Download SSC Psychiatry Research

SSC Psychiatry Research with Neuroscience Module 1
September – December 2013
Project Title & Summary
1. Trauma and forensic populations
Much has been written about the impact on adult mental health of trauma, whether
that is childhood trauma, adult trauma, or for example combat-related
trauma. There is a growing body of literature on the impact of combat-related
trauma on violent and aggressive behaviour but less has been written about the link
between trauma-related mental health problems in the general population and
violence. Past trauma is an underexplored risk factor for subsequent violence and a
better understanding of the pathways to violence following traumatic experiences
could improve management of many patients within forensic services or could help
prevent individuals ending up in forensic services.
Supervisor(s)
Dr Deirdre MacManus
Research Fellow
Specialist Registrar Forensic
Psychiatry
[email protected]
I propose a literature review of research which has studied the impact of a variety of
life-time traumatic experiences on violent behaviour to lead onto a discussion of
how our knowledge in this area may aid our management of aggressive and violent
behaviour among patients with trauma-related disorders, especially those who find
themselves under the care of forensic services.
2. What is the effect of gentrification in a neighbourhood on mental health Dr Laura Goodwin
Lecturer in Epidemiology
outcomes?
King’s Centre for Military
It is well established that where an individual lives and the neighbourhood Health Research
characteristics impact on a range of health outcomes, health behaviours and mental Department of Psychological
health. Change in a neighbourhood can occur either through the process of Medicine
gentrification which can broadly be defined as higher-income households moving
into lower-income neighbourhoods, or through government led regeneration [email protected]
projects, and negative change may occur when a neighbourhood becomes more
deprived and those who can afford to will move away. Whilst the gentrification
phenomena could be viewed as improving the facilities available to all individuals Dr Charlotte Woodhead
in a neighbourhood, it may also result in social segregation between middle and Researcher
lower SEC groups and potentially to socio-spatial segregation when lower SEC Psychological Medicine
groups are displaced and priced out of their neighbourhood.
By using existing longitudinal studies, epidemiologists and health [email protected]
researchers have been able to study the effects of change in various neighbourhood k
characteristics and composition on various health outcomes, on those who remain in
the same area, including change in health over time. The objectives of this
literature review are to focus on mental health outcomes and to review studies
which have looked at the effects of change in neighbourhood on mental health.
Boyle P., Norman P., Rees P. (2004). Changing places. Do changes in the relative deprivation of areas influence
limiting long-term illness and mortality among non-migrant people living in non-deprived households?. Social
Science and Medicine. 58 (12), 2459-2471.
Butler, T. & Robson, R. (2001). Social Capital, Gentrification and Neighbourhood Change in London: A
Comparison of Three South London Neighbourhoods. Urban Studies, 38, (12), 2145–2162
Dalgard O.S., Tambs K. (1997). Urban environment and mental health. A longitudinal study. British Journal of
Psychiatry. 171, 530-536.
3. Oxidative stress and depression
Many neurodegenerative and neuropsychiatric diseases, including depression, have
recently been linked to oxidative stress, a pathological condition arising when
physiological oxidative actions by reactive oxygen species are no longer balanced
by antioxidative defenses. At the same time, excessive or persistent activation of
glutamate-gated ion channels may cause neuronal degeneration in the same
conditions. Glutamate and related acidic amino acids are the major excitatory
neurotransmitters in the brain and may be utilized by 40 percent of the synapses.
Thus, two broad mechanisms -oxidative stress and excessive activation of glutamate
receptors- are converging and represent sequential as well as interacting processes
that provide a final common pathway for cell vulnerability in the brain. We want to
review the molecular pathways underlying these mechanisms.
Dr Patricia Zunszain
Researcher
Psychological Medicine
[email protected]
4. Systematic review of the evidence for linking personality factors to physical
health disorders
Dr Piyal Sen
Consultant Forensic
Psychiatrist
It is only in the field of Cardiology that we see personality being mentioned, with
Visiting Research Fellow,
Type A personality type being more likely to suffer from coronary heart disease as
Institute of Psychiatry,
opposed to Type B. However, there is a link between anxiety and a number of
King's College, London
physical health conditions like diabetes, cancer, infertility, Irritable Bowel
and St. Andrew's
Syndrome, etc, while the anxiety itself could well be a product of the type of
personality. There is some evidence from the field of personality disorder that these Academic Centre,
Northampton.
patients attend doctors more frequently, but if a genuine link is found between
personality factors and some types of physical disease, there is a strong case to carry 01268 723847
[email protected]
out personality screening assessments in these clinics and offer basic psychological
therapy to address those personality difficulties through liaison psychiatry or
[email protected]
through IAPT interventions. The research case to explore this is thus very strong.
(please send any emails to
both addresses)
5. Systematic review of the evidence of whether certain personality traits or
disorders are more predictive of PTSD or depression after experiencing a
traumatic event.
Compensation claims continue to increase in all areas of British society, whether it
be the effect of a road traffic accident or being badly treated by the police following
stop and search, or being treated poorly while in hospital or prison. If it is
established that certain personality traits or disorders are more predictive of an
adverse reaction to a traumatic event, this will also help to answer prognostic
calculations about the likelihood of a full recovery, which might assist towards the
assessment of the level of compensation. This could also assist authorities who
might be the victim of a compensation claim to be more cautious in their treatment
of individuals judged to be more vulnerable than others because of their personality
and devise some basic screening test for this in settings like police stations, prisons,
hospitals, etc.
Dr Piyal Sen
Consultant Forensic
Psychiatrist
Visiting Research Fellow,
Institute of Psychiatry,
King's College, London
and St. Andrew's
Academic Centre,
Northampton.
01268 723847
[email protected]
[email protected]
(please send any emails to
both addresses)
6. Human stem cells as models of autism spectrum disorders
Further details to be discussed with supervisor
Prof Noel Buckley
Professor of Molecular
Neurobiology
Centre for the Cellular
Basis of Behaviour
(CCBB)
[email protected]
7. Reward sensitivity in schizophrenia: a systematic review
A main limitation in current diagnostic criteria is the lack of correspondence
between symptoms and pathophysiological mechanisms. Many advocate a shift to a
classification system with a clear association with biological mechanisms. However,
our current understanding of the neurobiology and genetics of psychiatric disorders
is largely insufficient to advance alternative classification criteria. One of the major
limitations in developing this framework is the lack of a clear correspondence
between biological and behavioural abnormalities. Recently the National Institute of
Mental Health in the US advanced an alternative framework to study mental health
conditions called the Research Domain Criteria (RDoC). RDoC aims to be a
biologically-valid framework for the understanding of mental disorders.
Converging research indicates that individuals with schizophrenia show a marked
impairment in tasks involving sensitivity to feed-back. Sensitivity to feed-back is a
basic function needed to regulate our behaviour following positive and negative
consequences which is essential for learning and decision-making. Deficits in
reward sensitivity in particular have been associated with the dopamine system
which is thought to be implicated in the pathophysiology of schizophrenia. Reward
sensitivity has been put forward as one of the five RDoC as this mechanism is
considered promising in linking the biology and the behaviour.
The current project aims to systematically review the research conducted on reward
learning in schizophrenia to highlight associations between behavioural adaptation
(i.e. learning) and biological mechanisms. Knowledge in this area will inform both
biological theories of dopamine imbalance but also psychological interventions for
symptoms of schizophrenia resulting from reduced reward sensitivity (e.g. poor
motivation, anhedonia).
Clementine Edwards
PhD Student
Department of Psychology
[email protected]
k
Dr Matteo Cella
Lecturer
Department of Psychology.
[email protected]
8.Title TBC
The 2009/10 pandemic saw the mass distribution of antiviral drugs to the general
population, using a novel system involving the automated assessment of symptoms
via an on-line service and the issuing of a unique authorisation code which could be
taken to a pharmacist. This model was useful during the pandemic, and public
health experts are now interested in its applicability to other situations where mass
distribution of medicines may be needed.
Dr James Rubin
Senior Lecturer in the
Psychology of Emerging
Health Risks
Psychological Medicine
[email protected]
Yet while the supply of medicine worked well in the pandemic, adherence by the
public was remarkably low. Estimates suggest that fewer than 50% of the antivrals
issued were actually taken. If we are to develop the mass distribution system further,
understanding the behaviour of the patient once they receive their authorisation code
is clearly essential - why do some not collect their tablets at all, while others cease
taking their tablets before they have finished their course?
In this review, we will identify all studies relating to the pandemic which provide
data on this issue. We will provide a list of the key risk factors for non-adherence to
antivirals and attempt to quantify these risk factors where possible. The review will
then inform a larger body of work on this, currently being run by KCL, UCL and
Public Health England.
9. Biological correlates of cognitive decline in Alzheimer’s disease
Dr Wendy Noble
Lecturer in Neuroscience
Alzheimer’s disease (AD) brain is characterised by deposits of β-amyloid (Aβ) in King's College London
neuritic plaques, intracellular neurofibrillary tangles (NFTs) comprising aggregated Institute of Psychiatry
tau, synaptic dysfunction and neuronal loss. Accumulating evidence suggests that it Department of Neuroscience
is not the presence of plaques and tangles themselves that cause damage to synapses (PO37)
and loss of neuronal function, but rather that the damage is caused by specific
alterations to the structure or localisation of tau and A that occur before their
inclusion into filamentous lesions. Since progressive synaptic dysfunction and
neuronal loss gives rise to the clinical symptoms of dementia and a spectrum of
additional cognitive and behavioural abnormalities, it is important that we develop a
more complete understanding of the biological events underlying synaptotoxicity
and neurodegeneration in AD. To address this aim, the student will conduct a
literature review of the pathological correlates of disrupted neuronal functioning and
cognitive decline in AD.
10. Multi-dimensional description of the delivery of psychotherapy: a
systematic review and a proposal
Psychotherapy traditionally occurred once a week as an outpatient. Over the past
couple of decades there has been an upsurge of interest in the delivery of
psychological therapies in different formats and intensities. Thus a trial might
investigate (a) the numbers of sessions (e.g “one session treatment”, “brief” therapy
or long term therapy (b) the duration of sessions (c) the frequency of sessions (e.g.
sessions delivered intensively over a week or every other day) (c) different levels of
training and experience of a therapist (e.g. low intensity Psychological Well Being
Practitioners v highly experienced therapist) (d) individual or group or family
therapy (e) different settings (e.g home treatment; internet delivered therapy; outpatient; residential) (f) different formats (e.g. written text, video or computer
software; face to face). Different researchers and therapists may use different terms
to describe the same format or the same term to describe different formats. Thus the
term “low intensity” is used by NICE to mean the number of sessions or the
delivery of the therapy over the telephone or by the type of therapist.
Dr David Veale
Consultant Psychiatrist
Centre for Anxiety Disorders
and Trauma, The Maudsley
Hospital and Visiting Senior
Lecturer, Institute of
Psychiatry and Chair of the
NICE Evidence Update on
OCD
[email protected]
Dr Oliver Suendermann
Clinical Psychologist at the
Anxiety Disorders Residential
Unit
Standardization would assist in the reporting of clinical trials or protocols; and
comparing similar studies in meta-analysis. Specifically a common description
would improve the Consort Statement for Non-Pharmacological Interventions that
requires “Precise details of the interventions intended for each group and how and
when they were actually administered”. However there is no standardized method of
reporting different formats or intensity of a psychological therapy and it is
extremely difficult to extract this information in a systematic review.
The aim of this review is (1) to scope the different ways of delivering psychological
therapies, (2) to recommend a multi-dimensional description for reporting for the
delivery of psychological therapies (3) sample how many controlled trials currently
provide the information required in a format that can be easily obtained. The review
should lead to a publication and perhaps a standard of reporting to be adopted in
future protocols and trials of psychotherapy.
[email protected]
hs.uk
11. Are blood-based protein biomarkers for Alzheimer’s disease also involved
in other brain disorders?
Dr Martina Sattlecker
Researcher, Bioinformatician
Institute of Psychiatry
The number of people with dementia, especially Alzheimer’s disease (AD), is
rapidly growing. Currently there is no fast, objective and accurate method for an
early diagnosis and thus the search for biomarkers in blood is a fast growing
research area. Similarly, researchers are turning to the blood proteome for markers
of other brain disorders. So far no attempt has been made to review whether the
protein biomarkers reported in the literature are specific or are indicative of general
brain disorder.
[email protected]
Dr Steven Kiddle
Researcher
Institute of Psychiatry
[email protected]
Recently we executed a literature search and summarised the most frequently
reported AD protein biomarkers in blood. The next step will be to identify if these
AD proteins are specific to AD or whether they are also involved in other dementia
types and mental illnesses, such as Lewy body dementia, Parkinson’s disease,
Schizophrenia and Autism. This literature review will show if blood-based protein
markers are AD specific or involved in various brain disorders.
12. Searching for unpublished trials of anti-psychotics in Obsessive Compulsive
Disorder
Anti-psychotic drugs are often prescribed “off-license” by clinicians to augment a
selective serotonergic reuptake inhibitor (SSRI) anti-depressant for people with
severe Obsessive Compulsive Disorder (OCD) who are refractory to SSRIs and
cognitive behaviour therapy. The evidence base for adding an anti-psychotic is
limited, but as a class they are recommended in the NICE guidelines for OCD
(2006). More recently a Cochrane review (Komasssi, et al 2010) published a metaanalysis and suggested there was limited evidence for some specific anti-psychotics
in the short term. The NICE Evidence Update (2013) recently searched for any new
evidence in the past 3 years and has identified all the published controlled trials.
However, off-label uses may be particularly vulnerable to selective data publication,
which can lead to exaggeration of treatment benefits (Goldacre, 2012). The question
for this study is whether there are other unpublished data that should be included in
a meta-analysis of anti-psychotic augmentation, as it may lead to different
conclusions than the NICE recommendations. This project will explore various
methods for accessing unpublished results, and document barriers to access. There
are three objectives to this study: (1) to determine if there are any unpublished
studies or data on adverse effects or outcomes in long term on anti-psychotics in
OCD that have not been published (2) to document barriers to access to these results
(3) to summarise the results of the trials that have been done and to document their
shortcomings. Method: We will first tabulate all the published RCTs of antipsychotics used in OCD identified from the NICE Evidence Update on OCD
(2013), the NICE Clinical Guidelines on OCD and BDD (2006) and 4 published
systematic reviews (Fineberg et al, 2006; Bloch et al, 2006; Komossa, K, et al
(2010) and Zhornitsky et al (2013). These currently total about 15 RCTs including
risperidone, quetapine, aripiprazole, olanzapine; amisulpiride and amisulpiride. The
list of RCTs will facilitate cross-checking against various registries including the 1)
European Medicine Agency (EMA), 2) US Food and Drug Administration (FDA),
3) Medicines Healthcare and Regulations Agency Database (MHRA) 4) the WHO
International Clinical trials registry 5) EU and industry registries and contacting
pharmaceutical companies directly (Chan et al, 2012). Output: If new data is found
then we will conduct a new meta-analysis that combines the published and
unpublished data and submit for publication and submit our findings to NICE. If no
further unpublished trials are found, a publication would set out the different
avenues for getting access to results, the barriers encountered when searching for
unpublished trials for unlicensed uses of a drug, and the shortcomings in systems,
regulations and voluntary codes.
13. Is getting old like a bit like having a cingulotomy?
The cingulum is a bundle of white matter fibres that runs front to back on the inner
surface of the cerebral hemisphere. It connects to the anterior cingulate cortex, the
function of which remains a hot topic in modern neuroscience. Cutting the cingulum
connections – or cingulotomy – is a form of psychosurgery still used to treat
depression and obsessive compulsive disorder. Stroke can also damage these
connections. Recently, we have shown that alteration in these connections as we
grow older leads to problems with cognitive control (Metzler-Baddeley et al. J
Neurosci 2012). The purpose of this review will be to revisit the cingulotomy
literature in the light of recent findings about cingulum function. Do those treated
with cingulotomy develop the same problems as those in whom the cingulum is
damaged by stroke? Are the benefits of cingulotomy shared by some patients with
stroke or as a result of ageing? Is it possible to devise a more precise procedure?
Dr David Veale
Consultant Psychiatrist
Centre for Anxiety Disorders
and Trauma, The Maudsley
Hospital and Visiting Senior
Lecturer, Institute of
Psychiatry and Chair of the
NICE Evidence Update on
OCD
[email protected]
Dr Ben Goldacre
Wellcome Research Fellow,
London School of Hygiene
and Tropical Medicine,
author of “Bad Pharma”
Dr Michael O’Sullivan
Senior Lecturer, Cognitive
Neuroscience
Institute of Psychiatry
[email protected]
Dr Rob Weeks
Consultant Neurologist,
Lead Clinician for Stroke
King’s College Hospital
[email protected]
14. Cognitive detective work on the stroke unit
Cognitive problems represent the greatest area of unmet need for stroke survivors.
Most commonly, patients complain of poor memory or poor concentration. Despite
the importance, very little is known about how cognitive deficits should be
identified on stroke units. Most of the tests used were developed in memory clinics
or in Alzheimer’s disease. Stroke brings particular problems however: tests based
on language may be difficult to administer and it may be difficult to pay attention to
demanding tasks in the busy, noisy environment of a stroke unit. Also, some deficits
after stroke are temporary and therefore not relevant to longer term problems.
This project will review approaches that have been evaluated early after stroke in a
stroke unit setting. In particular, it will aim to identify those tests that have helped to
guide rehabilitation or predict longer-term outcome. What use could be made of
technology such as smart phones or tablets? This project offers the opportunity to
truly shape the way a problem is approached in a leading stroke unit.
15. Exploring the association between patient delay in presentation and
Dr Michael O’Sullivan
Senior Lecturer, Cognitive
Neuroscience
Institute of Psychiatry
[email protected]
Dr Rob Weeks
Consultant Neurologist,
Lead Clinician for Stroke
King’s College Hospital
[email protected]
Maja Niksic
PhD student, Department
survival in lung and/or colorectal cancer
of Psychological Medicine,
Early detection of cancer could increase the chances for successful treatment Promoting Early Cancer
and improved survival. However, once cancer symptoms occur, the effects of Presentation Group
patient delay on survival are not clear. Approximately 40% of people delay [email protected]
consulting a doctor once they have detected an unexplained symptom, which
could lead to cancer diagnosis (Cancer Research UK, 2012). The association
between patient delay in presentation and cancer survival has been the (2 students)
subject of interest and considerable controversy for many years. There is
reliable evidence to suggest that longer patient delays in presentation are
associated with lower survival in breast cancer (Arndt et al., 2002; Richards
et al., 1999). However, inconclusive evidence exists for association between
patient delay and survival in colorectal (Kiran & Glass, 2002) and lung
cancer (Jensen et al., 2002; O'Rourke & Edwards, 2000). The aim of this
project is to explore the current evidence of the relationship between patient
delays in presentation and survival in lung and colorectal cancers. Objectives
of the review are: A) to explore the quality and strength of the evidence of
this association; B) to explore other, potentially confounding factors of the
association between patient delay in presentation and survival in lung and
colorectal cancer, such as patients’ age or stage of diagnosis; and, C) to
explore whether duration of patient delay (up to 3 weeks/ up to 6 months/ up
to one year/ more than a year) is associated with survival in lung and
colorectal cancer.
The project will involve the systematic review of literature using databases,
such as MEDLINE, Embase, PsycInfo and Cochrane Library.
There is a possibility to focus the project on one type of cancer only, such as
to explore only lung, or only colorectal cancer.
Students are strongly encouraged to develop a manuscript for publication at
the end of the project.
16. Differential roles for the dorsal and ventral hippocampus in Alzheimer’s
disease
Dr Sandrine Thuret
Lecturer in Neural Stem Cell
Research
Neuroscience
Further details to be discussed with supervisor
[email protected]
k
17. Number sense and Mathematical abilities.
This is relevant for studies on Autistic Spectrum Disorder and Learning
abilities/disabilities. Further details to be discussed with supervisor.
Dr Karim Malki
Researcher
SGDP
[email protected]
18. ADHD: The latest genetic findings
TBC
Dr Karim Malki
Researcher
SGDP
[email protected]
19. Computational Methods for exploring genome-wide data
Lately there have been many advances in the field of data-mining and Machine
Learning and it would be nice to summarise the current efforts and gain a future
perspective on how these methods will impact the field in the next 5 years.
Dr Karim Malki
Researcher
SGDP
[email protected]