Download Centre for Affective Disorders Launch Event

Centre for Affective Disorders Launch Event
January 31st 2014
Wolfson Lecture Theatre, Institute of Psychiatry, KCL
Affective or Mood Disorders represent one of the greatest challenges in medicine today. This group
of illnesses may occur at any age, in any demographic group and is associated with one of the
heaviest cost burdens both to the individual and to society. Affective disorders are common and
overlap with other psychiatric disorders and physical ill-health. Knowledge of this key area is
important for all practising health care professionals, policy makers and health service managers.
To advance understanding of the causes, care and cure of Affective Disorders, the Centre for
Affective Disorders (CfAD) has been created in the Institute of Psychiatry, King’s College London.
The CfAD is an international centre of excellence for understanding science related to these illnesses
and uses this knowledge to help develop new treatments of all types, including psychological and
pharmacological. The Centre brings together a number of world-leading clinician scientists at the
Institute of Psychiatry, King’s College London. These include Profs Anthony Cleare, Andre Tylée,
Carmine Pariante, Allan Young and others. Affective disorders overlap with many other areas of
psychiatry and medicine so we will be working with colleagues throughout King’s and more widely.
CfAD hosts the International Society for Affective Disorders and World Psychiatric Association
Section for Affective Disorders.
The Centre for Affective Disorders Launch Day offers all health professionals interested in affective
disorders the opportunity to meet the new team at the Centre for Affective Disorders, clinicians
from the tertiary South London and Maudsley NHS Foundation Trust Affective Disorders Service and
like-minded colleagues. It offers a forum to learn about the most recent advances in Affective
Disorders, to hear news from front line primary care and to learn from the patient perspective of
clinical care.
Programme
8.30:
Registration and coffee
9.00:
Welcome from Professor Shitij Kapur, Dean
9.15:
Professor Allan Young, Director, Centre for Affective Disorders & Clare Dolman Bipolar UK
Making treatment of Affective Disorders more effective - a patient’s perspective
Increasingly, medical practice at both primary and secondary levels has moved towards
emphasizing the need for a collaborative approach between clinicians and their patients.
There is a greater recognition of the benefits of considering how lifestyle choices impact on
treatment and how helpful inclusive approaches like shared decision-making and advance
planning can be for people with lifelong mental health conditions. This presentation will
offer the perspective of someone with lived experience of bipolar disorder that is also
involved in the Third Sector as Chair of the national charity Bipolar UK. It will give an insight
into how the charity engages with service users and the medical profession, and how the
charity’s work can complement clinical treatment, and also engage with current research.
A Raving and Melancholy Madness: Clinical Considerations in Bipolar Disorder.
Bipolar disorder (BD) is a common, chronic, severe, complex and costly group of recurrent
psychiatric illness that can be devastating for the affected individual and their families.
Suicide is an important risk across the life span of bipolar patients. To describe BD as
alternating periods of mania and depression is an oversimplification. Mania can present
with associated depressive symptoms and features leading to complicated, problematic
difficult-to-treat mixed states. Accurate differential diagnosis is not easy, particularly in
mixed states. Psychotic symptoms may suggest schizophrenia, and a major depressive
episode may appear to be unipolar depression, often over prolonged periods. Comorbid
anxiety and substance/alcohol abuse often confuse the diagnostic picture. These factors
contribute to under-diagnosis of BD. Incorrect diagnosis may worsen prognosis, increase
hospital stay and the overall costs of treatment and patient management. There is a
significant clinical need for more effective and better tolerated drug treatments for BD.
Although the pathophysiology and neurobiological processes responsible for BD are not fully
understood, a greater understanding of the causative underlying mechanisms is gradually
emerging. Identification of new drug targets driven by recent research should help define a
more tailored and potentially more successful approach to the treatment of BD. Future
advances are expected based on the ability to manipulate and redress the fundamental
disease processes and neurobiological dysfunction that underlie BD.
10.00: Professor Andre Tylee, Professor in Primary Care Mental Health
The future of anxiety and depression management in primary care
An overview of future developments in the treatment of depression and anxiety in primary
care settings will be provided. This will include the Improving Access to Psychological
Therapies Programme (IAPT) which was launched in 2008 by the Department of Health in
England to implement NICE guidelines for depression and anxiety by providing stepped first
line psychological therapy. The rationale, starting assumptions and 3 year results will be
discussed. Future plans include expanding and extending the scope to people with long term
physical health conditions (LTC) and medically unexplained symptoms (MUS). The economic
case for this will be discussed and national pilot projects will be described. Two related
research programmes being conducted at the Institute of Psychiatry and Kings Health
Partners will also be described. UPBEAT-UK is a nationally funded programme to understand
the relationship between coronary heart disease (CHD) and depression/anxiety and how the
results are being implemented within IAPT to improve care by IAPT for people with CHD.
PROMPT is a new research programme funded by the National Mental Health Biomedical
Research Centre at the IOP/Maudsley to understand the predictors of response to IAPT first
line treatments in order to improve response rates. Finally, recent policy changes and
opportunities for integration of care will be discussed.
10.30: Coffee
11.00: Professor Carmine Pariante, Professor of Biological Psychiatry
Molecular psychiatry of depression: from cells to emotions and back
A lack of understanding of the pathogenesis of mood disorders has in part been responsible
for a lack of innovation in treatment options over the last few years. A truly translational
approach starts with basic science and experimental models, which are used to generate
novel hypotheses for future therapeutic strategies. In our research group we have been
able to translate and back-translate between experimental and clinical models of
depression, and in doing so we have identified novel potential targetable mechanisms
relevant to neurogenesis and inflammation.
11.30: Professor Anthony Cleare, Professor of Psychopharmacology & Affective Disorders
Treatment Resistant Depression
Professor Cleare will outline the latest research findings on the optimal management of
complex and treatment resistant depression.
12.00: Lunch
The afternoon sessions will be a quick fire tour of our clinicians work and research.
13.30: Dr Daniel Dietch
Bipolar Disorders in Primary Care
This presentation will cover aspects of the GPs role in the diagnosis and management of
Bipolar Disorders.
Recognising previously undiagnosed Bipolar Disorders (BD) may be difficult within the
complexities of Primary Care, where patients present with a variety of medical or social
issues. Fatigue, relationship difficulties, insomnia and work-related stress are frequent
reasons for consultation and within this group may lie individuals with undiagnosed BD.
Furthermore, in those specifically seeking help for mood symptoms, patients with BD are
more likely to present with anxiety or depression, rather than with hypo/manic symptoms,
which may be overlooked. This is especially pertinent for individuals with Bipolar II or Bipolar
Spectrum Disorders, where hypomanic symptoms may be subtle. Even in individuals with
Bipolar I, recognising prodromal symptoms can be challenging. Consequently, there may be
delays to correct diagnosis and treatment and/or the prescription of antidepressants which
may be ineffective or induce hypo/mania, rapid cycling and suicidality.
The challenge for GPs therefore is recognising individuals who may have BD and arranging
further Psychiatric evaluation - whilst being cautious not to medicalise normal personality
traits and stress reactions.
Once a diagnosis is made, GPs can play a key role, alongside Psychiatric colleagues, in
ongoing patient management, including early intervention, psychoeducation,
psychopharmacology, optimising nutrition and reducing the risk of metabolic syndrome and
other complications.
13.50: Dr Paul Stokes
14.10: Dr Valeria Mondelli
Affective Disorders and Schizophrenia: is there a difference in the biological response to
stress?
Stress appears to play a crucial role in the onset and relapses of both affective disorders and
schizophrenia. Interestingly bipolar disorder, depression and schizophrenia are all
characterised by abnormalities in the activity of the hypothalamic-pituitary-adrenal (HPA)
axis, which is the main biological system involved in the response to stress. However, it is
still unclear whether and how the biological response to stress differs between affective
disorders and schizophrenia. In this talk, I aim to show some of our findings on similarities
and differences in biological response to stress between individuals suffering with affective
disorders or schizophrenia.
I will start by showing our findings on pituitary volume, as a proxy measure of HPA axis
activity, in relatives of individuals with bipolar disorder or schizophrenia; these data provide
evidence for the presence of a familial vulnerability to hyperactivate HPA axis in response to
stress in schizophrenia but not in bipolar disorder. I will then focus on our data on levels of
cortisol, the main stress hormone produced by the activation of the HPA axis. In particular I
will show how the association between cortisol levels during the day and cortisol awakening
response with affective and psychotic symptoms varies across different diagnoses. Finally, I
will conclude with our new data from a recent meta-analysis showing a different HPA axis
response to social stress in patients with depression and patients with psychosis, suggesting
a possible role of the HPA axis in defining a different trajectory to the onset of depression or
psychosis when the individuals are exposed to social stress.
The similarities and differences in the dysfunctional HPA axis activity in patients with
affective disorders and patients with schizophrenia, besides better explaining the biological
mechanisms underlying the onset of these disorders, may be an important target for helping
reducing negative effect of stress in these individuals.
14.30: Dr Roland Zahn
Translational cognitive neuroscience of major depressive disorder
There is a widespread recognition that psychiatric disorders such as major depressive
disorder (MDD) cannot be understood without identifying the cognitive and anatomical
components underpinning socio-moral cognition and emotion. Despite the current
flourishing of social cognitive neuroscience, bridging the gap between the phenomenology
of distinctive symptoms and their cognitive neuroanatomy remains difficult. Despite the
theoretical importance of guilt and self-blame, first highlighted by Freud, their neural bases
in MDD were unknown. We recently addressed this question using fMRI. As predicted from
our earlier work, overgeneralised self-blame and MDD were associated with functional
disconnection between temporal and frontal-subcortical brain regions when patients with
MDD experienced guilt but not whilst experiencing indignation. Future translational work
including 1) our ongoing MRC-funded study on predicting risk of recurrence in MDD from the
degree of self-blame-selective functional disconnection to probe their suspected causal
relationship, and 2) an ongoing fMRI neurofeedback proof-of-concept treatment trial will be
discussed.
14.50: Coffee
15.20: Dr James Stone
Ketamine for treatment resistant depression
It is well established that ketamine leads to a rapid antidepressant effect in patients with
treatment resistant depression. The long-term maintenance of response is much more
problematic, but despite this issue, ketamine is becoming more widely used as clinical
treatment. In this presentation, I will discuss current evidence for ketamine as an
antidepressant, strategies for maintenance of response, and the use of ketamine in clinical
practice. I will also dicuss the setting up of a ketamine clinic for patients with treatment
resistant depression within the South London and Maudsley NHS Trust.
15.40: Dr Agyris Stringaris
Early-onset bipolar disorder: state of the evidence in children and adolescents
People with bipolar often report having experienced their first symptoms in their childhood
or adolescence. Yet, the early origins of bipolar disorder remain a matter of intense debate.
I will start by examining critically some of the current prominent concepts of early-life mania
. Then, I will present data on the epidemiology of early-life mania and clinical data on the
progression of the illness in young people.
Finally, I will discuss three key themes. First, the significance of short-duration episodes with
mania-like in young people. Second, the importance of understanding the heterogeneity of
manic symptoms in youth and how this might explain paradoxical findings about the illness.
Third, I will discuss how combining treatment studies with neuroimaging may help us better
understand aetiology and the early onset of bipolar disorder.
16.00: Prof Allan Young
Round up and thanks
Faculty:
Professor Anthony Cleare
Prof Cleare trained in psychiatry at the Bethlem Royal and Maudsley Hospitals in London, also
spending time as a liaison psychiatrist at King’s College Hospital. At the end of his training, he was
awarded the Laughlin Prize of the Royal College of Psychiatrists for the highest examination
performance nationally. In 1998, he obtained his PhD looking at neuroendocrine aspects of affective
disorders, and has continued an active research programme into neurobiological aspects of affective
disorders.
Since 2001 he has led a tertiary care service - The National Affective Disorders Unit – at the Bethlem
Royal and Maudsley Hospitals, offering both outpatient and inpatient care. This unit specialises in
the multidisciplinary assessment and treatment of patients with treatment resistant depression and
bipolar disorder. He is also specialist advisor in aviation psychiatry to the Civil Aviation Authority.
Dr Daniel Dietch FRCP DCH MRCGP
Daniel has been a GP Partner at Lonsdale Medical Centre since 2001. He has a diverse range of
clinical interests including Affective Disorders, Psychopharmacology, Rheumatology, Respiratory
Medicine, Anaphylaxis and Nutrition. He works closely with Psychiatric colleagues and runs an
innovative Primary Care service for patients with Affective Disorders. This includes screening for
unrecognised Bipolar Disorders in patients with depression/anxiety and both acute and long term
management of patients with Bipolar Disorders. He recently led on publishing some new guidance
for GPs about recognising Bipolar Disorders in Primary Care.
Clare Dolman, BA BSc
Clare Dolman is a journalist who went back to university a few years ago to do a Psychology degree
and is currently halfway through a part-time PhD at the Institute of Psychiatry, London, on women
with bipolar disorder’s decision-making regarding pregnancy and childbirth.
She herself has experience of the difficult decisions to be made at this time for women with bipolar,
having had an episode of postpartum psychosis after the birth of her first child, and successfully
avoided another episode after her second child was born. She has been Chair of the national charity
Bipolar UK since 2010, and is also a trustee of the newly-founded charity ‘Action on Postpartum
Psychosis’ which supports women with this condition. Clare was diagnosed with Bipolar I at the age
of 23 after being hospitalized for a severe episode of mania, but has remained largely well on lithium
ever since.
Dr Valeria Mondelli
Dr. Valeria Mondelli is a Clinical Lecturer at the Institute of Psychiatry, KCL and Locum Consultant
Psychiatrist in South London and Maudsley Foundation NHS Trust (Psychosis Clinical Academic
Group). She obtained her degree in Medicine in 2000 and in General Adult Psychiatry in 2004 at the
University of Turin, Italy. She moved to London in 2005 to work at the Institute of Psychiatry, King’s
College London and at the Maudsley Hospital, where she completed her PhD in Psychological
Medicine in 2009, and obtained her Certificate of Completion of Specialist Training in General Adult
Psychiatry in 2012. Her research interest focuses on the role of stress – and its biological mediators,
like hormones and inflammation – in relation to the development of psychiatric disorders, their
clinical outcome, and the emergence of metabolic abnormalities.
Professor Carmine Pariante
Carmine Pariante is Professor of Biological Psychiatry at the Institute of Psychiatry, and Consultant
Perinatal Psychiatrist in the associated South London and Maudsley NHS Trust.
He investigates the role of stress in the pathogenesis of mental disorders and in the response to
psychotropic drugs, both in clinical samples and experimental settings. His work focuses on
depression and fatigue, with a particular interest in the perinatal period and in subjects with medical
disorders. Moreover, he also uses animal and cellular models.
Professor Pariante has received numerous awards for his research: for example, from the National
Alliance for Research in Schizophrenia and Depression (NARSAD), the American Psychiatric Institute
for Research and Education (APIRE), and the British Association for Psychopharmacology. He has
recently been awarded the 2012 “Academic Psychiatrist of the Year” Award from the Royal College
of Psychiatrists.
His dream is that new therapeutic tools targeting the stress system will soon be available to alleviate
the suffering of patients with mental health problems.
Dr Paul Stokes MB ChB BSc. (Hons) MRCPsych DIC PhD
Dr Stokes is a Clinical Senior Lecturer in Mood Disorders at the Centre for Affective Disorders,
Institute of Psychiatry and Consultant Psychiatrist at South London and Maudsley NHS Foundation
Trust.
Dr Stokes studied medicine at Birmingham University and completed clinical training in Psychiatry at
the Maudsley Hospital. Over the past nine years, Dr Stokes has used neuroimaging to examine the
role of the dopamine and GABA neurotransmitter systems in mediating psychosis, addictions and
personality traits relevant to psychiatric disorders. Dr Stokes obtained his PhD in 2011 from Imperial
College London and was awarded the 2013 Royal Society of Medicine Psychiatry Section Mental
Health Research Prize. Dr Stokes joined the Centre for Affective Disorders in 2013 where his main
research interest is to better understand the psychopharmacology and neurochemical basis of
bipolar disorder and related co-morbid addictions.
Dr James Stone MBBS MRCPsych PhD
Dr Stone studied medicine at the Royal Free Hospital School of Medicine, London. He trained in
Psychiatry at Cambridge and at the Maudsley. He was awarded an MRC Clinical Research Training
Fellowship in 2005, and obtained his PhD in 2008. Over the last 7 years, he has worked on brain
imaging and glutamatergic neurotransmission, and has completed a number of studies investigating
the effect of ketamine on brain function. He is currently working as a Clinical Senior Lecturer with
the BRC at the Institute of Psychiatry, King's College London.
Dr Argyris Stringaris, MD, PhD, MRCPsych
Argyris is a Senior Lecturer in Mood Disorders in Young People and a Wellcome Trust Fellow.
He trained in Psychiatry at the Maudsley Hospital, obtained his PhD from the Institute of Psychiatry,
and was a clinical research fellow at the National Institute of Mental Health, USA.
He is a Consultant in Child and Adolescent Psychiatry at the Mood Disorder Clinic for Young People
at the Maudsley Hospital. Argyris uses epidemiology, twin genetics and imaging to understand the
origins of mania, irritability, and depression in young people and to discover new treatments.
Professor Andre Tylee MBBS MD FRCGP MRCPsych
Academic Director, Mood Anxiety and Personality Clinical Academic Group (MAP CAG), Kings Health
Partners Academic Health Sciences Centre and Professor of Primary Care Mental Health, PO Box 028,
Health Services and Population Research Department, David Goldberg Building, Institute of
Psychiatry, Kings College London, de Crespigny Park, London SE1 8AF
After training in medicine at Guys Hospital, he was a GP with a special interest in mental health in
South London for 21 years before holding the (first) Chair in Primary Care Mental Health at the
Institute of Psychiatry, Kings College London since 2001. He is the Academic Director for the Mood,
Anxiety and Personality Clinical Academic Group (MAP CAG) of Kings Health Partners Academic
Health Sciences Centre (KHP AHSC). He works clinically for the South London and Maudsley
Foundation Trust in the Southwark Improving Access to Psychological Therapies (IAPT) team, coleading groups for people with long-term physical illness and depression/anxiety. His current
research funded by NIHR is conducted in primary care with people in general practice who have
coronary heart disease and depression/anxiety (UPBEAT-UK programme grant) and with people
attending IAPT for depression/anxiety to understand the predictors of treatment response
(PROMPT, funded by the NIHR Mental Health Biomedical Research Centre at the Institute of
Psychiatry and South London and Maudsley Foundation Trust). From 2011-13, as National Expert
Advisor on Long Term Conditions to the Improving Access to Psychological Therapies Programme
(IAPT) at the Department of Health, he helped set up 15 National Pathfinder pilot sites which are
currently underway. He has published over 100 research papers, on depression and anxiety in
primary care.
Professor Allan Young MB ChB, MPhil, PhD, FRCPsych, FRCPC
Chair of Mood Disorders,
Director of the Centre for Affective Disorders, Department of Psychological Medicine, King’s College
London, UK
Professor Allan Young holds the Chair of Mood Disorders at King’s College London where he is also
Director of the Centre for Affective Disorders within the Department of Psychological Medicine in
the Institute of Psychiatry. He has held academic appointments at the Universities of Oxford,
Newcastle upon Tyne (latterly holding the Chair of General Psychiatry at Newcastle), UBC,
Vancouver, Canada, where he held the Leading Edge Endowment Fund Endowed Chair in Research in
the Department of Psychiatry and was also the Director of the Institute of Mental Health and
Imperial College London where he held the Chair of Psychiatry and was Director of the Centre for
Mental Health.
Professor Young’s research interests focus on the cause and treatments for severe psychiatric
illnesses, particularly mood disorders. He has received research grant funding from the UK Medical
Research Council, the Wellcome Trust, the Stanley Medical Research Institute, and the Canadian
Institutes for Heath Research (CIHR), the National Institutes of Health (USA) and numerous other
funding agencies. He has published over 300 peer-reviewed publications and a number of books
about psychopharmacology and affective disorders including ‘Bipolar disorders: basic mechanisms
and therapeutic implications’ (2nd Ed.) with JC Soares, and ‘Practical management of bipolar
disorder’ with IN Ferrier and E Michalak (Cambridge University Press, 2010).
Professor Young is a member of a number of editorial boards and is a member of numerous
professional and scientific societies. He is currently Treasurer of the International Society for
Affective Disorders and Chair of the Psychopharmacology Committee of the Royal College of
Psychiatrists.
Dr Roland Zahn, MRC Clinician Scientist Fellow, Honorary Consultant Psychiatrist
Since Roland’s early doctoral research training in neuropsychology and neuroimaging, he has been
fascinated by the question of the neurocognitive underpinnings of psychiatric symptoms. During his
clinical training in psychiatry and cognitive behavioural therapy at Freiburg University in Germany,
he has developed a particular clinical and research interest in affective and cognitive disorders.
Funded by a series of fellowships he has continued his research at the National Institutes of Health in
the USA and at Manchester University, where he also completed his clinical training in old age
psychiatry and worked as an honorary consultant psychiatrist in cognitive assessment and specialist
services for affective disorders. He has recently joined the Centre for Affective Disorders at the
Institute of Psychiatry as a senior clinical lecturer. His current MRC clinician scientist fellowship aims
at developing the first functional MRI and EEG biomarker of recurrence risk in major depressive
disorder which could be used as a surrogate outcome measure in future clinical trials. His future
research interests are to develop novel treatments for affective disorders, especially depression, by
using neurostimulation (transcranial direct current stimulation), fMRI- and EEG-neurofeedback, as
well as neuropsychological interventions. His clinical expertise is in treatment-resistant affective
disorders, as well as differential diagnosis and treatment of cognitive and organic affective disorders.
Fees:
There is a £5 booking fee to secure your place. This includes refreshments and lunch.
To book a place on at this event please contact:
Caroline Loveland, Centre for Affective Disorders, Institute of Psychiatry
Email: [email protected]
Tel: 020 7848 0088
Venue:
The conference will take place in the Wolfson Lecture Theatre, Institute of Psychiatry, Denmark Hill
Campus, SE5 8AF