Schizophrenia: From Lab Bench to Clinical Practice

Pint of Science, Manchester, 15th May 2017

In mid-May BAP members Peter Haddad, Jo Neill and Lisa Heaney spoke in a city centre pub in Manchester in a lively and interactive public engagement session entitled ‘Schizophrenia: From Lab Bench to Clinical Practice’. The presentations highlighted the importance of translational preclinical work and how research findings have improved our understanding of schizophrenia and benefited clinical care. The session was chaired and organised by Charlotte Pelekanou, PhD student at Manchester University, with additional support provided by other students including Jack Barton. The session was part of the Pint of Science Festival.

Charlotte Pelekanou, Peter Haddad, Lisa Heaney and Jo Neill
Charlotte Pelekanou, Peter Haddad, Lisa Heaney and Jo Neill

The Pint of Science festival takes place in May every year. Researchers present informally in sessions held in public venues, mainly bars and pubs, and interaction with the audience is central. The festival was founded in 2012 by Dr Praveen Paul and Dr Michael Motskin, two postdoctoral neuroscience researchers at Imperial College London. The first festival was in 2013 with events in London, Oxford and Cambridge. Since then Pint of Science has grown into the World’s largest Science Festival with events being held in 175 cities across 10 countries in 2017. This explosive growth shows the public’s desire to hear about science and the enthusiasm of the scientific community to explain their work to the wider community. The festival has proved a great success on many levels. It is run by graduate students and introduces them to the importance of public engagement at the start of their careers. The discussion between researchers and members of their local community has proved to be inspiring for both sides. The format challenges the speakers to think about the practical implications of their work. By bringing together scientists and researchers the festival can also facilitate future research collaborations.

This Manchester session sold out in advance and was attended by about eighty people. The first presentation was from Peter Haddad, Consultant Psychiatrist and Honorary Clinical Professor at Manchester University, who spoke on ‘Using research to improve patient outcomes’. In a wide-ranging presentation, he highlighted how research has advanced our understanding of schizophrenia and its management over the last 70 years. In terms of causation of schizophrenia, the nature or nurture question of the past has been replaced by a recognition of the importance of both genetic and environmental factors and their interactions. Environmental risk factors that increase the likelihood of developing schizophrenia include birth asphyxia, being born in the winter, belonging to a minority migrant group, being brought up in an urban area, childhood trauma and cannabis use in adolescence. Brain imaging has demonstrated that excessive release of dopamine, a neurotransmitter, in a specific part of the brain termed the associative striatum is a key abnormality in schizophrenia. However, research now demonstrates that this is downstream of the primary dysfunction. He described care for people in asylums in the first half of the 20th century; despite often good intentions there were no effective treatments for psychiatric illness and so care largely focused on containment. In contrast, today care incorporates evidence based treatments which for schizophrenia include antipsychotic medication, cognitive behavioural therapy (CBT), family interventions and rehabilitation. Nowadays, care is mainly community-based with great value being placed on shared decision making and a collaborative approach between clinicians and patients. Research has highlighted the importance of early and effective treatment for psychosis leading to the establishment of early intervention teams. Furthermore, there is evidence that psychological interventions may delay or reduce the risk of development of psychotic disorder in people judged to be at high risk of developing psychosis. However more work is needed to confirm this. Despite these developments, care for people with schizophrenia is often inadequate as highlighted by the 2012 Schizophrenia Commission report ‘The abandoned Illness’. Challenges that lie ahead include reducing stigma, improving the physical health of people with schizophrenia, who have a reduced life expectancy of about 15 years, developing more effective and better tolerated medications and increasing the quality of clinical care. Peter concluded that meeting these challenges will partly depend on increased funding for clinical services and research.

An interval allowed people to mix and get a drink at the bar – the venue was a pub after all!  Charlotte Pelekanou organised a quiz with many of the questions focused on challenging stigma and misconceptions about schizophrenia. The quiz was marked during the interval and prizes awarded to three audience members drawn from those who got full marks.  Subsequently, Lisa Heaney went through the questions so that people understood the correct answers.

Jo Neill, Professor of Psychopharmacology at Manchester University, spoke on ‘Animal models for psychiatric disorders, promises and pitfalls’. Her presentation highlighted the progress made in this area and the disadvantages of previous approaches, including low reproducibility of some animal work and poor incentivisation to publish negative results. She discussed the work of her team to develop improved rodent models of aspects of mental illness untreated by current medication. She explained how she has worked over the past 15 years to develop a psychotomimetic model in rats using phencyclidine (PCP) to induce brain changes leading to cognitive and social behaviour disturbances of relevance to schizophrenia. She told us that such models are essential to test new drugs especially as we lack effective treatments for these aspects of the illness. She described some tests such as a task that requires intact executive function mediated by the prefrontal cortex area of the brain where both patients with schizophrenia and rats treated with PCP show comparable impairment. She also described a task that can identify whether a rat is optimistic (glass half full) or pessimistic (glass half empty). These tests can be used to identify new drugs to improve corresponding symptoms in patients. The importance of animal welfare, considering sex differences, using animals of both sexes, and taking an ethological approach with a clear understanding of the natural behaviour of the species under study was highlighted.

In the final presentation, Lisa Heaney, PhD student, spoke on ‘Gym rats: exercise and an animal model for schizophrenia’.  Her key message was that exercise is good for you and that the adage ‘what’s good for your heart is good for your brain’ is true. Exercise is a literal panacea and has been called ‘a miracle cure’ by researchers and physicians alike. It has been suggested that if exercise were a drug, it would be the most valuable pharmaceutical ever developed. Lisa reviewed the growing evidence base that exercise can be used to help a range of mental health disorders, including depression and schizophrenia She also talked about the seemingly never-ending benefits of exercise. For example, people who are active are less likely to get certain cancers, roughly 40% less likely to develop Alzheimer’s disease, and will live approximately 4 years longer than their sedentary counterparts. There is mounting evidence that exercise can lead to improvements in negative symptoms and cognitive functioning in schizophrenia. This is important as these symptoms are common, associated with poor functioning and are difficult to treat. Lisa wants to understand how exercise works on the brain to bring about these improvements. She is a member of Jo’s Neill’s lab and also works in Manchester with the PCP rat model. She describes her work as ‘rat gym’ because her rats are given access to running wheels, and because she thinks it sounds catchy. What she and the team she works with have found is that exercise can reverse the cognitive impairments induced by PCP treatment, and that this effect can last for several days after the last bout of exercise. This is novel and exciting work that Lisa hopes will ultimately help us to better understand the effect of exercise on schizophrenia and the underlying mechanisms involved.

After each presentation, there were questions from the audience and further discussion continued when the session officially ended. Interaction was encouraged by the informal setting and atmosphere. Attendees included students and members of the public and feedback was extremely positive. This was one of eighteen Pint of Science events that were held at six venues across Manchester, covering a diverse range of subjects including genomics, cardiology and extreme weather. A multitude of other cities in the UK and abroad participated. Science and public engagement have never been stronger! It is very exciting and encouraging to see that neuroscience and psychiatry are an important part of this.

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