Division of At-Risk Mental State (ARMS), Schizophrenia Spectrum and Other Psychosis Disorder

The division of ARMS and Psychosis is one of the active divisions of research in ARMS and Psychotic spectrum disorder including teaching and training.

Our focus is on gathering local evidence to inform health and social care policy about the evidence based psychosocial and pharmacological interventions for ARMS and Psychosis spectrum disorder.


One of our key objectives is to bring together a critical mass of international expertise and research excellence to build research capacity and capability in mental health Research within the division involves testing novel pharmacological and psychosocial interventions for ARMS and Psychosis. We have particular strength and interest in severe and enduring mental illnesses including ARMS, psychosis, bipolar disorder, self-harm and suicide prevention

Our Research

 The division works across following cross cutting themes;

  • Psychosocial interventions
  • pharmacological Interventions
  • Self-harm and suicide prevention
  • Digital mental health
  • Forensic mental health
  • Evidence synthesis
  • Arts and huminites
  • Biostatistics and health economics
  • Multimorbidity

Within these themes we are collaborating globally with national and international experts to address the huge treatment gap in LAMICs.

The division comprise of experts in qualitative and quantative research with a range of expertise in cultural adaptations, clinical trials, evidence synthesis, epidemiology and digital health.

Teaching and Training

Research and training across wide range of mental health issues in all type of health problems. As part of our capacity building programs, we offer different training programs to early career researchers to become the future leaders in mental health research.

Early career researchers are provided opportunities to get regular ongoing supervision from both national and international experts in good clinical practices, research ethics and governance, clinical trials management, how to write a research paper, grant writing, systematic reviews etc.

Regular trainings and mentorship are provided to researchers in the administration of assessment tools such as Positive and Negative Syndrome Scale (PANSS), Comprehensive Assessment for At Risk Mental State (CAARMS), Schizophrenia Proneness Instrument, Structured Clinical Interview for DSM-5, Calgary Depression Scale etc.

We have trained master trainers for a number of psychosocial interventions such as Culturally adapted Cognitive Behavior Therapy for Psychosis (caCBTp), Culturally adapted family intervention for psychosis, Culturally Adapted Manual Assisted Problem Solving (CMAP) Intervention for self-harm.

Assessment Package for Psychosis offered at PILL

Psycholological Assessments

The Comprehensive Assessment of At-Risk Mental States is a semi-structured instrument designed to identify help-seeking individuals who are at immediate risk of developing a psychotic disorder. The CAARMS comprises of psychopathological domains like cognitive changes, emotional disturbances, negative symptoms, behavioural changes, motor and physical changes, and general psychopathology.

The Structured Clinical Interview for DSM- IV (SCID-IV) is a semi-structured interview tool used to conduct major psychiatric diagnoses according to the criteria established in the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM). It is typically administered by a clinician or mental health professional who is familiar with the DSM criteria.

Schedule for Assessment of Insight (SAI) is a semi-structured interview which measures the patient’s insight across 3 domains; awareness of the illness, recognition for need of treatment and ability to see that the psychotic symptoms (hallucinations/delusions) are a result of the illness.

The Schizophrenia Proneness Instrument, Adult Version (SPI-A) examines basic symptoms that are self-experienced disturbances in thinking, perception, speech and motor functioning. These typically appear before the onset, during or after the onset of a psychotic episode.

The Schizotypal Personality Questionnaire (SPQ) is 74-item self-report measure developed to assess schizotypal personality. The questionnaire is divided across 9 subscales such as Odd beliefs or Magical thinking, Unusual perceptual experiences, Ideas of reference, Paranoid ideation/suspiciousness, Excessive social anxiety, No close friends, Constricted affect, Odd or eccentric behavior, and Odd speech.

The PANSS is a widely used structured clinical interview to examine the severity of positive and negative symptoms for individuals with schizophrenia. About 30 items – from which seven are positive symptoms, seven are negative symptoms, and 16 are general psychopathology symptoms – of schizophrenia are assessed of the most recent week.

The Montgomery–Asberg Depression Rating Scale (MADRS) is a clinician-rated scale, 10-item scale which tests the severity of core depressive symptoms. Nine of the questions are patient-rated while one question is observer-rated. The scale examines mood symptoms like sadness, tension, lassitude, pessimistic thoughts, and suicidal thoughts.

PSYRATS is a clinical scale developed to assess and quantify the severity of hallucinations and delusions, commonly used in research for patients with schizophrenia and psychosis. It contains two different subscales for auditory hallucinations (11 items) and delusions (6 items).

The Global Assessment of Function scale is widely used by mental health clinicians to test the severity of mental health illnesses. It uses interviews and questionnaires to examine how symptoms may impact the psychological, social and occupational wellbeing or functioning of an individual and ultimately their ability to perform daily activities.

The CGI is devised to offer a brief assessment of the patient’s global functioning before and after administering a study medication. It covers information such as knowledge of the patient’s history, psychosocial circumstances, symptoms, behavior, and the impact of the symptoms on the patient’s ability to function. CGI measures illness severity (CGIS), global improvement or change (CGIC) and therapeutic response.

The Abnormal Involuntary Movement Scale (AIMS) is a 12-item scale rated by clinicians to measure the severity of dyskinesias which are involuntary movements often observed in patients taking antipsychotic medication.

The SFS is a 76-item measure designed to assess the social skills and functioning for individuals with schizophrenia. It has 7 subscales including social engagement/withdrawal, interpersonal behaviour,  pro-social activities, recreation, independence-competence,  independence-performance, and employment/occupation.

This self-rated questionnaire includes a visual analogue scale and provides an overview of an individual’s health status across 5 dimensions; mobility, self-care, usual activities, pain/discomfort and anxiety/depression.

SOFA is a scale that is derived from the Global Assessment of Functioning and measures the social and occupational performance of an individual which is independent to the severity of an individual’s psychological symptoms. Other extraneous or environmental factors are usually not considered as an influence.

ECI is a self-rated 66-item questionnaire that assesses the impact of caregiving for carers of individuals who suffer from psychotic illnesses.

The Brief IPQ is a 9-item measure to evaluate a patient’s perception or representation of their illness across domains like cognitive illness representation, emotional representations, and causal representations.

The Herth Hope Index is a 12-item assessment tool to clinically examine the construct of hope as theorized by Dufault and Martochhio. The three domains assessed are inner sense of temporality and future, inner positive readiness and expectancy, and interconnectedness with self and others.

Neurological Assessments

The Cogstate Brief Battery has been used extensively as a rapid and reliable screening assessment in a range of clinical indications, including Alzheimer’s Disease, schizophrenia, dementia, etc. It provides a measure of four core cognitive domains: processing speed, attention, visual learning and working memory. It has also been used widely in the context of measuring cognitive dysfunction relative to healthy groups in both pediatric and adult populations.

CANTAB accurately measures cognitive function, identifies levels of performance and impairment, and quantifies the effectiveness of treatments in the brain. CANTAB tests have demonstrated sensitivity to detecting changes in neuropsychological performance and include tests of working memory, learning and executive function; visual, verbal and episodic memory; attention, information processing and reaction time; social and emotion recognition, decision making and response control.

Wechsler Adult Intelligence Scale is an IQ test designed to measure intelligence and cognitive ability in adults and older adolescents. The test contains numerous scales (Indices) assessing qualitatively different types of intellectual functioning. It scores four main indices; Verbal Comprehension, Working Memory, Perceptual Reasoning, and Processing Speed. WAIS measures intellectual performance as a multidimensional construct.

SCWT is a neuropsychological test that is used to assess the Stroop Effect. The Stroop effect is the delay in reaction time between automatic and controlled processing of information, in which the names of words interfere with the ability to name the color of ink used to print the words. It is used for both experimental and clinical purposes. This test can be used to measure a person’s selective attention capacity and skills, processing speed, automaticity, and cognitive flexibility.

The verbal fluency task (VFT) is a short screening test that evaluates cognitive function. Verbal fluency tasks are widely used to assess verbal functioning in clinical and research settings. This is because the tasks have compelling face validity: A person with a serious deficit in executive control abilities or both will perform poorly in the tasks. It can be used to screen for Alzheimer’s disease or another type of dementia.


Ongoing Projects

It has been reported that individuals diagnosed with psychosis disorders are also identified with developing experiences of self-harm, completed suicide or suicide attempts but evidence suggested advances in development of effective non-pharmacological treatments like CBT for psychosis. There are currently no early intervention services in Pakistan and given the shortage of appropriately trained clinicians to deliver psychosocial interventions novel approaches are needed. We have culturally adapted Cognitive Behavior therapy which demonstrated feasibility and acceptability for psychosis in Pakistan. The aim of this study is to refine, and feasibility test a combination of a Culturally adapted Cognitive Behavioural Therapy for Psychosis (CaCBTp) and Culturally Adapted Manual Assisted Brief Psychological Intervention for Self-harm (CMAP), which we have provisionally called (CMAP Plus) for individuals experiencing Suicidal Ideation (SI) in First Episode Psychosis (FEP).

Psychosis is one of the leading causes of disability affecting 29 million people worldwide and the First Episode Psychosis (FEP) occuring between ages 15–35 years is thought to be a critical period, influencing the long-term course of the disorder. Cognitive Behavioural Therapy (CBT) has been proven to be highly effective for the treatment of psychosis and culturally adapted CBT interventions are known to generate positive outcomes for patients with schizophrenia in low-middle-income countries. Mobile Health (mHealth) is a growing approach where cellular phones and smartphones can be used to facilitate healthcare provision, when time or distance-related challenges create barriers to mental health care access. This research on the feasibility of the TechCare app showed that most participants were able to get the “right help” when using the app for managing symptoms and gaining comprehensive insights about the illness.

Suicide accounts for around 800,000 deaths globally per annum and 78% of all deaths by suicide occur in low and middle-income countries (LMIC). An under-researched population in LMIC are individuals at high risk of developing a psychotic disorder; a population referred to as Ultra-High Risk psychosis (UHRp) or At Risk Mental State (ARMS). The aim of this study is to evaluate the prevalence, over a 5 year follow-up period, of suicide, suicidal ideation, and self-harm in individuals vulnerable to developing psychosis.

Completed Projects

This study evaluate two treatments, Sodium Benzoate and N-acetylcysteine (NAC), added to treatment as usual in patients with early schizophrenia. This study aim to test the acceptability and tolerability of Sodium Benzoate and or NAC added to treatment as usual in patients with early schizophrenia, aged 18-35. As well as, the impact on positive symptoms, negative symptoms and general psychopathology. This study was 12-week study, employing a randomised, double-blind, placebo-controlled, factorial design. The study was conducted in Rawalpindi, Lahore, Karachi, Quetta and Hyderabad in major psychiatric teaching and non-teaching hospitals/departments. The patients was assessed with clinical scales, side-effect check-lists and neuropsychological assessments at baseline, 4, 8 and 12 weeks.There was 16 patients in each cell, giving a total of 64 patients over 12 weeks.

MAC study

MAC is an acronym used for the research study Minocycline Augmentation of Clozapine for Treatment Resistant Schizophrenia: A Multicentre randomised double-blind placebo-controlled trial. MAC trial. Treatment resistant schizophrenia (TRS), thus has become a major public health concern especially in low income countries such as Pakistan. Clozapine, an atypical antipsychotic is best alternative for such resistant patients but still 70% of the patients treated with Clozapine, respond only partially and continue to have debilitating symptoms (Chakos, Lieberman, Hoffman, Bradford, & Sheitman, 2001). The aim is to determine the beneficial effects of minocycline augmentation to clozapine in Treatment Resistant Schizophrenia (TRS). This would be the first such study in the Pakistan. The study was caried out over the period 12 weeks as a randomized placebo controoled trial on 2 treatment arms one arm receiving TAU with minocycline and the other TAU with placebo. This study was conducted in Rawalpindi, Lahore, Karachi, Peshawar, Quetta and Hyderabad in major psychiatric teaching and non-teaching hospitals/departments. The patients was assessed on clinical, neuropsychological, physical and haematological assessments on baseline and follow-up visits (2, 4, and 8 weeks) and outcome assessment were carried out in the 12th week. The total of 18 patients, who are on clozapine treatment for a minimum of 3 months, were randomized in the trial. The analysis of the study is in progress.

At-risk mental state (ARMS) individuals are those who have a high likelihood of developing psychosis but are not clinically diagnosed with the illness. Unfortunately, there is no specific course of treatment for individuals with ARMS especially in low-middle-income countries like Pakistan. This research trial attempted to examine the efficacy of minocycline and omega-3 fatty acids as treatment interventions for individuals with ARMS. Such evidence can contribute to growing literature for ARMS treatment options as minocycline and omega-3 fatty acids are low-cost interventions and previous evidence has shown their ability to delay or prevent the onset of full psychosis.

A Culturally adapted Family Intervention (CulFI) was developed through a scientific framework for the treatment of schizophrenia in Pakistan. Compared to treatment as usual, CulFI had greater acceptability as it was highly rated by participants. The significant treatment gap in low-middle-income countries for providing care to schizophrenic patients warrants the need to conduct a full-scale trial of this study and create pathways to develop psychosocial interventions for schizophrenia in Pakistan.

This feasibility study aimed to assess the efficacy of the immune-suppressant drug methotrexate to treat individuals with schizophrenia. Methotrexate is typically used in the treatment systemic autoimmune disorders. A total of ninety-two participants who had been diagnosed with schizophrenia in the last five years were recruited from various healthcare facilities in Karachi, Pakistan. This was the first evidence reported of testing methotrexate in patients with schizophrenia and whether such a drug would be effective in managing psychotic symptoms.

Division Publications

Preliminary Results From a Multi-Centre, Double-Blind, Randomised Placebo Controlled Feasibility Trial of Add-on Sodium Benzoate and/or N-acetylcysteine in Patients With Early Schizophrenia. https://www.biologicalpsychiatryjournal.com/article/S0006-3223(22)00845-9/fulltext

Husain MO, Chaudhry IB, Khan Z, Khoso AB, Kiran T, Bassett P, Husain MI, Upthegrove R, Husain N. Depression and suicidal ideation in schizophrenia spectrum disorder: a cross-sectional study from a lower middle-income country. International journal of psychiatry in clinical practice. 2021 Sep 1;25(3):245-51. https://www.sciencedirect.com/science/article/abs/pii/S0165032722002865

Chaudhry IB, Husain MO, Husain MI, Khoso AB, Buch M, Kiran T, Fu B, Bassett P, Qurashi I, Rahman R, Baig S, Kazmi A, Corsi-Zuelli F, Haddad P, Deakin JFW, Husain N. A randomised clinical trial of methotrexate points to possible efficacy and adaptive immune dysfunction in psychosis. Translational Psychiatry 2020, 2020TP000429R.


Drake RJ, Husain N, Marshall M, Lewis SW, Tomenson B, Chaudhry IB, Everard L, Singh S, Freemantle N, Fowler D, Jones PB, Amos T, Sharma V, Green CD, Fisher H, Murray RM, Wykes T, Buchan I, Birchwood M. Effect of delaying treatment of first-episode psychosis on symptoms and social outcomes: a longitudinal analysis and modelling study. Lancet Psychiatry July 2020 Vol. 7, 602–610.


Husain MO, Khoso AB, Renwick L, Kiran T, Saeed S, Lane S, Naeem F, Chaudhry IB, Husain N. Culturally adapted family intervention for schizophrenia in Pakistan: a feasibility study. International Journal of Psychiatry in Clinical Practice 2020, DOI:

10.1080/13651501.2020.1819332. https://www.tandfonline.com/doi/abs/10.1080/13651501.2020.1819332

Deakin B, Suckling J, Dazzan P, Joyce E, Lawrie SM, Upthegrove R, Husain N, Chaudhry IB, Dunn G, Jones PB, Lisiecka-Ford D. Minocycline for negative symptoms of schizophrenia and possible mechanistic actions: the BeneMin RCT. Efficacy and Mechanism Evaluation. 2019;6(7):1-66.


Deakin B, Suckling J, Barnes TRE, Byrne K, Chaudhry IB, Dazzan P, Drake RJ,Giordano A, Husain N, et al. The benefit of minocycline on negative symptoms of schizophrenia in patients with recent-onset psychosis (BeneMin): a randomised, double-blind, placebo-controlled trial. Lancet Psychiatry. 2018 Nov;5(11):885-894.



Husain MO, Chaudhry IB, Thomasson R, Kiran T, Bassett P, Husain MI, Naeem F, Husain N. Cognitive function in early psychosis patients from a lower middle-income country. Int J Psychiatry Clin Pract. 2018 Mar;22(1):13-18.


Husain MO, Chaudhry IB, Mehmood N, ur Rehman R, Kazmi A, Hamirani M, Kiran T, Bukhsh A, Bassett P, Husain MI, Naeem F. Pilot randomised controlled trial of culturally adapted cognitive behavior therapy for psychosis (CaCBTp) in Pakistan. BMC health services research. 2017 Dec;17(1):808.


Reeder FD, Husain N, Rhouma A, Haddad PM, Munshi T, Naeem F, Khachatryan D, Chaudhry IB. The relationship between childhood trauma and adult psychosis in a UK Early Intervention Service: results of a retrospective case note study. Neuropsychiatric Disease and Treatment 2017 Feb 8;13:269-273.


Husain N, Gire N, Kelly J, Duxbury J, McKeown M, Riley M, Taylor CD, Taylor PJ, Emsley R, Farooq S, Caton N, Naeem F, Kingdon D, Chaudhry IB. TechCare: mobile assessment and therapy for psychosis – an intervention for clients in the Early Intervention Service: A feasibility study protocol. SAGE Open Med. 2016 Oct 18;4:2050312116669613.


Lisiecka DM, Suckling J, Barnes TRE, Chaudhry IB, Dazzan P, Husain N, Jones PB, Joyce E, Lawrie SM, Upthegrove R and Deakin B. The benefit of minocycline on negative symptoms in early-phase psychosis in addition to standard care – extent and mechanism (BeneMin): study protocol for a randomized controlled trial. Trials 2015 Mar 2;16 (1):71.


Marshall M, Husain N, Bork N, Chaudhry IB, Lester HE, Everard L, Singh SP, Freemantle N, Sharma V, Jones PB, Fowler D, Amos T, Tomenson B, Birchwood M. Impact of early intervention services on duration of untreated psychosis: data from the National EDEN prospective cohort study. Schizophrenia Research 2014 Oct; 159(1):1-6.



Adam U, Husain N, Haddad P, Munshi T, Tariq F, Naeem F, Chaudhry IB. Tardive dyskinesia in a South Asian Population with first episode psychosis (FEP) treated with antipsychotics. Neuropsychiatric Disease and Treatment 2014 Oct 14;10: 1953-9.


Khan F, Rhouma A, Siddiq H, Gire N, Chaudhry IB, Husain N. Early Intervention in Psychosis (EIP) Services, UK: A Critical Analysis Of The Evidence. Journal of Pakistan Psychiatric Society 2013 10 (1): 8-13.


Haddad PM, Das A, Keyhani S, Chaudhry IB. Antipsychotic drugs and extrapyramidal side-effects in first episode psychosis: a systematic review of head-head comparisons. Journal of Psychopharmacology 2012; 26: 15-26.


Haddad PM, Chaudhry IB. Challenges in management of early psychosis. Journal of Psychopharmacology 2012; 26: 5-6.


Some Beautiful Highlights

“On 6th Global Mental Health Research Capacity and Capability Building Training Programme, Prof. Gabriel De Erausquin (Physician Scientist at University of Texas Health San Antonio), gave training on the Psychological Assessment tool entitled as “Schedules for Clinical Assessment in Neuropsychiatry (SCANS)”.

Comprehensive Assessment for At Risk Mental State (CAARMS) training by Prof Imran Chaudhry ( Professor of Adult Psychiatry at the University of Manchester) at 6th Global Mental Health Research Capacity and Capability Building for Research

National Team

Prof. Imran B. Chaudhry

Senior Scientist

Dr. Haider Ali Naqvi

Head of Division

Mr. Ameer B Khoso

Assistant Director

Ms. Zaib Un Nisa

Research Associate

Ms. Maryam Tahir

Research Assistant

Ms. Komal Akram

Research Assistant

Ms. Nawaz Khan

Research Assistant

Mr. Akhter Zaman

Research Assistant

Mr. Awais Khan

Research Assistant

Ms. Hifza Malik

Research Assistant

International Collaborators

Prof. Nusrat Husain

Dr. Inti Qureshi

Dr. Omair Husain

Mr. Madi