Psychosis can affect people in very different ways, making it difficult to predict who will develop more severe or persistent difficulties, and which treatments will be most helpful. Ian Scott PhD Scholarship recipient, James Martin, investigated two concepts central to psychosis, termed basic symptoms and self-disorder, which describe distinct and subtle changes in how people experience their thinking, perception, sense of self, and the world around them. The thesis explores why young people who initially seem to have similar difficulties can go on to experience very different diagnoses, recovery, and longer-term outcomes. Capturing these experiences may provide useful information that is not easily identified by standard approaches.

The research examined basic symptoms and self-disorder from several perspectives. First, a review of previous neuroimaging research was used to develop a model explaining how these experiences might relate to differences in brain functioning. The thesis then examined a large dataset of young people considered at increased risk of developing psychosis. In this sample, a particular subset of basic symptoms involving changes in thinking was found to be associated with schizotypal personality disorder, but not with several other commonly occurring mental health conditions. These symptoms were also associated with differences in an electrical brain response linked to attention and information processing.

A separate study of young people at elevated risk of psychosis, or who had experienced an episode of acute psychosis, examined whether self-disorder could be detected through subtle changes in facial expressions, speech, and language. This analysis found reduced activation of a facial muscle involved in genuine smiling, as well as greater coherence in meaning across spoken sentences, in those reporting more self-disorder.

Together, these findings suggest that basic symptoms and self-disorder are linked to measurable differences in symptoms and biological functions which likely impact recovery and well-being. The thesis went on to provide practical guidance for incorporating assessment of these experiences into services providing early intervention care for psychosis. Overall, this work supports the potential value of understanding people’s subtle lived experience and how these complement conventional symptoms rather than compete with them, with the longer-term aim of improving assessment and developing more personalised approaches to early psychosis care.

The findings provide practical ways for early psychosis services to use these approaches, with the longer-term goal of identifying difficulties earlier and tailoring care to the individual rather than treating everyone at risk of psychosis as the same.

Media contact: [email protected]       First published 10th September 2026

Graphic acknowledgement: Freepik.com