 2020

This research investigates the underlying mechanism of addictive behaviour as exemplified by cocaine addiction, and how it impacts on other behaviours such as eating.

Cocaine is adept at being both highly pleasurable and highly habit-forming and both processes are involved in the development of addiction. But are these behavioural changes specific to just cocaine consumption or do they impact other behaviours? This is an interesting question because food consumption is a paradigmatic example of behaviour that can be dominated by both deliberate (so-called goal-directed) and habitual control. As an example, people on diets will exert a high degree of control over their calorific and nutritional intake (‘goal directed’) only to find themselves falling back into old patterns of eating (‘habits’). This is an important question to ask because what we eat has clear and direct consequences for our health; if cocaine addiction has detrimental implications for food consumption, this will have health consequences, beyond the direct consequence of cocaine use.

The researchers presented participants with pictures of food and asked them to rate how much they were willing to pay for them, and how much they wanted to eat the foods. In addition they used questionnaires to investigate both the reasons why cocaine-addicted individuals use cocaine, and the factors influencing their food-related choices.

The results suggest that cocaine addiction narrows the goals of individuals away from ‘normal’ motivators like food, and diverts it towards cocaine. Further, the results suggest that food behaviour in cocaine addiction is more habitual, supporting the hypothesis that the habits developed are wide-reaching and affect behaviours beyond cocaine.

These results will be of interest to those working with individuals with cocaine addiction – they suggest that more attention should be paid to the eating habits of those affected. Further they add support for the ‘habit theory’ of addiction, and suggest that further research into treatments for cocaine addiction should consider the possibility of habits training, that is, methods of directing this ‘habit bias’ towards healthier, more meaningful, activities.

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Publication: International Journal of Geriatric Psychiatry

Kershenbaum A, Cardinal RN, Chen S, Underwood B, Seyedsalehi A, Lewis JR, Rubinsztein JS

4 November 2020

Previous studies have shown increased rates of death and dementia in older people in specific serious mental illnesses (SMI) such as bipolar disorder or depression.

In this study researchers examined the rates of death and dementia in older people referred into a secondary care psychiatric service across a range of SMIs, using an anonymised dataset across 6 consecutive years with 28,340 patients aged 65 years and older from a single secondary care psychiatric trust in the United Kingdom.

They identified deaths and incident dementia in patients with bipolar disorder/mania, schizophrenia, recurrent depression and anxiety disorders. They compared mortality and dementia rates between these diagnostic groups and in different treatment settings, and also examined mortality rates and dementia rates compared with general population rates.

Patients with schizophrenia showed the highest hazard rate for death compared to other groups with SMIs. Survival was reduced in patients referred to liaison psychiatry services. There were no significant differences between the SMI groups in terms of rates of dementia. However, risks of death and dementia were significantly increased compared to the general population; and older adults referred into an old age psychiatry service showed higher rates of dementia and death than those reported for the general population.

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Publication: ACL Anthology

Wang Z, Ive J, Moylett S, Mueller C, Cardinal RN, Velupillai S, O’Brien J, Stewart R

1 November 2020

While Dementia with Lewy Bodies (DLB) is the second most common type of neurodegenerative dementia following Alzheimer’s Disease (AD), it is difficult to distinguish from AD.

Here the researchers propose a method for DLB detection by using mental health record (MHR) documents from a (3-month) period before a patient has been diagnosed with DLB or AD. The objective is to develop a model that could be clinically useful to differentiate between DLB and AD across datasets from different healthcare institutions.

The researchers cast this as a classification task using Convolutional Neural Network (CNN), an efficient neural model for text classification. They experiment with different representation models, and explore the features that contribute to model performances.

In addition, they apply temperature scaling, a simple but efficient model calibration method, to produce more reliable predictions. They believe the proposed method has important potential for clinical applications using routine healthcare records, and for generalising to other relevant clinical record datasets.

To the best of the team’s knowledge, this is the first attempt to distinguish DLB from AD using mental health records, and to improve the reliability of DLB predictions.

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Publication: Brain, Behavior, and Immunity

Emanuele F.Osimo, Benjamin I.Perry, Rudolf N.Cardinal, Mary-EllenLynall, Jonathan Lewis, Arti Kudchadkar, Graham K.Murray, Jesus Perez, Peter B. Jones, Golam M.Khandaker

09 October 2020


A study with early intervention mental health service found that sixty percent of people cared for in their first episode of psychosis recovered well.

The research team used a research database to review blood markers and health outcomes for service users, in a longitudinal study of anonymous patient records between January 2013 and November 2019.

Researchers found that around sixty percent of people with first episode psychosis recovered well enough to be discharged to their GP. Several blood markers were consistently higher or lower in other people who required long term specialist psychiatric care. Read the full press story.

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Publication: Journal of Psychiatric Research

Chen S, Jones PB, Underwood BR, Moore A, Bullmore ET, Banerjee S, Osimo EF, Deakin JB, Hatfield CF, Thompson FJ, Artingstall JD, Slann MP, Lewis JR, Cardinal RN

22 September 2020

COVID-19 has affected social interaction and healthcare worldwide.

Here researchers examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths.

They conducted interrupted time series analyses with respect to the time of UK “lockdown”, which was shortly before the peak of COVID-19 infections in this area, and examined changes in standardized mortality ratio for those with and without severe mental illness (SMI).

Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking).

This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change.

Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity.

In conclusion, the research showed that COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. “Supply” changes may have reduced access to mental health services for some. “Demand” changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.

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Publication: European Neuropsychopharmacology

Rose E, Chen S, Turrion C, Jenkins C, Cardinal RN, Fernández-Egea E

17 September 2020

Approximately one-third of patients presenting with a first episode of psychosis need long-term support, but there is a limited understanding of the sociodemographic or biological factors that predict this outcome. ]

Researchers used electronic health records from a naturalistic cohort of consecutive patients referred to an early intervention in psychosis service to address this question.

They extracted data on demographic (age, sex, ethnicity and marital status), immune and metabolic factors at baseline, and subsequent need for long-term secondary (specialist) psychiatric care.

Of 749 patients with outcome data available, 447 (60%) had a good outcome and were discharged to primary care, while 302 (40%) required follow-up by secondary mental health services indicating a worse outcome.

The need for ongoing secondary mental healthcare was associated with high triglyceride levels, a low basophil:lymphocyte ratio, and a high monocyte count at baseline.

In conclusion, the research provides evidence that triglyceride levels and several blood cell counts measured at presentation may be clinically useful markers of long-term prognosis for first episode psychosis in clinical settings. These findings will require replication.

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Publication: Neuropsychopharmacology

Rafa Romero-Garcia, Roxanne W. Hook, Jeggan Tiego, Richard A. I. Bethlehem, Ian M. Goodyer, Peter B. Jones, Ray Dolan, Jon E. Grant, Edward T. Bullmore, Murat Yücel & Samuel R. Chamberlain

12 September 2020


Impulsivity refers to behaviours that are inappropriate, risky, unduly hasty, and that lead to untoward outcomes. By contrast, compulsivity refers to repetitive, perseverative actions that are excessive and inappropriate to a given situation.

For example, an individual with attention-deficit hyperactivity disorder (ADHD) may manifest impulsive problems such as making a statement they regret to a colleague; or jumping a red light; whereas an individual with obsessive-compulsive disorder (OCD) may repeatedly (i.e. compulsively) check the front door is locked, for hours per occasion.

It is well known that impulsive and compulsive problems often occur together in the same individual, but very little is known about processes in the brain that may contribute to this. To address this, in this study supported by the NIHR Cambridge BRC researchers studied brain structure and impulsive-compulsive problems in young adults, and the relationship between them.

They found that most of the occurrence of impulsive and compulsive problems could be explained by difficulty regulating urges and habits, known as ‘disinhibition’. Disinhibition was related to changes in the structure of the brain, especially in regions important for top-down control such as the frontal lobe.

The study identified a new brain-based vulnerability marker contributing to impulsive and compulsive problems. Unlike previous research, the findings go beyond traditional psychiatric diagnostic boundaries, by examining a comprehensive range of behaviors, rather than only one disorder studied in isolation.

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Publication: Nature Communications

Varun Warrier, David M. Greenberg, Elizabeth Weir  Clara Buckingham, Paula Smith, Meng-Chuan Lai,  Carrie Allison, Simon Baron-Cohen

7 August 2020


Transgender and gender-diverse individuals are more likely to be autistic and report higher autistic traits

Researchers reviewed over 600,000 people and used five datasets where participants provided information such as gender identity and if they received a diagnosis of autism or other psychiatric conditions such as depression or schizophrenia. Participants also completed a measure of autistic traits.

Researchers found that transgender and gender-diverse adult individuals were between three and six times more likely to indicate that they were diagnosed as autistic compared to cisgender individuals. The study used data from adults who said they had received an autism diagnosis, however, it is likely there are more individuals on the autistic spectrum who are undiagnosed.

This research will help improve access to mental health care and support for transgender and gender-diverse individuals. Read the full news story.

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Publication: Journal of Psychopharmacology

Kanen JW, Arntz FE, Yellowlees R, Cardinal RN, Price A, Christmas DM, Sahakian BJ, Apergis-Schoute AM, Robbins TW

18 February 2020

The involvement of serotonin in responses to negative feedback is well established. Acute serotonin reuptake inhibition has enhanced sensitivity to negative feedback (SNF), modelled by behaviour in probabilistic reversal learning (PRL) paradigms. Whilst experiments employing acute tryptophan depletion (ATD) in humans, to reduce serotonin synthesis, have shown no clear effect on SNF, sample sizes have been small.

The researchers studied a large sample of healthy volunteers, male and female, and found ATD had no effect on core behavioural measures in PRL.

These results indicate that ATD effects can differ from other manipulations of serotonin expected to have a parallel or opposing action.

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Publication: Molecular Psychiatry

Varun Warrier, Simon Baron-Cohen

29 October 2019


People with a higher genetic likelihood of autism are more likely to report higher childhood maltreatment, self-harm and suicidal thoughts. Following on from a previous study, researchers looked at the genetic likelihood for autism in 100,000 people. They found those with a higher number of genetic varients associated with autism were more likely to report maltreatment and self-harm.

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Publication: Psychopharmacology

Lim TV, Cardinal RN, Savulich GJ, Moustafa AA, Robbins TW, Ersche KD

1 August 2019

Drug addiction has been suggested to develop through drug-induced changes in learning and memory processes. Whilst the initiation of drug use is typically goal-directed and hedonically motivated, over time, drug-taking may develop into a stimulus-driven habit, characterised by persistent use of the drug irrespective of the consequences.

Converging lines of evidence suggest that stimulant drugs facilitate the transition of goal-directed into habitual drug-taking, but their contribution to goal-directed learning is less clear.

Computational modelling may provide an elegant means for elucidating changes during instrumental learning that may explain enhanced habit formation.

The research team used formal reinforcement learning algorithms to deconstruct the process of appetitive instrumental learning and to explore potential associations between goal-directed and habitual actions in patients with cocaine use disorder (CUD).

They re-analysed appetitive instrumental learning data in 55 healthy control volunteers and 70 CUD patients by applying a reinforcement learning model within a hierarchical Bayesian framework. They used a regression model to determine the influence of learning parameters and variations in brain structure on subsequent habit formation.

The research showed that poor instrumental learning performance in CUD patients was largely determined by difficulties with learning from feedback, as reflected by a significantly reduced learning rate.

Subsequent formation of habitual response patterns was partly explained by group status and individual variation in reinforcement sensitivity. White matter integrity within goal-directed networks was only associated with performance parameters in controls but not in CUD patients.

The data indicate that impairments in reinforcement learning are insufficient to account for enhanced habitual responding in CUD.

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Publication: Psychopharmacology

Kanen JW, Ersche KD, Fineberg NA, Robbins TW, Cardinal RN

20 July 2019

Disorders of compulsivity such as stimulant use disorder (SUD) and obsessive-compulsive disorder (OCD) are characterised by deficits in behavioural flexibility, some of which have been captured using probabilistic reversal learning (PRL) paradigms.

This study used computational modelling to characterise the reinforcement learning processes underlying patterns of PRL behaviour observed in SUD and OCD and to show how the dopamine D2/3 receptor agonist pramipexole and the D2/3 antagonist amisulpride affected these responses.

The researchers applied a hierarchical Bayesian method to PRL data across three groups: individuals with SUD, OCD, and healthy controls. Participants completed three sessions where they received placebo, pramipexole, and amisulpride, in a double-blind placebo-controlled, randomised design.

The researchers compared seven models using a bridge sampling estimate of the marginal likelihood.

The results showed that stimulus-bound perseveration, a measure of the degree to which participants responded to the same stimulus as before irrespective of outcome, was significantly increased in SUD, but decreased in OCD, compared to controls (on placebo).

Individuals with SUD also exhibited reduced reward-driven learning, whilst both the SUD and OCD groups showed increased learning from punishment (nonreward).

Pramipexole and amisulpride had similar effects on the control and OCD groups; both increased punishment-driven learning. These D2/3-modulating drugs affected the SUD group differently, remediating reward-driven learning and reducing aspects of perseverative behaviour, amongst other effects.

The research showed how perseverative tendencies and reward- and punishment-driven learning differentially contribute to PRL in SUD and OCD.

D2/3 agents modulated these processes and remediated deficits in SUD in particular, which may inform therapeutic effects.

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Publication: Psychopharmacology

Robbins TW, Cardinal RN

4 April 2019

Psychopharmacology needs novel quantitative measures and theoretical approaches based on computational modelling that can be used to help translate behavioural findings from experimental animals to humans, including patients with neuropsychiatric disorders.

Here, researchers carried out a brief review which exemplifies this approach when applied to recent published studies of the effects of manipulating central dopaminergic and serotoninergic systems in rodents and marmoset monkeys, and possible comparisons with healthy human volunteers receiving systemic agents or patients with depression and schizophrenia.

Behavioural effects of central depletions of dopamine or serotonin in monkeys in probabilistic learning paradigms are characterised further by computational modelling methods and related to rodent and human data.

Several examples are provided of the power of computational modelling to derive new measures and reappraise conventional explanations of regional neurotransmitter depletion and other drug effects, whilst enhancing construct validation in patient groups. Specifically, effects are shown on such parameters as ‘stimulus stickiness’ and ‘side stickiness’, which occur over and above effects on standard parameters of reinforcement learning, reminiscent of some early innovations in data analysis in psychopharmacology.

Computational modelling provides a useful methodology for further detailed analysis of behavioural mechanisms that are affected by pharmacological manipulations across species and will aid the translation of experimental findings to understand the therapeutic effects of medications in neuropsychiatric disorders, as well as facilitating future drug discovery.

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Publication: Psychopharmacology

Alsiö J, Phillips BU, Sala Bayo J, Nilsson SRO, Calafat-Pla TC, Rizwand A, Plumbridge J, López-Cruz L, Dalley JW, Cardinal RN, Mar AC, Robbins TW

19 June 2019

Dopamine D2-like receptors (D2R) are important drug targets in schizophrenia and Parkinson’s disease, but D2R ligands also cause cognitive inflexibility such as poor reversal learning. The specific role of D2R in reversal learning remains unclear.

Here researchers tested the hypotheses that D2R agonism impairs reversal learning by blocking negative feedback and that antagonism of D1-like receptors (D1R) impairs learning from positive feedback.

Male Lister Hooded rats were trained on a novel visual reversal learning task. Performance on “probe trials”, during which the correct or incorrect stimulus was presented with a third, probabilistically rewarded (50% of trials) and therefore intermediate stimulus, revealed individual learning curves for the processes of positive and negative feedback.

The effects of D2R and D1R agonists and antagonists were evaluated. A separate cohort was tested on a spatial probabilistic reversal learning (PRL) task after D2R agonism.

Computational reinforcement learning modelling was applied to choice data from the PRL task to evaluate the contribution of latent factors.

The team found that D2R agonism with quinpirole dose-dependently impaired both visual reversal and PRL. Analysis of the probe trials on the visual task revealed a complete blockade of learning from negative feedback at the 0.25 mg/kg dose, while learning from positive feedback was intact. Estimated parameters from the model that best described the PRL choice data revealed a steep and selective decrease in learning rate from losses. D1R antagonism had a transient effect on the positive probe trials. They concluded that D2R stimulation impairs reversal learning by blocking the impact of negative feedback.

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Publication: Journal of Alzheimer's Disease

Raha-Chowdhury R, Henderson JW, Raha AA, Vuono R, Bickerton A, Jones E, Fincham R, Allinson K, Holland A, Zaman SH.

7 May 2019

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Publication: Journal of Child Psychology and Psychiatry

Meiser-Stedman R, McKinnon A, Dixon C, Boyle A, Smith P, & Dalgleish T

25 March 2019

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Publication: Australian & New Zealand Journal of Psychiatry

Chamberlain SR, Tiego J, Fontenelle LF, Hook R, Parkes L, Segrave R, Hauser TU, Dolan RJ, Goodyer IM, Bullmore E, Grant JE, Yucel M.

6 March 2019

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Publication: Molecular Autism

Sun X, Allison C, Wei L, Matthews FE, Auyeung B, Wu YY, Griffiths S, Zhang J, Baron-Cohen S, Brayne C.

28 February 2019

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Publication: Schizophrenia Research

Treen D, Savulich G, Mezquida G, Garcia-Portilla MP, Toll A, Garcia-Rizo C, et al.

February 2019

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Publication: Mit Press Journals

Anna O Ermakova, Nimrod Gileadi, Franziska Knolle, Azucena Justicia Diaz, Rachel Anderson, Paul C Fletcher, Michael Moutoussis, Graham K Murray.

1 February 2019

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Publication: Frontiers in Behavioural Neuroscience

George Savulich, Emily Thorp, Thomas Piercy, Katie A Peterson, John D Pickard, Barbara J Sahakian.

21 Jan 2019


A new ‘brain training’ game designed by researchers at the University of Cambridge improves users’ concentration, according to new research published today. The scientists behind the venture say this could provide a welcome antidote to the daily distractions that we face in a busy world.

A team from the Behavioural and Clinical Neuroscience Institute at the University of Cambridge, has developed and tested ‘Decoder’, a new game that is aimed at helping users improve their attention and concentration. The game is based on the team’s own research and has been evaluated scientifically.

In a study published in the journal Frontiers in Behavioural Neuroscience Professor Sahakian and colleague Dr George Savulich have demonstrated that playing Decoder on an iPad for eight hours over one month improves attention and concentration. This form of attention activates a frontal-parietal network in the brain. Read the full story here

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Publication: Psychological Medicine

Fernandez-Egea E, Worbe Y, Bernardo M, Robbins TW.

December 2018

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Publication: Neuroimage

Cury C, Durrleman S, Cash DM, Lorenzi M, Nicholas JM, Bocchetta M, et al.

6 December 2018

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Publication: The Journal of Nervous and Mental Disease

Mezquida G, Fernandez-Egea E, Treen D, Mane A, Berge D, Savulich G, et al.

Novermber 2018

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Publication: Journal of Alzheimer's Disease,

Moylett S, Price A, Cardinal RN, Aarsland D, Mueller C, Stewart R, O’Brien JT.

28 November 2018

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Publication: Frontiers in Psychiatry

Savulich G, Jeanes H, Rossides N, Kaur S, Zacharia A, Robbins TW, et al.

21 November 2018

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Publication: Brain

Surendranathan A, Su L, Mak E, Passamonti L, Hong YT, Arnold R, et al.

6 November 2018

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Publication: Journal of Autism and Developmental Disorders

Hull L, Mandy W, Lai MC, Baron-Cohen S, Allison C, Smith P, Petrides KV

25 October 2018

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Publication: Nature

Baland Jalal, Annette Brühl, Claire O’Callaghan, Thomas Piercy, Rudolf N. Cardinal, Vilayanur S. Ramachandran and Barbara J. Sahakian

23 October 2018


A ‘brain training’ app could help people who suffer from obsessive compulsive disorder (OCD) manage their symptoms, which may typically include excessive handwashing and contamination fears.

One of the most common types of OCD, affecting up to 46% of OCD patients, is characterised by severe contamination fears and excessive washing behaviour. Excessive washing can be harmful as sometimes OCD patients use spirits, surface cleansers or even bleach to clean their hands. The behaviours can have a serious impact on people’s lives, their mental health, their relationships and their ability to hold down jobs.

Cambridge researchers developed a new treatment to help people with contamination fears and excessive washing. The intervention, which can be delivered through a smartphone app, involves patients watching videos of themselves washing their hands or touching fake contaminated surfaces. Read the full story here

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Publication: Nature Communications

Young AL, Marinescu RV, Oxtoby NP, Bocchetta M, Yong K, Firth NC, et al.

15 October 2018

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Publication: Molecular Psychiatry

Koriath C, Kenny J, Adamson G, Druyeh R, Taylor W, Beck J, et al.

2 October 2018

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Publication: Neuropsychopharmacology

Skandali N, Rowe JB, Voon V, Deakin JB, Cardinal RN, Cormack F, et al.

26 September 2018

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Publication: Neurobiology of Aging

Mak E, Padilla C, Annus T, Wilson LR, Hong YT, Fryer TD, Coles JP, Aigbirhio FI, Menon DK, Nestor PJ, Zaman SH.

August 2018

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Publication: Molecular Psychiatry

Lombardo MV, Auyeung B, Pramparo T, Quartier A, Courraud J, Holt RJ, et al.

13 August 2018

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Publication: Molecular Autism

Cassidy S, Bradley L, Shaw R, Baron-Cohen S.

31 July 2018

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Publication: PLoS One

Holt R, Upadhyay J, Smith P, Allison C, Baron-Cohen S, Chakrabarti B.

27 July 2018

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Publication: Behavior Research Methods

Lassalle A, Pigat D, O’Reilly H, Berggen S, Fridenson-Hayo S, Tal S, et al.

30 April 2018

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Publication: Psychological Medicine

Savulich G, Menon DK, Stamatakis EA, Pickard JD, Sahakian BJ.

11 April 2018

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Publication: Journal of Alzheimer's Disease

Mc Ardle R, Morris R, Hickey A, Del Din S, Koychev I, Gunn RN, et al.

10 April 2018

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Publication: Molecular Neurobiology

Galindo L, Moreno E, Lopez-Armenta F, Guinart D, Cuenca-Royo A, Izquierdo-Serra M, et al.

2 January 2018

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Publication: Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring.

Mak E, Bethlehem RA, Romero-Garcia R, Cervenka S, Rittman T, Gabel S, Surendranathan A, Bevan-Jones RW, Passamonti L, Rodríguez PV, Su L.

1 January 2018

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Publication: BMJ Open

Price A, Farooq R, Yuan J-M, Menon VB, Cardinal RN, O’Brien JT

3 November 2017

The researchers here aimed to use routine clinical data to investigate survival in dementia with Lewy bodies (DLB) compared with Alzheimer’s dementia (AD).

DLB is the second most common dementia subtype after AD, accounting for around 7% of dementia diagnoses in secondary care, though studies suggest that it is underdiagnosed by up to 50%.

Most previous studies of DLB have been based on select research cohorts, so little is known about the outcome of the disease in routine healthcare settings.

Working with Cambridgeshire & Peterborough NHS Foundation Trust, a mental health trust providing secondary mental health care in England, the researchers used samples from 251 DLB and 222 AD identified from an anonymised database, derived from electronic clinical case records across an 8-year period (2005-2012), with mortality data updated to May 2015.

Raw (uncorrected) median survival was 3.72 years for DLB and 6.95 years for AD. Controlling for age at diagnosis, comorbidity and antipsychotic prescribing the model predicted median survival for DLB was 3.3 years for males and 4.0 years for females, while median survival for AD was 6.7 years for males and 7.0 years for females.

The researchers concluded that survival from first presentation with cognitive impairment was markedly shorter in DLB compared with AD, independent of age, sex, physical comorbidity or antipsychotic prescribing.

This finding, in one of the largest clinical cohorts of DLB cases assembled to date, adds to existing evidence for poorer survival for DLB versus AD. There is an urgent need for further research to understand possible mechanisms accounting for this finding.

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Publication: BMC Medical Informatics and Decision Making

Rudolf N Cardinal

26 April 2017

Electronic medical records contain information of value for research, but contain identifiable and often highly sensitive confidential information.

Patient-identifiable information cannot in general be shared outside clinical care teams without explicit consent, but anonymisation/de-identification allows research uses of clinical data without explicit consent.

This article presents CRATE (Clinical Records Anonymisation and Text Extraction), an open-source software system with separable functions: (1) it anonymises or de-identifies arbitrary relational databases, with sensitivity and precision similar to previous comparable systems; (2) it uses public secure cryptographic methods to map patient identifiers to research identifiers (pseudonyms); (3) it connects relational databases to external tools for natural language processing; (4) it provides a web front end for research and administrative functions; and (5) it supports a specific model through which patients may consent to be contacted about research.

Creation and management of a research database from sensitive clinical records with secure pseudonym generation, full-text indexing, and a consent-to-contact process is possible and practical using entirely free and open-source software.

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Publication: Molecular Psychiatry

Kappelmann, N., Lewis, G., Dantzer, R., Jones, P.B. and Khandaker, G.M., 2016

18 October 2016

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Publication: Proceedings of the National Academy of Sciences

Whitaker, K.J., Vértes, P.E., Romero-Garcia, R., Váša, F., Moutoussis, M., Prabhu, G., Weiskopf, N., Callaghan, M.F., Wagstyl, K., Rittman, T., Tait, R., Suckling, J., Ooi, C., Inkster, B., Fonagy, P., Dolan, R., Goodyer, I.M., Jones, P.B., the NSPN Consortium, Bullmore, E.T.

25 July 2016

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Publication: Science

Ersche, K.D., Gillan, C.M., Jones, P.S., Williams, G.B., Ward, L.H., Luijten, M., de Wit, S., Sahakian, B.J., Bullmore, E.T. and Robbins, T.W

17 June 2016

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Publication: npj Schizophrenia

Cardinal RN, Savulich G, Mann LM, Fernández-Egea E

21 October 2015

The impact of psychotropic drug choice upon admissions for schizophrenia is not well understood. This study aimed to examine the association between antipsychotic / antidepressant use and time in hospital for patients with schizophrenia.

The researchers conducted an observational study, using 8 years’ admission records and electronically generated drug histories from an institution providing secondary mental health care in Cambridgeshire, UK, covering the period 2005-2012 inclusive.

Patients with a coded ICD-10 diagnosis of schizophrenia were selected. The primary outcome measure was the time spent as an inpatient in a psychiatric unit. Antipsychotic and antidepressant drugs used by at least 5% of patients overall were examined for associations with admissions. Periods before and after drug commencement were compared for patients having pre-drug admissions, in mirror-image analyses correcting for overall admission rates.

Drug use in one 6-month calendar period was used to predict admissions in the next period, across all patients, in a regression analysis accounting for the effects of all other drugs studied and for time.

In mirror-image analyses, sulpiride, aripiprazole, clozapine, and olanzapine were associated with fewer subsequent admission days. In regression analyses, sulpiride, mirtazapine, venlafaxine, and clozapine-aripiprazole and clozapine-amisulpride combinations were associated with fewer subsequent admission days.

Use of these drugs was associated with fewer days in hospital. Causation is not implied and these findings require confirmation by randomized controlled trials.

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