SSC Psychiatry Research: advances, challenges, and controversies Phase 3 Block 1 Module 1
December 2011
Project Title & Summary
Unemployment and Mental Health (module 1 code: 11/01)
Schizophrenia is a neuropsychiatric illness associated with high morbidity and
need for care. The causes of schizophrenia are not completely understood
(Keshavan et al 2011). The role of social disadvantage in the development of
schizophrenia is increasingly recognised (Selten and Cantor-Graae, 2007),
especially in light of current socio-economic change in the U.K and around the
world . In particular, rates of unemployment in patients with schizophrenia have
been noted to be high (Ramsey et al. 2011). The direction of causality in the
relationship between schizophrenia and unemployment is not clear. The student
will undertake a systematic literature review of studies on unemployment and
schizophrenia, employing appropriate search terms and methodologies. Key
questions will include: what is the rate of unemployment in patients with
schizophrenia, what factors account for variation between studies, what are the
possible mediators of the relationship between unemployment and schizophrenia?
The final element of the review will be to recommend what further research could
be conducted to clarify the relationship between schizophrenia and employment
status.
Modelling the environment: combining genetics and refined
endophenotyping to study factors that contribute to depression (Modules 1 &
2, Code 11/02)
Stress is a key environmental factor that influences the development of depression
and stressful life events have often been associated with the onset of depression
(Nestler et al, 2002). In particular, stressful life events associated with absence or
loss of social support have been associated with both the onset and relapse of
depression (Paykel, 1994), whereas social support may have a protective effect
(deVries et al, 2003). Although adverse life events and the development of
behavioural disorders are clearly related, the behavioural and genetic mechanisms
underlying this relationship are not fully understood. The aim of this project is to
identify gene by environment interactions for behavioural endophenotypes of
relevance to depression using a mouse model of social support (Westenbroek et
al, 2003) in combination with a murine genetic reference population (C57BL/6JChr #A/NaJ chromosome substitution strain panel). CSS offer several advantages
for dissecting complex traits and are a powerful tool to identify genes for
behaviour in mouse. The effect of manipulating social environment across
different genetic backgrounds was studied using females from 10 lines of the
C57BL/6J-Chr #A/NaJ CSS panel and a large battery of tests to assess behaviours
ranging from anxiety to cognitive ability. This behavioural test battery allows us
to collect refined measures for a range of endophenotypes of relevance to
depression. Module 1 will involve a systematic literature review on this topic.
Module 2 will involve scoring and analysis of the data collected from the
cognitive battery but will not require any animal handling as all data and samples
have been collected already. This is a novel study on a genomewide model of
gene by environment interactions and it will give the student experience in a range
of rodent behavioural methods, data collection and statistical analysis.
September –
Supervisor(s)
Dr Vishal Bhavsar
Academic Clinical Fellow
Department of Psychosis
Studies
vishal.2.bhavsar@kcl.ac.uk
Dr Jane Boydell
Senior Lecturer
Department of Psychosis
Studies
Dr Cathy Fernandes
RCUK Fellow, Lecturer
Department of Psychosis
Studies
catherine.fernandes@kcl.ac.uk
Depression and mortality in older people (to update Saz & Dewey, 2001)
(module 1, code: 11/03 )
Studies of mental health problems in general usually suggest that there is an
increased mortality associated with all conditions and depression is no exception.
A particular problem with reviewing studies in older adults is trying to separate
effects of depression and any concurrent physical illness. In the earlier review this
proved impossible but with more studies available we might have more success.
Prof Michael Dewey
Department of Health Service
and Population Research
michael.dewey@kcl.ac.uk
What will I do? Write a protocol for the review based on the original
review and update it to modern standards. Carry out the literature search.
Extract data from the articles found. Optionally update the meta-analysis.
What do I need to know? It would be helpful if you had at least some
practical familiarity with literature searching. If you wish to attempt the
meta{analysis familiarity with Stata or R would be useful.
Target journal: The International Journal of Geriatric Psychiatry
Who will I work with? I am one of the authors of the original review
and am based in the Section of Epidemiology at IoP. I am a statistician by
background.
Does Adversity in Childhood Predict More Severe Psychotic Symptomology
in Adulthood? (modules 1 & 2, Code: 11/04)
Studies have shown an association between childhood adversity and development
of psychotic disorders. However, little work has been done on assessing whether
early adversity predicts a more severe symptomatology in adulthood. This project
aims to examine the relationship between early adversity such as separation and
loss of a parent(s), sexual and physical abuse in childhood and symptom severity
in adulthood. The student will conduct a systematic literature review on papers
that have been written on adversity in childhood and symptom severity on first
episode psychosis patients.
To further improve research skills he/she may conduct a data-based project in
module 2, looking at markers of adversity in childhood and symptom severity
assessed using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN)
in patients from the GAP study.
Involvement of oxytocin in depression (module 1, Code: 11/05)
Dr Simona Stilo MD, PhD
student
Department of Psychosis
Studies
simona.stilo@kcl.ac.uk
Prof Robin Murray
Professor of Psychiatric
Research
Department of Psychosis
Studies
robin.murray@kcl.ac.uk
Dr Patricia Zunszain
Stress, Psychiatry and
Immunology Laboratory (SPILab),Centre for the Cellular
Basis of Behaviour
Department of Psychological
Medicine
patricia.zunszain@kcl.ac.uk
SOUL-D (module 1, Code 11/06)
SOUL-D is a cohort study of nearly 2000 people with newly diagnosed type 2
diabetes. We are testing whether depression at baseline is associated with worse
glycaemic control 2 years later. One of the subprojects that we are currently
focusing on is how depression influences eating patterns and physical activity and
to what extent this might explain poor diabetes control. The SSM will therefore
involve doing a systematic review on the prevalences/mechanism of night
eating/binge eating disorders in the diabetes population.
Beliefs about insulin in people with newly diagnosed type 2 diabetes –
findings from the South London (SOUL-D) Type 2 diabetes study (module 1,
Code: 11/07)
Dr Carol Kan
Clinical Researcher
Department of Psychological
Medicine
Carol.kan@kcl.ac.uk
Dr Khalida Ismail
Liasion Psychiatrist, Consultant
Psychiatrist King’s College
Hospital
Department of Psychological
Medicine
khalida.2.ismail@kcl.ac.uk
The South London Diabetes Study (SOUL-D) is a prospective cohort study of
people with incident Type 2 diabetes from Lambeth, Southwark and Lewisham.
The main aim of the study is to determine biopsychosocial factors associated with
poor diabetes outcomes at 2 years. At present the cohort consists of 1200
participants and 680, and 180 people have been seen for their 1 and 2 year followups respectively. We know that people with diabetes often have ‘psychological
insulin resistance’ which can delay their diabetes being treated in the best way
possible especially as the disease progresses and loss of beta cell function
necessitates the need for insulin. We are collecting questionnaire data on insulin
beliefs at each phase of data collection and will therefore be able to determine
cross-sectionally, how positive or negative people are regarding insulin treatment
at the time of diabetes diagnosis, and prospectively whether such beliefs can
affect outcome and if these beliefs change over time.
The neurobiology of treatment compliance (Module 1, Code: 11/08)
The specific details of the literature review to be discussed with the supervisor.
Prof Steven Williams
Prof Steven Williams
Director of the Centre for
Neuroimaging Sciences
steven.williams@kcl.ac.uk
A systematic Review of fatigue (lethargy) in context of psychosis new onset
and chronic (module 1, Code: 11/09)
Prof Trudie Chalder
Department of Psychological
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.
A systematic review of interventions for distress in Inflammotory Bowel
Disease (Module 1, Code: 11/10)
Details to be discussed with supervisor
Medicine
trudie.chalder@kcl.ac.uk
Prof Robert Murray
Professor of Psychiatric
Research
Department of Psychosis
A systematic review of fatigue and disability in people who are HIV positive
(Module 1, Code: 11/11)
Details to be discussed with supervisor
Marital and relationship dissolution in the military and general population:
A comparison (modules 1 & 2, Code: 11/12)
Studies
robert.murray@kcl.ac.uk
Mary Keeling
Researcher
Department of Psychological
The recent conflicts in Iraq and Afghanistan have placed increased demands on Medicine
military personnel; in turn this has placed extra strain and stress on mary.keeling@kcl.ac.uk
marital/romantic relationships. In the US Karney and Crown (2007) have
investigated the impact of increased military action on marital relationships, Dr Nicola Fear
however they report that marital dissolution figures in the US military do not Reader in Military
support these claims. Understanding the impact of military lifestyle on Epidemiology
marital/romantic relationships is important as negative relationship experiences Department of Psychological
can lead to military personnel developing mental health difficulties which can Medicine
affect personnel’s ability to complete their jobs (Gottman, Gottman, & Atkins, Nicola.t.fear@kcl.ac.uk
2011) and contribute to them not re-enlisting at the end of service (Hoge, Castro,
& Eaton, 2006). Evidence also suggests that personal relationships are crucial in
terms of offering support (Greene, Buckman, Dandeker, & Greenberg, 2010). A
logical starting point in this investigation is to investigate the marital/relationship
dissolution rates within the UK military and compare these to the general
population to investigate if there are any significant differences. These can also be
compared to the US military and general population to see if there are any
differences cross-culturally. This proposed project will initially start with a review
of the literature on marital/romantic relationship dissolution rates in both UK
military and the general population and also in the US. Following this a metaanalysis and comparison of these rates could be conducted to investigate if the
differences between the military and general populations are significant.
Advanced healthcare planning (module 1, Code: 11/13)
Advanced healthcare planning for when a person is unable to decide for
themselves is an emerging area in medicine and psychiatry. It interfaces with
developments in law (the Mental Capacity Act (2005)) and with fascinating
discussions in ethics concerning autonomy and personal identity.
This project will review the empirical literature addressing advanced directives
and proxy decision-making with special reference to Dementia and Bipolar
Affective Disorder.
Supervision will come from Dr Gareth Owen (a Wellcome Trust Clinical
Research Fellow in Biomedical Ethics) and Dr Ben Spencer (a postgraduate
psychiatrist with an interest in general medicine and law)
Nuclear Magnetic Resonance (NMR)-Based Metabonomics of
Neurodegenerative Diseases
(Module 1 and possibly module 2, 11/14)
The metabolome is the set of biochemicals present in cells, tissues and biological
fluid and the assessment of the metabolome or metabolic profiling is termed
metabonomics or metabolomics. Metabonomics has the potential to impact
hugely on clinical practice1 and central to metabonomics is the concept that the
metabolic state is the sum of genetically encoded and environmental factors.
1
H magnetic resonance spectroscopy (MRS) is commonly used to assess major
neurochemicals such as amino acids, organic acids, phosphocreatine and inositols
in vivo in neurological studies2. However, similar experiments can be done,
usually termed ‘high resolution NMR spectroscopy’, on in vitro or ex vivo
samples such as tissue samples and biological fluids, e.g., cerebrospinal fluid,
blood plasma and urines; providing a metabolic ‘fingerprint’ that is the sum of a
number of cellular processes in the body. NMR, unlike MRS, provides fully
quantitative data with high spectral resolution as well as more sensitive limits of
detection. A literature review (module 1) will undergo a systematic review of the
published research on NMR-based metabonomics in the study of
neurodegenerative diseases such as Alzheimer’s Disease. Module 2 involving
studying biological fluids from certain neurodegenerative diseases by NMR may
be possible.
1.
2.
Lindon et al., (2004). Biomarkers 9: 1-31.
Rudkin and Arnold (1999). Arch Neurol 56: 919-926.
Dr Gareth Owen
Wellcome Trust Clinical
Research Fellow
Honorary Consultant, South
London and Maudsley NHS
Foundation Trust
Department of Psychological
Medicine
gareth.1.owen@kcl.ac.uk
Dr Ben Spencer
Psychiatrist
Benjamin.Spencer@slam.nhs.u
k
Dr Po-Wah So
Lecturer
Dept of Neuroimaging
po-wah.so@kcl.ac.uk
Celeste Cheung, MSc
PhD Student
SEFOS (Sibling EEG FollowADHD is one of the most common neuropsychiatric disorders in children with up Study)
high rates persistence. Medication is frequently used for managing ADHD MRC SGDP Centre
symptoms including inattention, hyperactivity/impulsivity. However, studies have celeste.cheung@kcl.ac.uk
also shown that stimulant medication reduces cognitive impairments such as
response time variability, behavioural inhibition and working memory. Further Dr. Jonna Kuntsi
evidence suggests that stimulants also modulate atypical brain activities in Senior Lecturer SGDP
ADHD, measured by electroencephalography (EEG). The aim of this systematic jonna.kuntsi@kcl.ac.uk.
review is to examine the differential effects of stimulant medication on cognitive
performances and EEG markers in ADHD. This review will be clinically relevant,
as it will clarify how specific stimulant medications are on targeting ADHD
impairments on a cognitive and neural level. Stimulants are widely used in the
treatment of ADHD, yet the effects on brain and cognition are poorly understood.
A review of this area will help to establish the most prominent findings, which are
important to our understanding of ADHD and the treatment response to
stimulants.
Effects of stimulant medications on EEG and cognitive measures in ADHD:
a systematic review (module 1, 11/15)
The axon initial segment in health and disease (module 1, 11/16)
It is emerging that the axon initial segment (AIS) has important roles in regulating
axonal transport and neuron excitation. This specialised region of the axon, which
sits adjacent to the neuron cell body has only recently been described. However, it
is becoming apparent that this structure is critical for several key neurone
functions. These include influencing what is transported anterogradely along the
axon, and the initiation of an action potential. Our evidence suggests an
involvement of the AIS in neurodgenerative disease, but the mechanisms that
underlie this remain poorly understood. The aim of this project is to review the
current literature about the AIS and to shed more insight into its normal function
and how it may be compromised in disease.
Relevance of tau in Alzheimer’s disease: beyond microtubule binding
(module 1, 11/17)
The presence of highly phosphorylated forms of tau protein in tangles in
Alzheimer’s disease brain is one of the hallmark neuropathological lesions
associated with this disorder. It is important therefore to understand the
physiological roles of tau so as to elucidate the molecular mechanisms that
underlie tau deposition in pathological conditions since these might be responsible
for the progressive loss of cognition and ultimately dementia. The most wellestablished function of tau protein, which is found primarily in axons, is to
stabilise the neuronal cytoskeleton by binding to microtubules. However, it is
becoming clear that tau possesses additional functions beyond its ability to
stabilise microtubules. Recent evidence from our laboratory and others has shown
that tau is associated with the plasma membrane in neuronal cells and other
studies have suggested that tau may be present in neuronal nuclei. These findings
suggest that tau may have alternative functions, such as intracellular signalling,
that are unrelated to microtubule stabilisation. The student will conduct a
literature review of the localisation of tau and its potential alternative roles in
neuronal cells to better understand the spectrum of tau function in health and
disease.
Dr Jonathan D. Cooper
Reader in Experimental
Neuropathology
Head of Pediatric Storage
Disorders Laboratory
MRC Centre for
Neurodegeneration Research
jon.cooper@kcl.ac.uk
Dr Diane Hanger
Senior Lecturer
MRC Centre for
Neurodegeneration Research,
Department of Neuroscience
Diane.Hanger@kcl.ac.uk
Differential responses of neurons in specific brain regions in Alzheimer’s
disease (module 1, 11/18)
Alzheimer’s disease (AD) is characterised by deposits of β-amyloid (Aβ) in
neuritic plaques and intracellular neurofibrillary tangles (NFTs) comprising
aggregated tau. These lesions are closely associated with the progressive synaptic
dysfunction and neuronal loss that leads to symptoms of dementia and a spectrum
of additional cognitive and behavioural abnormalities. Although the precise
molecular mechanisms underlying the development of AD are not understood, it
is generally accepted that elevated Aβ results in abnormalities in tau protein that
lead to neurodegeneration. We have generated data suggesting that the mechanism
leading to neuronal loss in the cerebral cortex differs from that in the
hippocampus, and this could have important implications for the development of
new treatments for AD. The student will conduct a literature review of the
differences between cortical and hippocampal neural cells to find clues to the
mechanisms by which neurons in these two brain regions are differentially
affected by Aβ in AD.
Literature review on web-based psychological treatments (CBT) (module 1,
11/19)
The aim is to investigate and review the literature on the use of web-based
programmes of cognitive behaviour therapy (CBT) for the treatment of
psychological/mental disorders. CBT is a proven treatment for a range of
psychological and psychiatric conditions including anxiety disorders, depression,
psychotic and personality disorders. A significant problem has been in increasing
access to these effective treatments due to a low level of resource, such as the
number of, or access to, trained therapists. One way of resolving this problem has
been to use technological advances to increase access to CBT. Initially this was
through computer programmes of CBT. More recently, CBT web based
treatments have become more prevalent with a number of evaluative studies
(including randomized controlled trials) becoming published. This project would
be to survey the literature on web-based CBT trials. This would involve initially
investigating the extent and breadth of published work, such as the range of
disorders included in published studies, and depending on the breadth of literature
to systematically review the field or if this literature is too extensive then to focus
on a smaller range of disorders. The investigation would also need to consider the
advantages and disadvantages of using an eHealth platform compared to the more
conventional platform of direct therapist contact.
Dr Wendy Noble
Lecturer in Neuroscience
MRC Centre for
Neurodegeneration Research
King's College London
Institute of Psychiatry
Wendy.Noble@kcl.ac.uk
Professor Nicholas Tarrier
Professor of Clinical
Psychology and Mental Health,
Department of Psychology
nicholas.tarrier@kcl.ac.uk
Risk Factors of Eating Disorders (Module 1, 11/20)
Dr Isabel Krug
Postdoctoral Research Fellow
Eating disorders (ED) have multifactorial causes, where environmental and isabel.krug@kcl.ac.uk
biological-genetic factors are continuously involved. Notwithstanding the fact that
approximately half of the contributing factors of EDs are non-genetic in origin,
environmental causes have hardly been examined. Research has mainly centered
on the discovery of new genetic and physiological causes and has neglected a
cross-cultural standpoint. In addition, the literature on the etiology of EDs has
been troubled by the fact that only a few studies meet the thorough quality
criteria, as regards to methodology and sample sizes. Therefore according to an
outstanding contemporary systematic review on EDs “replication studies are
needed”. We will undertake psychological research across different types of EDs
(Anorexia, Bulimia and EDNOS) and across different European countries (UK,
Spain, Austria, Slovenia and Italy), to detect shared and distinctive factors
associated with EDs. Through different questionnaires and interviews, we have
already collected a vast amount of data relating to psychological, environmental
and cross-cultural variables. We have assessed both ED patients and healthy
controls (a subsample of the data also assesses sister-pairs). We also have genetic
data available to do gene environment interaction studies. This exciting data has
been granted by a European project a few years ago. Recently we also have
received ethical approval to collect further data. The student will be able to choose
a specific area of interest and conduct his/her own research in the desired field.
We anticipate that the findings from this project will lead to an improvement in
the current body of knowledge of EDs and will help us to develop an integrated
etiological models of EDs.
A systematic review of the psychological factors predicting clinical outcome
in rheumatoid arthritis (Module 1, 11/21)
Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis,
affecting around 475,000 people in the UK and its symptoms are considered the
most disabling. It is well established that the impact of RA represents a complex
interaction between patho-physiological and psychological factors; pain in
particular may link closely to anxiety and disability to depression.
Dr. Claire Goodchild
Arthritis Research UK
Foundation Fellow
Department of Psychology
Claire.Goodchild@kcl.ac.uk
The aim of the review would be to systematically search and review existing
literature that examines the links between psychological factors and clinical
outcomes of interventions delivered to RA patients. The specific details of the
literature review will be discussed with the supervisor prior to starting the review.
Your Choice (Module 1, 11/22)
I am willing to supervise any topic within psychiatry of your choice. I am trained
as an epidemiologist with an interest in the incidence of psychosis and social
causes of variation in incidence. I have published widely in this area and have
ongoing studies into social cohesion and unemployment. As a consultant
psychiatrist I am trained in general adult psychiatry and substance misuse. I care
for women admitted to hospital with a range of mental illnesses. These include
depression, schizophrenia, mania, bipolar, borderline personality disorder,
antisocial personality disorder, severe anxiety disorders and obsessive compulsive
disorders often complicated by substance misuse and social adversity. I am
particularly interested in reviews into treatment of personality disorder and the
impact of mental illness on parenting.
Dr Jane Boydell
Senior Lecturer
Department of Psychosis
Studies
jane.boydell@kcl.ac.uk
The Role of the Circadian Clock in Alzheimer’s Disease (Module 1, 11/23)
Alison Baird PhD
Department of Old Age
Alzheimer’s disease (AD) is the most common form of dementia in later life, Psychiatry
affecting more than 20% of individuals over the age of 80 years. The major Institute of Psychiatry
neuropathological hallmarks of the disease are senile plaques containing beta- alison.baird@kcl.ac.uk
amyloid and neurofibrillary tangles consisting of microtubule-associated tau
protein. The clinical characteristics of the disease include progressive loss of
memory and cognitive function, in addition to other neurobehavioural problems.
Disturbed sleep-wake cycles are also characteristic of AD, with observed sleep
deficits including insomnia, hypersomnia, REM sleep behaviour disorder and
sundowning syndrome. Furthermore, sleep disturbance has been shown to
correlate with cognitive and functional decline and to worsen with disease
progression. Importantly severe sleep disturbance in AD is the most frequent
cause for institutionalization.
The master circadian pacemaker located in the (suprachiasmatic nucleus of the
anterior) hypothalamus is responsible for the generation of circadian rhythms, and
it is integral to determining the sleep wake cycle. Considerable research has aimed
to determine the nature of the perturbations to the circadian system that occur in
AD, including the molecular clockwork that forms the basis of circadian rhythm
generation, endocrine outputs of the master pacemaker and the behavioural
manifestations of circadian disturbance.
This review will therefore focus upon how alterations in the circadian system may
contribute to the pathogenesis of AD and potential therapeutic strategies for the
treatment of some of these symptoms of the disease.
Physician-in-training mental health issues (Module 1, 11/24)
The recent decade has been characterized by upsurge in interest for physician
health as well as resident (or junior doctor) wellbeing. A meta-analytic review
revealed markedly higher risk of suicides among practicing physicians, with rate
ratios of 1.41 among male physicians and 2.27 for female physicians
(Schernhammer and Colditz, Am J Psychiatry 2004). While little is known about
the suicide risk among physicians-in-training, there is an increasing body of
literature suggesting that medical students and residents (junior doctors) in
particular have high rates of burn-out, depression and suicidal ideation.
Meanwhile, increasing attention has been to the deleterious impact of long
training hours and sleep deprivation on patient care as well as on training
physician’s physical and mental health. In this context, a systematic review on
physicians-in-training mental health issues appears quite timely and potentially
useful. While this systematic review may revolve around wellbeing and mental
issues in general, it may revolve on more specific aspects, such depression and
burn-out, suicide, or the deleterious impact of call duty hours and sleep
deprivation.
Systematic Review of Physical and Exercise Therapies in Schizophrenia
(Module 1, 11/25)
The life expectancy of patients with schizophrenia is dramatically shortened
compared to the general population. This is attributable to a number of factors
including lack of exercise, poor diet, poor lifestyle choices, side effects of
psychotropic medication, but also lack of awareness amongst patient and
physicians.This systematic review will examine, synthesise and report the
literature around physical interventions in schizophrenia and their benefits on
physical and mental health.
François Bourque MD MSc
FRCPC
Clinical Research Fellow, PhD
Candidate
Institute of Psychiatry
francois.bourque@kcl.ac.uk
Marco Picchioni
Senior lecturer
Honorary Consultant Forensic
Psychiatrist
Department of Forensic and
Neurodevelopmental Science
and Psychological Medicine
marco.picchioni@kcl.ac.uk
Marco Picchioni
Stigmatisation of patients in forensic mental health services (Module 1, 11/26) Senior lecturer
Honorary Consultant Forensic
People resident in secure, forensic mental health services face the potential double Psychiatrist
stigma of having mental disorder and of being an offender.This project will
Department of Forensic and
examine concepts of stigma, its causes and consequences in relation to this
Neurodevelopmental Science
complex group. Particular attention will be paid to empirical studies of stigma and and Psychological Medicine
its effects.
marco.picchioni@kcl.ac.uk
Geoff Dickens
Visiting Lecturer
Department of Forensic and
Neurodevelopmental Science
Emotional information processing in at risk mental status and first episode
psychosis: a review of behavioral and neuroimaging findings (Module 1,
11/27)
People at risk of schizophrenia and other psychotic disorders (At Risk Mental
States, ARMS) are characterised by attenuated affective and psychotic symptoms
has generated a large volume of research over the past decade. They have subtle
subjective cognitive deficits and affective disturbance, which are qualitatively
similar but less severe to those seen in patients diagnosed with schizophrenia or
other psychotic disorders. These subtle cognitive and emotional changes attract
substantial interest, both in behavioural and neuroimaing studies. However to date
most of the studies are focused on the cognitive processes only. Nevertheless,
accumulating evidence suggests the presence of the fundamental disturbance of
emotional processing among those with prodromal psychosis symptoms. A
systemic review is warranted to summarize and compare the behavioural and
neuroimaging findings between those who are at risk of psychotic disorders, and
who have already been in their first episode of psychotic disorders.
The proposed review is closely related to the current project ‘Emotional
experience, expression and integration in prodromal and first episode psychosis’
conducted by Dr. Paul Allen
(http://www.kcl.ac.uk/iop/depts/ps/research/firstepisode/emotionalprocessingande
arlypsychosis.aspx) and will obtain help and suggestions from him and the
research group.
Huai-Hsuan Tseng
PhD student
Department of Psychological
Medicine
Prof Philip McGuire
Professor of Psychiatry &
Cognitive Neuroscience
Department of Psychological
Medicine
Dr Paul Allen
Senior Lecturer
Department of Psychosis
Studies
A systemic review of early presentation of features of bipolar symptoms in
community and clinical sample (Module 1, 11/28)
Emerging evidence suggests early presentation before the onset of bipolar
disorder have tremendous potential for early identification and intervention, and
some clinical features and preceding the onset of bipolar disorder can be identified
within genetic and clinical high risk groups. In contrast, in community sample, a
larger proportion of people have experienced (hypo)manic symptoms within their
lifetime, especially during their adolescence, but not necessarily develop into
bipolar disorders. A systemic review and comparison between the characteristics
of the presentations of bipolar symptoms in both clinical setting and the
community sample can help us to untangle the obscure nature of prodromal
symptoms of bipolar disorder, which may consecutively help the development of
programs for early detection and intervention.
Electromagnetic sensitivity? (Module1, 11/29)
The BBC recently ran a story (http://www.bbc.co.uk/news/world-us-canada14887428) about people in America who have had to move to an out of the way
place in West Virginia because they develop severe illness when exposed to wifi
signals. There is a special refuge created for them where there is no wifi. Many of
them are severely disabled. The story says that 5% of US citizens might have
electromagnetic sensitivity. But some years ago there were similar stories about
people having to move to similar out of the way locations because they suffered
from what was then called Twentieth Century Allergy, or Total Allergy
Syndrome, now sometimes called multiple chemical sensitivity. How has this
happened, given that wifi did not exist when these earlier stories were written.
Are these really two separate disorders, or are they instead culture bound
syndromes? Have these things happened in earlier times – after all, in previous
epochs monks sometimes moved to the wilderness to escape the impurities of this
world.
Huai-Hsuan Tseng
PhD student
Department of Psychological
Medicine
Prof Philip McGuire
Professor of Psychiatry &
Cognitive Neuroscience
Department of Psychological
Medicine
Dr Paul Allen
Senior Lecturer
Department of Psychosis
Studies
Prof Simon Wessley
Vice Dean, Academic
Psychiatry
Head, Department of
Psychological Medicine
Director, King's Centre for
Military Health Research
Institute of Psychiatry
simon.wessely@kcl.ac.uk
What do veterans think would help with access to care? (Module 1, 11/30)
We know that less than 50% of ex-service personnel with mental health problems
seek help from medical services. This is an important public health issue because
untreated mental health problems are associated with impaired quality of life and
occupational impairment. We have data from a large sample of unwell ex-service
personnel and we have asked the question – What would help with getting you
access to care? The answers are provided as free text. In this study you would first
research the literature on help-seeking amongst ex-service personnel, and then
look at the health service research literature on pathways to care/access to care.
You will then use thematic analysis to code the free text responses received in
order that you can identify themes and sub-themes in the responses. We will help
you write this up into a paper.
Dr Nicola Fear
Reader in Military
Epidemiology
Department of Psychological
Medicine
Nicola.t.fear@kcl.ac.uk
Dr Amy Iversen
Senior Clinical Lecturer
Department of Psychological
Medicine
Amy.c.iversen@kcl.ac.uk
The clinical epidemiology of mental competence in patients with psychiatric
disorders (Module 1, 11/31)
The objective of this review is to describe the clinical epidemiology of mental
competence in patients with psychiatric disorders in general hospital settings
including
a) Prevalence of Mental incompetence in the general hospital settings. And
b) Associations of Mental incompetence in this group.
Dr David Okai
Department of Psychosis
Studies
david.okai@kcl.ac.uk
This will be a parallel study to one previously published in the British journal of
psychiatry.
Okai, David, Gareth Owen, Hugh McGuire, Swaran Singh, Rachel Churchill and
Matthew Hotopf. 2007. "Mental capacity in psychiatric patients." The British
Journal of Psychiatry 191(4):291-297.
Autism and Serotonin (module 1, 11/32)
One of the most consistent findings in Autism Spectrum Disorder (ASD) research
is an elevation of the chemical serotonin (5-hydroxtryptamine, 5-HT) in blood and
plasma samples when compared to controls. More needs to be understood about
the reasons and consequences of findings about this neurotransmitter. A review
of the research would encompass serotonin’s role in behaviour and neurobiology
related to the triad of impairments found in ASD: social and communication
difficulties and restrictive and repetitive behaviours. It would also include the
genetic aspects of ASD involving the genes and gene variants related to 5-HT
such as neuro-receptors and their binding, as well as chemicals involved in the
synthesis and breakdown of 5-HT.
Eileen Daly
Lecturer
Department of Forensic and
Neurodevelopmental Science
Eileen.daly@kcl.ac.uk
SHIELD: KHP’s self-harm service improvement project
Self-harm is a common and challenging presentation to manage effectively in the
ED. SAHIELD is a large service development project to attempt to improve the
care pathway for those who self-harm and we seek medical student involvement
in our work. We have run several successful (including prize winning!) SSCs over
the last year. Ongoing SSCs are available as part of the service development
project. The precise content of the projects will vary and can be built around the
interest of the individual. All will offer the student to be involved in a dynamic
team based in the Emergency Departments at St Thomas’ and King’s College
Hospitals and will give the opportunity to develop audit and service evaluation
skills. Examples of pre-arranged ones include:
Dr Sean Cross
Consultant Liaison Psychiatrist,
SHIELD project
sean.cross@kcl.ac.uk
Mental health service follow up of self-harm (Modules 1 & 2, Code: 11/33)
Approximately half of those who present to A&E are known to mental health
services or subsequently referred to them. We would like to have a better
indication of what occurs in the follow up of patients who are known to one of the
many mental health services within SLaM. Benchmarks exist for when and how
follow up should be offered to those in child and adolescent services but not in
general adult services. We would like to know how the self-harm event is
communicated to SLaM workers, if the event is revisited by SLaM workers with
the patient and how this is done. This project would lay the foundations for future
research and service development work which you would be welcome to be
involved in beyond the demarcated boundaries of this SSC project.
Module 1: Literature review of self-harm follow up
Module 2:
 Clinical governance audit and service evaluation committee application
 Outreach to CMHT and other team leaders for discussion on
communication processes
 Design of an appropriate audit tool
 Audit of approximately 100 consecutive self-harm presentations
 Collation and presentation of results, together with recommendations in
variety of forums
Preparation for alternative forms of follow up of self-harm(Modules 1 & 2,
Code: 11/34)
There are a number of plans to offer different kinds of follow up to patients who
have presented with self-harm. The literature points to a number of different ways
in which this could be offered including postcard, telephone, text and email follow
up. We have plans over the next 2 years to offer a variety of these. Prior to this
role out it would be very useful to look at the availability of contact details
currently kept on patients and to conduct a small service evaluation on how these
might be practically offered. This would offer a well boundaried SSC project and
lay the foundations for future research.
Module 1: Literature review of self-harm follow up
Module 2:
 Clinical governance audit and service evaluation committee application
 Design of an appropriate audit tool
 Service evaluation of approaches to alternative follow up
 Audit of approximately 100 consecutive self-harm presentations
 Collation and presentation of results, together with recommendations in
variety of forums
Dr Sean Cross
Consultant Liaison Psychiatrist,
SHIELD project
sean.cross@kcl.ac.uk
Comparison of audit data between self-poisoning and other forms of selfharm (Modules 1 & 2, Code: 11/35)
Self-poisoning accounts for approximately 70% of all self-harm presentations
though the Emergency Dept. There is evidence to suggest that other forms of selfharm do not receive the same level of assessment. As part of our ongoing
SHIELD audit project we offer the opportunity for a medical student to work with
us on assessing the quality of the assessments previously offered to those who
presented with self-harm locally.
Dr Sean Cross
Consultant Liaison Psychiatrist,
SHIELD project
sean.cross@kcl.ac.uk
Module 1: Literature review of self-harm follow up
Module 2:
 Clinical governance audit and service evaluation committee application
 Design of an appropriate audit tool
 Audit of approximately 100 consecutive self-harm presentations
 Collation and presentation of results, together with recommendations in
variety of forums
Stem cells and psychiatric disorders (module 1, 11/36)
Professor Noel Buckley
Professor of molecular
Stem cells are unique. They act as a potentially limitless repository of self- neurobiology
replicating progenitor cells that, when activated, can give rise to specialised Centre for the Cellular Basis of
progeny. These cardinal properties of self-replication and developmental potential Behaviour
lend stem cells a unique biomedical potential. This has been realised for over 50 noel.buckley@kcl.ac.uk
years since the first bone marrow stem cell transplants took place in 1959 to treat
radiation exposed nuclear plant workers. However, their potential value toward
diagnosis and treatment of neurological and psychiatric disorders has been
realised much more recently. Applications of stem cells include (1) replacement
of cells lost in neurodegenerative disorders (2) stimulation of endogenous repair
(3) identification of biomarkers for incidence and progression of disease (4)
screening drugs for efficacy in cell line models of disease.
One of the problems with use of human stem cells lies in their derivation:
human embryonic stem cells requires destruction of foetus whilst derivation of
human neural stem cells from neural tissue requires sourcing human foetal
material. These issues raise both ethical and scientific concerns. The signal
discovery by Yamanaka in 2006 that somatic cells could be reprogrammed to a
stem cell like state has revolutionised stem cell biology. These induced pluripotent
stem cells (iPSCs) can be derived from many tissue sources and can be
programmed to become neural stem cells, which in turn can be differentiated to
neurons and astrocytes. The ability to make patient –specific stem cells opens up
immense opportunity. Firstly, they are derived without destruction of any human
embryo hence obviating many ethical and legal concerns. Secondly, for
regenerative medicine, they offer a source of cells derived from the patient so
transplantation is not accompanied by rejection problems. Thirdly, as a diagnostic
and investigative tool they offer a patient-specific in vitro tool to assess actions of
known and novel drugs.
The iPSC field has rapidly burgeoned and there is an urgent need to
review the literature to assess the different means of derivation of neural stem
cells and their potential application to the study and treatment of psychiatric
disorders.
http://www.youtube.com/watch?v=vSuWlB6ETCU for an interview with Shinya
Yamanaka.
Can simulation 'sex up' Patient Safety? (Module 1, 11/37)
Patient safety is the new buzzword for government and the DoH with a major new
funding stream currently on offer from the NIHR to fund Patient Safety
Translational Research Centres. However, patient safety is not high on junior
doctors agendas. It is not taught formally in most medical schools in the UK, and
1 in 5 of medical students recently surveyed felt that it was an irrelevant topic for
their training. Simulation is a popular teaching tool which students and health
professionals consistently rate highly, but it use in patient safety teaching has not
been fully exploited. In this review, you will pull together a systematic literature
review on the use of simulation to enhance patient safety. You will work with the
simulation lead for KHP (Peter Jaye) to be guided to appropriate resources and
you will be helped to prepare a systematic review for publication.
Different paths: A comparison of the training routes and support for US
Junior Academic Clinicians compared to the UK (Module 1, 11/38)
Academic Medicine is under threat on both sides of the Atlantic for different
reasons related to the culture and financial and politic climate around healthcare.
Thus there is much interest in the development of effective ways to develop and
nurture the careers of promising junior academics from medical school onwards.
How can such individuals be identified, and supported to become clinician
scientists during busy medical training? In this review you will collate evidence
from the US and UK and write a review based on published and unpublished
sources. We will collaborate with Professor Harold Pincus in America who is
keen to contribute to the preparation of a paper for publication.
Child and adolescent mental health services for ethnically diverse
communities: A review of quality improvement strategies (Module 1, 11/39)
Children and young people from black and minority ethnic (BME) communities
are under-represented in CAMHS. This may be due in part to low acceptability of
mental health care. In particular, fear of social stigma from peers, concerns about
culturally inappropriate care and lower perceived treatment credibility have all
been identified as key barriers to service use for families from BME groups
(Bradby et al., 2007; Richardson, 2001; Sarno Owens et al., 2007).
Although several policy initiatives have proposed measures for improving access,
outcomes and experience of NHS mental health services for BME communities,
implementation has centred on adult services. There is also a lack of systematic
evidence that brings together existing sources on the specification and evaluation
of culturally responsive CAMHS. Thus, CAMHS practitioners, managers and
commissioners are limited in being able to make well-informed choices about
suitable approaches for improving the quality of care for users in different ethnic
groups.
The present project will use systematic review methods to identify and synthesise
available evidence on service delivery models, staff training interventions and
psychotherapeutic programmes that have been developed specifically to improve
mental health care for children and young people from BME groups. The aims
are to advance knowledge and inform practice by (1) describing models of
culturally responsive care that have been evaluated in CAMHS, and (2) assessing
their effectiveness.
Dr Louise Murphy
Catherine.Murphy@slam.nhs.u
k
Prof Simon Wessley
Vice Dean, Academic
Psychiatry
Head, Department of
Psychological Medicine
Director, King's Centre for
Military Health Research
Institute of Psychiatry
Dr Louise Murphy
Catherine.Murphy@slam.nhs.u
k
Prof Simon Wessley
Vice Dean, Academic
Psychiatry
Head, Department of
Psychological Medicine
Director, King's Centre for
Military Health Research
Institute of Psychiatry
Dr Daniel Michelson
Senior Clinical Research
Associate
CAMHS Research Unit
Department of Psychology
daniel.m.d.michelson@kcl.ac.u
k
Treatment of childhood disruptive behaviour across cultural and ethnic
groups: A review of parent training interventions (Module 1, 11/40)
The vast majority of research on child mental health interventions originates from
Western theories of normative child development, and is based on white middle
class samples from North America, Europe and Australia. Despite the inclusion
of black and minority ethnic (BME) children and families as participants in some
studies, little is known about the effectiveness of reputed “evidence-based
interventions” (EBIs) with specific BME groups, and the extent to which
outcomes could be enhanced by tailoring interventions to diverse cultural features.
Even less is known about the outcomes and experience of EBIs in non-Western
countries.
One of the most widely studied EBIs in the field of child mental health is parent
training for childhood disruptive behaviour problems. This treatment modality
draws on social learning theory and relationship-based approaches to address
dysfunctional parenting practices and their role in maintaining behaviour
difficulties such as aggression, opppositionality, defiance and other serious
violations of age-appropriate social rules. Although contextual variables such as
family structure and parental psychopathology have been identified as important
influences on child behaviour, the developers of well-known parent training
programmes (e.g. Incredible Years and Triple P) have tended to overlook culture
and ethnicity in their conceptualisations of parenting. There has also been little
consideration given to cross-cultural applicability of parent training interventions
in existing reviews and clinical guidelines.
The present project will develop the evidence base and inform practice by
drawing together the small but increasing body of literature on ethnic and cultural
dimensions in the treatment of childhood disruptive behaviour. The aims are (1)
to describe models of parent training that have been specifically adapted to treat
child behaviour problems in BME groups in western settings, and in non-Western
countries; and (2) to assess their acceptability and effectiveness.
Dr Daniel Michelson
Senior Clinical Research
Associate
CAMHS Research Unit
Department of Psychology
daniel.m.d.michelson@kcl.ac.u
k
DOORWAYS (module 1, code: 11/41)
A MIND report (MIND, 2004) examining acute wards across England and Wales
found that service users often complained about the boredom they experienced on
wards, with very few activities offered. Service users recognised that the lack of
therapeutic activities (or the cancellation of those on offer) is often due to staff
shortages and/or too many demands being placed on staff. Higgins and
colleagues (1999) reported that nurses blamed the need to focus on resolving
crises for a small number of patients, as well as the increase in administrative
duties expected of them, as the primary reasons for not being able to spend time
on therapeutic activities or in direct patient contact. Furthermore, MIND
concluded that steps must be taken so that staff retention improves, which would
lead to a decrease in the need to rely on agency staff who may not have the skill or
familiarity with the ward to run such activities. A Sainsbury Centre for Mental
Health (2005) report provided a more upbeat picture, finding that 73% of ward
managers across England reported that both practical therapeutic activities (e.g.
cooking skills) and talking therapies occurred regularly on their wards, and 64%
reported leisure activities (e.g. film nights) occurring regularly. It was pointed out
that ward managers may have considered using counselling skills/talking to
service users as therapeutic activities, which although therapeutic cannot be
considered on a par with formal therapies. Specifically, therapies with a strong
evidence base, such as CBT, only occurred on 20% of wards. The
recommendations include increasing the availability of training in therapeutic
activities which have an evidence base (Sainsbury Centre for Mental Health,
2005). What is omitted from the report is any discussion that although activities
of all types may be something the wards aim to provide and indeed make plans to
do so, how often they happen in practice may be a different matter. Furthermore,
therapies with a strong evidence base, such as CBT, only occurred on a minority
of wards. Nursing staff have also expressed that they would like to have more
time to spend engaging in direct client contact. Collins and colleagues (1985)
confirmed the finding that inpatient activity and social interaction are associated
with positive clinical outcomes, and that the least restrictive (least formal) staffservice user interactions were the most beneficial. In spite of this, Poole et al
(1981) found that patients and staff interacted only 11% of the time on average,
while Higgins et al (1999) found service users reported spending only 4% of their
time in direct contact with nursing staff. This is despite the finding that service
users judge the time nurses spend in direct patient contact as one of the most
important indicators of the quality of care they receive (Hansson et al.,1993).
Service user perceptions are important not just in and of themselves, but because
they are associated with objective and subjective outcomes. Priebe et al (2009)
found that service users (admitted involuntarily) with the lowest satisfaction
ratings of the care they received were more likely to be readmitted within a year.
The DOORWAYS project is an evaluation of the effects of increasing therapeutic
activities on acute inpatient wards. .Module 1 would involve a literature review
about inpatient activities and service user-nurse interactions.
Dr Emese Csipke,
Project Co-ordinator
emese.1.csipke@kcl.ac.uk
emese.csipke@slam.nhs.uk
0207 848 5001
Prof Til Wykes
Department of Health Service
and Population Research
Til.wykes@kcl.ac.uk
For further information on the
measures used and the protocol
please see
www.perceive.iop.kcl.ac.uk
The impact of posttraumatic stress disorder on physical health outcomes
(Module 1, 11/42)
Dr Laura Goodwin
King’s Centre for Military
Health Research
Posttraumatic stress disorder (PTSD) is a psychological condition that can occur Department of Psychological
after a traumatic event, which is known to impact on quality of life and social Medicine
functioning. As important is the potential impact of PTSD on both current and laura.goodwin@kcl.ac.uk
future physical health. There is evidence for an increased prevalence of somatic
symptoms, such as chest pain and headaches in patients who were currently Dr Nicola Fear
diagnosed with PTSD (Kroenke et al., 2011), with further evidence of an Senior Lecturer in Military
increased prevalence, and onset, of more serious disease among Iraq and Epidemiology
Afghanistan veterans, including circulatory, hypertensive and digestive system Department of Psychological
disease (Andersen et al., 2010). In particular, there may be a specific association Medicine
between PTSD and cardiovascular disease, with higher odds of angina and heart King’s Centre for Military
failure in patients with PTSD (Spitzer et al., 2009) and a greater self-reported Health Research
symptom burden in patients with cardiovascular disease who have PTSD (Cohen Nicola.t.fear@kcl.ac.uk
et al., 2009).
Why is it important?
There are no recent systematic reviews in this area of which I am aware, so it
would be very useful to determine if the findings across research studies are
consistent. It is important to determine whether PTSD does have a longer term
impact on physical morbidity, so that future research can investigate potential
pathways for this effect, in order to target future treatments appropriately. There is
evidence for the longer term effects of trauma on future physical health outcomes,
which could be biological in nature, or alternatively could result from patients
with PTSD undertaking unhealthy behaviours.
What would it involve?
This project may take a wider approach looking at the impact of PTSD on all
physical illness/disease or it could focus on particular disease outcomes, such as
cardiovascular disease. Some of the research in this field has examined crosssectional associations between current illness in patients with a PTSD diagnosis,
whereas other studies follow-up older participants who have a history of PTSD to
examine the longer-term effects of PTSD. There is scope as to whether this
project will take these methodological factors into account, in regard to the
research question.
References
Lowe B. Kroenke K. Spitzer RL. Williams JB. Mussell M. Rose M. Wingenfeld
K. Sauer N. Spitzer C. (2011). Trauma exposure and posttraumatic stress disorder
in primary care patients: cross-sectional criterion standard study. Journal of
Clinical Psychiatry. 72(3):304-12.
Andersen J. Wade M. Possemato K. Ouimette P. (2010). Association between
posttraumatic stress disorder and primary care provider-diagnosed disease among
Iraq and Afghanistan veterans. Psychosomatic Medicine. 72(5):498-504.
Spitzer C. Barnow S. Volzke H. John U. Freyberger HJ. Grabe HJ. Trauma,
posttraumatic stress disorder, and physical illness: findings from the general
population. Psychosomatic Medicine. 71(9):1012-7.
Cohen BE. Marmar CR. Neylan TC. Schiller NB. Ali S. Whooley MA. (2009).
Posttraumatic stress disorder and health-related quality of life in patients with
coronary heart disease: findings from the Heart and Soul Study. Archives of
General Psychiatry. 66(11):1214-20, 2009 Nov.