SSC Psychiatry Research: advances, challenges, and controversies Module 1 September – December 2012 Project Title & Summary Supervisor(s) Depression and the Environment Dr Vishal Bhavsar Academic Clinical Fellow There is a reported association between depression and characteristics of Department of Psychosis the built environment (Weich et al 2002, Galea et al 2005, Mair et al 2008). Studies However, there is limited evidence on the relationship between built firstname.lastname@example.org environment characteristics and the rates of other mental disorders, such as psychosis. The mechanism by which the physical environment exerts effects on mental health is also unclear. The project will involve the systematic review of literature using Ovid, PsychInfo, and MedLINE: A) To gather and review literature investigating built environment characteristics and other mental health outcomes, including psychosis. B) To gather and review literature investigating the mechanisms of the mental health effects of the environment. Machine learning applications in psychiatric research The diagnosis of psychiatric illnesses suffers from high inter-rated reliability, complex and heterogeneous clinical presentations, which impair treatment. In terms of risk factors, a myriad of genetic and environmental factors and their interactions are thought to be involved. This review aims to provide a general outlook of the recent application of statistical machine learning classification methods in risk prediction and characterization of psychiatric disorders. Being clinically heterogeneous and etiologically multi-factorial, psychiatric illnesses are likely to profit from statistical methods which can address multiple putative factors and large, complex datasets. Specialized in developing such methods, the machine learning classification approach has started to be used in very recent years and has successfully revealed biomarkers for schizophrenia, bipolar disorder, depression, Alzheimer´s disease, among others. The data types that can be used range from genetic and proteomic through structural and functional neuroimaging to neuropsychological and environmental. Apart from contributing to our knowledge of disease etiology and mechanisms, these biomarkers can most promisingly be used as tools to improve diagnosis, early disease detection and disease prevention. The high translational potential of machine learning classification is enhanced by it allowing a biomarker characterization at the level of the individual rather at grouplevel as in previous techniques. Diana Prata NIHR Post-Doc Fellow Department of Psychosis Studies email@example.com Exploring the inflammatory cytokines and their role in mood disorders Converging evidence suggests that the activation of the inflammatory cytokine pathway is important in the pathophysiology of mood disorders. Differences in inflammatory profiles potentially exist between bipolar disorder patients and unipolar depressed patients with the potential existence of disorder-specific inflammatory profiles. The presence of these distinct profiles could aid in clinical diagnoses. Furthermore, research (including work from our group) has shown that levels of inflammatory cytokines at both the level of transcription and protein level can predict responsiveness to particular antidepressants and so may have useful applications clinically in terms of patient-specific treatment selection. The aim of the current project is to review existing literature on the role of the inflammatory cytokines and to explore their role in the pathophysiology and treatment of mood-disorders. We aim to publish the review as a paper in its own right or as part of an introduction for a current project underway. Timothy Powell PhD Student SGDP firstname.lastname@example.org Dr Leo Schalkwyk Reader SGDP email@example.com k Are there evidences that social class at birth increase risk of psychosis? Dr Simona Stilo MD, PhD A systematic literature review. student Department of Psychosis In accordance with the social causation hypothesis of psychosis, social Studies disadvantage may play a role in the development of psychosis. Several firstname.lastname@example.org studies have suggested an association between low social class and schizophrenia (Eaton 1985; Dohrenwend 1992) whilst other studies did not Prof Robin Murray find this association (Cannon 1996). Professor of Psychiatric Towards a clear conclusion, the student will conduct a systematic literature Research review on papers that have been written on social class/socio economic Department of Psychosis status and psychosis. Studies To further improve research skills he/she may conduct a data-based project email@example.com looking at social class at birth and risk of psychosis in the Genetic and Psychosis sample (GAP study). Child Psychiatry (possible topics) A literature review of teaching of child psychiatry to medical students Meeting the health needs of children with developmental disabilities Inpatient psychiatric services for young people with developmental disabilities -anticonvulsants as a treatment for behavioural disturbance in children with developmental disabilities Dr Sarah Bernard Consultant Psychiatrist Mental Health of Child and Adolescent Learning Disability Service The Michael Rutter Centre Sarah.Bernard@slam.nhs.uk PSTD Details to be discussed with supervisor Factors that Determine Health Care Seeking During a Public Health Crisis Large scale public health crisis such as pandemics, industrial accidents or terrorist attacks present many challenges for the health care system. One of these is the tendency for large numbers of people to attend hospital in order to obtain treatment or reassurance, even though they have probably not have been directly affected by the incident. Such patients used to be called 'the worried well.' However, it is becoming clear that many are not well and a surprising number are not worried. Understanding why people seek healthcare during a major incident would allow communicators and emergency responders to reduce this surge, while making sure that any genuine health needs are still looked after. In this systematic review, we will identify the factors that promote healthcare seeking during a crisis. The project will be jointly supervised by Dr James Rubin (KCL Department of Psychological Medicine: Senior Lecturer in the Psychology of Emerging Health Risks) and Dr Richard Amlot (HPA Emergency Response Department: Team Leader, Behavioural Sciences). Children’s perceptions of having a father in the military Dr Laura Goodwin Postdoctoral Fellow King’s Centre for Military Health firstname.lastname@example.org Dr James Rubin Senior Lecturer in the Psychology of Emerging Health Risks Psychological Medicine email@example.com Dr Sarah Rowe Senior Research Coordinator Children of military families face many unique stressors such as parental King's Centre for Military absence, frequent relocations, impact of deployment, influence of media, Health Research impact of parental injury, illness or bereavement, and adjustments to family Department of Psychological life post-deployment. These stressors may subsequently have an adverse Medicine effect on areas such as health and wellbeing, development of childhood firstname.lastname@example.org behaviour and retention of Service personnel. Much of the literature has focused on parental perceptions of child outcomes in military families. This may be problematic as parental perceptions may be biased by their own mental health and coping levels. We have data from a sample of military children aged 11-16 years that ask about the positive and negative aspects of having a father in the military. This project is made up of two parts: For module 1, the student will conduct a systematic literature review on children’s perceptions of having a father in military. There is the potential of this being extended into module 2 where the student will use thematic analysis to code the free text responses received from military children in order to identify themes and sub-themes in the responses. A systematic Review of fatigue (lethargy) in context of psychosis new onset and chronic patients The purpose of this review is to examine contributing factors so that a new model of fatigue may be developed in this context and a rehabilitation treatment developed and evaluated. Prof Trudie Chalder Department of Psychological Medicine email@example.com A systematic review of interventions for distress in Inflammotory Bowel Disease A systematic review of fatigue and disability in people who are HIV positive The prevalence and risk factors for domestic violence in military families What is the optimum method of delivering CBT to employees with common mental health problems? Child Psychiatry Teaching A perennial concern in psychiatry is recruitment into the specialty and previous studies have shown that undergraduate experience plays a role in career choice. Within psychiatry, child psychiatry often struggles to attract trainees to the specialty. Child psychiatry often exists within paediatrics on the medical syllabus. Many questions arise as to where it is best placed, how it is relevant to the greater medical curriculum and how it could be improved. Here we propose a systematic review of the teaching of child psychiatry on the undergraduate curriculum. The review could include issues around attitudes to child psychiatry, teaching methods, place on the syllabus and career choice. Such a review has never been done and would be highly valuable to medical educators and child psychiatrists. The Child Psychiatry faculty of the Royal College of Psychiatrists offers places for undergraduates to present work and such a review would be potentially publishable. Dr Deirdre MacManus Specialist Registrar MRC Research Training Fellow Institute of Psychiatry firstname.lastname@example.org k Dr Ira Madden Senior lecturer in occupational medicine, King’s College London Chief medical advisor at Houses of Parliament Ira.email@example.com Dr Ben Baig Clinical Lecturer Department of Child and Adolescent Psychiatry Institute of Psychiatry Benjamin.firstname.lastname@example.org Mental Health of Children and Adolescents in Sub-Saharan Africa Dr Ben Baig Clinical Lecturer Department of Child and Adolescent Psychiatry Institute of Psychiatry Benjamin.email@example.com Epidemiological studies of psychiatric illness in Africa are few in number compared to those in high income countries. Problems exist in the opportunity to gain standardised assessment measures, accurate reporting and sufficient funding for such research. Epidemiological measures of child psychiatric illness are even fewer. However, Millennium Development Goals (MDGs) highlight the importance of child health and (3 students) education. Both of these are affected by child psychiatric issues and it would be important to integrate what research has been done to look at the epidemiology, aetiology and treatment of these issues. A systematic review of child and adolescent mental health in sub Saharan Africa would be both timely and useful. The review could either focus on a specific disorder, a specific geographical region or a specific treatment or process. The review would give a wider insight into transcultural psychiatry and whether certain child psychiatric disorders may be more prevalent in high income countries. Such a review could be aimed at the International Psychiatry Journal and would be of value at a Royal College of Psychiatry Special Interest group presentation. Furthermore it may be of use for a student interested in pursuing an elective in Sub-Saharan Africa. Mental Health and Quality of Life in Paediatric Renal Disease Liaison psychiatrists have studied the overlap between physical and mental health issues on a wide range of chronic illnesses. There is good evidence that depression is very common in physical health conditions and leads to worse prognosis, longer hospital stay and poorer work and educational outcome. Such literature does not exist to the same extent in a paediatric population. Renal disease can cause a wide number of symptoms and consequences for mental health. Medical admissions, dialysis, transplant and living with a chronic disease all impact on child development, schooling and socialising. The following review will seek to combine available literature on all child renal disease to assess the nature and extent of mental disorder and quality of life. The completed review would be of great interest to child psychiatrists, liaison psychiatrists and nephrologists alike and publication and presentation of the work could be sought in each of these areas. Serotonin and gastrointestinal issues in Autism Autism spectrum disorders (ADS) are pervasive neurodevelopmental conditions characterised by impairments in social interaction and communication and presence of repetitive and stereotyped interests and behaviours. Gastrointestinal disturbances are frequently reported in ASD. Additionally there is evidence of abnormalities of the neurotransmitter serotonin in ASD. In addition to its role in the brain, serotonin is also present in the gut. Therefore we are interested in a review of the literature pertaining to ASD, serotonin and the gut. The under-diagnosis of personality disorder amongst Afro-Caribbean service users in the UK. Eileen Daly Lecturer Department of Forensic and Neurodevelopmental Science Eileen.firstname.lastname@example.org 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@example.com firstname.lastname@example.org (please send any emails to both addresses) This review would include an analysis of possible causes for this, leading to a draft publication. The review would target the Afro-Caribbean group specifically, as this group has a much higher incidence of schizophrenia, which is explained by the higher incidence of neurodevelopmental trauma in this group. The same traumas constitute risk factors for personality disorder as well, but why do we then see an under-diagnosis, or is it a case of missed diagnosis? According to the only other systematic review available, this under-diagnosis is much more of a problem in the UK compared to the USA, and why that might be the case, is there something specific to the difficulties within the Afro-Caribbean community? The prevalence of personality disorder in non-Western countries, and the possible reasons for the significant under-diagnosis. If they are not (2 students) being diagnosed as personality disorder, what labels are being ascribed to them, or is personality disorder a culture-bound disorder confined to Western psychiatry? There are currently no systematic reviews available on this topic. Ketamine Ketamine, a drug of abuse (and anesthetic medication), has been found to produce a rapid antidepressant effect. It is an N-methyl-D-aspartate (NMDA) receptor antagonist that has shown promising therapeutic effects in treatment-resistant depression. However, it requires intravenous injections and hospitalization for at least 24 hours post infusion, and can induce behaviour abnormalities in rodents that simulate those observed in schizophrenic patients.These apparently contradictory observations (both antidepressant and psychosis induction properties) have been proposed to be related to the regulation of the kynurenine pathway. We are interested in undersatnding the molecular actions of this drug. Dr Patricia Zunszain Stress, Psychiatry and Immunology Laboratory (SPI-Lab),Centre for the Cellular Basis of Behaviour Department of Psychological Medicine email@example.com Prof CarminePariante Stress, Psychiatry and Immunology Laboratory (SPI-Lab) Department of Psychological Medicine firstname.lastname@example.org Non-coding RNAs and neurodevelopmental disorders Prof Noel Buckley Professor of Molecular Until recently, the human genome was thought to comprise of Neurobiology around 21,000 protein coding genes occupying less than 2% of the genome, Centre for the Cellular Basis dispersed as oases across a genomic landscape that was largely seen as a of Behaviour (CCBB) gene desert, consisting of large regions of non-functional, often repetitive DNA. However, this view has been completely undermined in the course email@example.com of the past decade as large scale sequencing of the human transcriptome has revealed widespread and pervasive transcription of the human genome resulting in production of >10,000 long non-coding RNAs (lncRNAs) in addition to several hundred short microRNAs. lncRNAs and miRNAs represent an important and widespread means of gene regulation that is only beginning to be appreciated. Following rapidly on the heels of this epiphany has been the realization of the relevance of ncRNAs to disease. ncRNAs are a recent evolutionary event and seem to be highly developed in human. The majority of lncRNAs and many miRNAs are expressed in the brain, many in a cell-type and stage-specific manner further underwriting the emerging view that ncRNAs may play a pivotal role in neurodevelopmental and psychiatric disorders. The ncRNA field has rapidly burgeoned and there is an urgent need to review the literature to assess the relevance of ncRNAs and their potential application to the study and treatment of psychiatric disorders. See John Mattick discuss the recent evolution of non-coding RNAs. http://vimeo.com/13664571 Impact of mental health difficulties on romantic relationships Mary Keeling Researcher There is a wealth of literature suggesting marriage is beneficial for mental Department of Psychological health (Marcussen, 2005) and enhances psychological well-being. Medicine Questions exist in the research literature as to whether this apparent firstname.lastname@example.org protective factor is due to the social rewards such as increased social support, social integration, financial gains and avoidance of the stigma of Dr Nicola Fear being unmarried, or due to the characteristics of those who get married; are Reader in Military those with better psychological health more likely to get married (Horwitz, Epidemiology Raskin, & Howell-White, 1996). It is probable that the answer is a Department of Psychological contribution of the two factors. However, what happens when someone in a Medicine relationship develops a mental health problem? Literature from military Nicola.email@example.com health suggests that soldiers returning from operations in Iraq and Afghanistan with Post Traumatic Stress Disorder and/or symptoms of common mental illness experienced lower relationship satisfaction for both them and their spouse (Goff, Crow,; Reisbig, &; Hamilton, 2007). Due to the extra strain and possible burden a spouse with mental health difficulties places on romantic relationships it is possible that the development of mental disorders could disrupt relationships however literature investigating this in the general population is sparse. This project would aim to investigate, in the general population, current findings regarding the association between mental health and the impact it plays on romantic relationships. A systemic review (or if possible meta-analysis) about factors affecting duration of sickness absence due to depression. Details to be discussed with supervisor Can robots deliver psychological care? This will be a scoping review of a) the increasing use of interactive robotic devices to deliver and support activities of daily living using examples of current practices eg for the elderly and disabled b) the feasibility of using these technologies to also deliver interactive psychological support. Dr Ali Hashtroudi Consultant in Occupational Medicine and Honorary Senior Lecturer Occupational Health Department The Education Centre St Thomas' Hospital Westminster Bridge Road London SE1 7EH Telephone: 020 7188 4152 Fax: 020 7188 4146 Dr Carol Kan Clinical Researcher Department of Psychological Medicine Carol.firstname.lastname@example.org Dr Khalida Ismail Liasion Psychiatrist, Consultant Psychiatrist King’s College Hospital Department of Psychological Medicine email@example.com Possible topics (1 student only) Neural correlates of BDNF polymorphism: A systematic review of functional and structural neuroimaging studies of the BDNF polymorphism. Definitions of happiness in psychiatry: A systematic review of how happiness and health is quantified in psychiatric disorders. Dr Cynthia Fu Senior Lecturer and Honorary Consultant Psychiatrist MRC Social, Genetic and Developmental Psychiatry Centre firstname.lastname@example.org Cognitive enhancers in depression: A systematic review of the use of cognitive adjunctive enhancers in depression. Epidemiology of atypical vs typical depression: A systematic review of the features of atypical depression in comparison with melancholic depression. (2 students) Neurological disorders in haematology patients Neurological disorders in liver patients Psychosocial aspects of epilepsy in adolescence Sleep related disorders Neurological complications of alcohol Incidence of alcohol and or drug use in patients with non epileptic seizures: literature review and or prospective study Obsessive compulsive disorders and patients with epilepsy, literature review and case series Dr Chris Clough Neurology Consultant Department of Neurology King’s College London email@example.com Dr Nick Moran Department of Neurology King’s College London firstname.lastname@example.org t Dr Tom Britton Department of Neurology King’s College London Thomas.email@example.com, or firstname.lastname@example.org Dr Franz Brunnhuber Department of Neurology King’s College London Dr Lina Nashef Department of Neurology King’s College London email@example.com Neurobiology of Depression: Possibility of co-authoring a book chapter Karim Malki PhD Student Major depressive disorder (MDD) is etiologically complex and has a SGDP heterogeneous presentation. This heterogeneity limits the ability of firstname.lastname@example.org molecular genetics research to detect small effects conferred by common genetic variation. Recently, a mega-analysis of genome-wide association Dr Leo Schalkwyk studies for major depressive disorder was unable to uncover any single Reader nucleotide polymorphism at genome-wide level of significance. Current SGDP diagnosis for depression is centred on a quantitative system based on email@example.com symptom count that is independent of any etiological considerations. It is k possible that etiologically different disorders may be homogeneously diagnosed as MDD. This complicates the selection of patient-groups for research endeavours. Genetic approaches still hold significant promise to fundamentally improve our understanding of the pathophysiology and etiology of depression and may eventually help to inform treatment and prevention strategies. In this essay we want to present a summary of the current understanding of the neurobiological substrate underpinning MDD and explore how these findings will eventually help refine diagnostic definitions and eventually lead towards individualised prescription of antidepressants drugs. We aim to work with the student to develop this essay into a book chapter. However co-authorship will only be given if the work produced is of quality. * If you are interested in this project please contact Karim Malki for an informal discussion. Given the nature of this project the supervisors may hold some informal interviews to choose the student they wish to work with.