Depression affects more than 150 million people around the world and is a leading cause of disability across the globe. The main focus of treatment has been on mood symptoms. However, cognitive functions affected in depression represent an important, yet under recognized aspect of the disorder. The efforts to acknowledge cognition as a core element in depression was addressed in the recent workshop in the USA at the National Academy of Sciences, Washington, DC.
People always want to know about stress and how it affects their life. There were ample opportunities this week at the Latitude Festival, where Salon London together with the Wellcome Trust organised two events during which I was asked to talk about the effects of stress on the brain. As usual, people had a surprisingly good level of knowledge on these topics, and were prepared to resonate emotionally with the research findings and to bring their own personal experiences into the open through insightful questions. It was great fun and very rewarding.
Reassembling the Self is a touring exhibition curated and devised by Susan Aldworth featuring work by herself and two other artists, Camille Ormston and Kevin Mitchinson. The exhibition’s theme is how psychotic disorders, especially schizophrenia, affect perception, emotion and identity. The exhibition, originally funded by Newcastle University, was previously shown to great acclaim at the Hatton Gallery and Vane Gallery, both in Newcastle (2012), and the GV Art gallery, London (2014). Through a research collaboration with Autifony and Newcastle University, academics at the University of Manchester become aware of the exhibition and participated in an educational event at the GV gallery. When it was announced that the exhibition would be shown at the Waterside Arts Centre, Manchester, between 7 February and 30 May 2015, a group of clinicians and researchers from the University of Manchester, led by Professor Jo Neill, Dr Peter Haddad and Dr Michael Harte, joined Jenny Waterson, Curator, and Kelda Savage, Freelance Curator and Events, to devise a series of supporting educational activities. These were promoted across various networks including press, education, health, science and arts organisations. In this article we review the exhibition and supporting events. From the outset public engagement and reducing the stigma of psychosis were key aims.
BAP Past President Prof Guy Goodwin, and Guardian journalist David Adams addressed a full house at Cheltenham Science Festival on Tuesday 2nd June, as part of the BAP-sponsored session entitled “Treating Mental Illness”.
Cannabis has been used for thousands of years, for a variety of medical, religious and recreational purposes. Today it is used by 178 million people each year, or 3.8% of the global population. Despite its long history and abundance, it is difficult to think of many psychoactive substances that polarise opinion more than cannabis. Preparations of the plant Cannabis Sativa L. and the 100+ chemicals it produces (called ‘cannabinoids’, such as delta-9-tetrahydrocannabinol or ‘THC’) show potential in a wide range of applications in modern medicine. These include multiple sclerosis, chronic neuropathic pain, intractable nausea and vomiting, loss of appetite and weight in the context of cancer or AIDS, psychosis, epilepsy, addiction, and metabolic disorders. Furthermore, when considering non-medical use, cannabis is often considered a ‘soft drug’; it is the only substance to have ever been reclassified to less harmful category in the UK Misuse of Drugs Act (this came into effect in 2004 but was reversed 5 years later). Nevertheless, strong concerns have been raised about the negative consequences of cannabis use. For example, it has been linked to an increased risk of psychotic disorders such as schizophrenia. However, it is not clear whether cannabis actually increases this risk, or if it simply coincides with other factors that do, as explained elsewhere on the BAP website.
Drug discovery for schizophrenia has long been based upon the dopamine hypothesis resulting in many compounds with similar mechanisms of action and which provide relief of the hallucinations and delusions of the disease. Unfortunately these ‘antipsychotic’ drugs have limited effectiveness against the negative symptoms (such as reduced motivation) and cognitive deficits (such as impaired flexibility of thinking and working memory); symptoms which are especially associated with impaired functional outcome.
Stigma occurs when society labels someone as tainted or less desirable. Stigma involves three elements; a lack of knowledge (ignorance), negative attitudes (prejudice) and people behaving in ways that disadvantage the stigmatised person (discrimination). Several health conditions are associated with stigma including some cancers, HIV, AIDS and skin conditions such as psoriasis. However the stigma related to mental health problems is particularly severe and widespread. This article discusses mental health stigma, its consequences and what can be done to reduce it.
Ciara McCabe and Phil Burnet presented their latest research findings in a lively BAP-sponsored session at Cheltenham Science Festival last week. After giving an overview of different types of food that can affect brain function, Phil explained the surprising truth that the bacteria in our gut have the potential to alter our mood and behaviour.
In the second week of May around two thousand scientists and clinicians descended on a hotel in Midtown Manhattan for the Society of Biological Psychiatry’s Annual Meeting. The theme of the meeting was ‘Accelerating Scientific Translation’. Consistent with this, the plenary sessions updated us on progress in the identification of biomarkers, the challenges associated with drug development, and the emergence of novel treatment strategies. There was also tantalising glimpses of the results being obtained by several of the large-scale neuroscience projects currently underway, including the Human Connectome Project. Overall, the programme covered the entire spectrum of psychiatric disorders, as well as covering a significant amount of preclinical science and conditions traditionally thought of as neurological disorders, notably Alzheimer’s disease.
Social interaction is a feature of every aspect of human life. Deficits causing impairment in social function can have a debilitating effect in someone’s life and are prominent in many neuropsychiatric disorders, such as autism and schizophrenia. This has provided a strong impetus to understand the neural substrate of social behaviour with a view to developing effective treatments. This task has been hindered by the complexity of human social interactions. Nonetheless, animal research since the 1970s has identified a class of molecules that play a key role in the development and regulation of social behaviour and its neural substrate.
Professor Ed Bullmore (Cambridge & GSK) opened the meeting and eloquently set up the challenge for psychiatry – that is, the therapeutic inertia in the field. The intertia was captured in a suggestion that a practicing psychiatrist today would perform reasonably well based on a text book from 1990! This is unlikely to be true in other fields. He proceeded to use a concrete example of an Experimental Medicine approach to drug development from his work at GSK in the development of an opioid antagonist for appetite control.
During the University of Cambridge Science Festival, this event, sponsored by the British Association for Psychopharmacology (BAP), and supported by the medical charity Anxiety-UK, attracted a full audience to the lecture hall on 11th March at 8pm: the event was booked out weeks in advance.
Emma Moody (Upper 6th, Dollar Academy, Scotland), and Rudi Stanislaus-Carter (first year PhD student, St Andrews University) give their reaction to the 16th Annual Jeeves lecture at the School of Psychology & Neuroscience, University of St Andrews. The lecture, given by Professor Barbara Sahakian (Department of Psychiatry, Cambridge University,) was entitled: The Impact of Neuroscience on Society: The Neuroethics of ‘Smart Drugs’.
Following the lecture, Professor Sahakian signed copies of the book she has recently co-authored with Dr Jamie Nicole Labuzetta: Bad Moves: How decision making goes wrong, and the ethics of smart drugs (OUP, 2013).
Report on a session conducted at the ‘Festival of Neuroscience’, organised by the British Neuroscience Association.
The ‘Festival of Neuroscience’ was a 4-day scientific event held at the Barbican centre in London, UK. This was an event organised by the British Neuroscience Association (BNA) in partnership with eighteen societies with interests in both clinical and non-clinical aspects of neuroscience. There were 56 scientific sessions and 7 plenary lectures involving more than 240 speakers, over 80 from outside the UK. The session on ‘Impulsivity Compulsivity and Habit Formation’ was a contribution from the British Association for Psychopharmacology (BAP).
The first major breakthroughs in the development of effective psychiatric drugs came in the years following the Second World War. The introduction of effective anti-psychotics, to treat schizophrenia, and anti-depressants revolutionised how the mentally ill were cared for. The ability to control the florid symptoms of psychotic episode in schizophrenia or break someone out of a deep depression was a major step forward. For the first time many patients were able to live more ‘normal’ lives inside and on occasion outside of the confines of asylums and mental hospitals. Patients with more developed and serious conditions experienced a slowing down of the worsening of their disorders. A few suffers were even able to become treatment free as their illness appeared to disappear.
Why not use pills to get smarter? This was the topic of an extraordinarily engaging event entitled ‘Smart Pills, anyone?’ that took place on the evening of Monday 18th March at the Cambridge Science Festival 2013. The event was organized by the Naked Scientists (delivery partner of the Wellcome Trust-funded Smarter UK project) and the University of Cambridge Behavioural and Clinical Neuroscience Institute (BCNI), and was supported by the Wellcome Trust, the British Association for Psychopharmacology and the University of Cambridge. Fully booked and attended by more than 150 people, mostly college students, ‘Smart Pills, anyone?’ was chaired by Alok Jha (science correspondent at The Guardian) and included presentations by a panel composed of Professor Barbara Sahakian (Department of Psychiatry and the MRC/Wellcome Trust BCNI University of Cambridge), Dr. Hannah Critchlow (Naked Scientists) and Ben Johnston (Graphic Science and lead of the Smarter UK project). The evening also included a highly articulate debate on the use of cognitive enhancers by GSCE/A Level students from local schools.
The Cambridge Science Festival 2013 hosted the public event “Focusing ADHD” (Attention Deficit Hyperactivity Disorder) on 14th March 2013. The event was a part of the Brain Awareness Week (11th-17th March) campaign. Many public engagement events took place all over the UK to raise awareness for brain and mental health problems. “Focusing ADHD” event was organised by the University of Cambridge Behavioural and Clinical Neuroscience Institute (BCNI) and sponsored by the Wellcome Trust, the British Association for Psychopharmacology and the University of Cambridge.
What is ketamine?
Ketamine is an anaesthetic which was first developed by the drug company Parke-Davis in 1962. It is typically considered a ‘dissociative’ anaesthetic due to the unusual effects it can produce, which include out-of-body experiences. Recent years have also seen significant growth in its use within the party scene, where it is commonly referred to as ‘Special K’. However, as it has a safety profile superior to that of many other anaesthetics, ketamine is still widely used by clinicians for emergency, paediatric and veterinary anaesthesia (Jansen, 2001; Perry et al., 2007).
BAP had, for the third year running, a strong presence at the premier British Science Festival in Cheltenham last June. We supported two events, each of which was sold out to capacity audiences: one on depression and one addressing the roles of genes and environment in mental illness. These events are both challenging and hugely rewarding for speakers: challenging in the need for each speaker to condense often very complex topics into about 10 minutes, rewarding in the enthusiastic response and feedback that comes from the audience. The majority of the hour or so of each session is given over to open discussion, and this often carries on with audience members and speakers for long after the end of the event, as it did for the BAP sessions.
Why study alcohol use?
Alcohol is a widely available, legal drug in the United Kingdom. Most individuals drink some alcohol, with around 70 % of men and 55 % of women reporting having consumed an alcoholic drink on at least one day during the previous week. Heavy alcohol use appears to be a factor in risky, aggressive and socially unacceptable behaviours and is associated with increased risk for liver disease and cirrhosis, several types of cancer, raised blood pressure and coronary heart disease. As a result there is growing concern about the societal impact of heavy alcohol use, including the associated burden on the economy and public health. Psychopharmacology research is developing our understanding of how alcohol affects behaviours and thought processes that might lead to heavy and harmful alcohol use, including short-term (e.g. intoxication and drunkenness) and long-term (e.g. continued drinking over a long period of time) effects of alcohol use on how we act and think.
Schizophrenia is a rare but serious illness, which can cause psychotic symptoms, anxiety and depression, and emotional ‘flattening’, amongst other things. You can read more about schizophrenia elsewhere on the site here. While intoxicated on cannabis, people can experience short-term feelings of paranoia, hallucinations or delusions, which are similar to the psychotic experiences of schizophrenics. But feeling paranoid while you’re ‘high’ or under the effects of the drug is not the same as having a debilitating disorder like schizophrenia. Intoxication effects last a few hours; psychosis can involve episodes for days, or longer.
What is lithium?
In the 5th century AD a Roman physician was reputed to have recommended the use of alkaline waters to patients suffering with mental disorders. The effect of these waters on their mental state is thought to be due to the lithium levels found in them (Marmol 2008). Since the 1800s lithium has been used to treat recurrent depression and other depressive states. It is now the ’Gold standard‘ treatment for bipolar disorder (manic-depression), both for mania and relapse prevention. Lithium is also used with other antidepressant treatments in difficult to treat depression (Cade 1949; Collins, Barnes et al. 2010).
More people consume caffeine more often than any other drug. Worldwide the predominant sources of caffeine are tea and coffee, although colas, ‘energy’ drinks, mate, guarana, and cocoa (chocolate) also contribute significantly to consumption.
After consumption of a caffeine-containing drink, caffeine is distributed rapidly throughout the body, reaching its highest concentration in the bloodstream and in the brain within 30-40 minutes. Caffeine and its metabolites are then gradually eliminated from the body, mainly in the urine. For adults, the elimination half-life of caffeine – the time it takes for half of the caffeine consumed to be eliminated from the body – is around 3 to 6 hours.
Depression is a clinical condition broadly characterised by pervasive sadness and by lack of enjoyment of every-day life activites. It is distinguished from normal sadness because of its duration (at least 10-14 days of continuous or almost continuous presence of these emotional difficulties) and by its negative impact on daily functioning, in areas such as work performances and personal relationships. In most cases, depression is also associated with feeling of anxiety and with disrupted sleep, appetite and libido. At its worst, depression is accompanied by the very distressing thoughts such as that life is not worth living, and even by acts of self-harm leading to attempted or successful suicide. In the Western world, depression is considered one of the leading causes of disability, with one in five people experiencing depression in the lifetime.
ADHD affects about 5% of children worldwide, regardless of culture. It is more than 2-fold more common in boys and over half of children with ADHD continue to suffer from this disorder as adults. Diagnosis of ADHD is based on ‘hyperactivity’ (e.g. inability to sit still, lack of organisation), ‘inattentiveness’ (forgetful, poor concentration, abandoning tasks before completion) and ‘impulsivity’ (acting without considering the risks, interrupting). These three features must be evident before the age of seven; they must be present in at least two settings (e.g., school, workplace or home); and they must last for at least 6 months. The expression of ADHD by patients is described as either: Predominantly Inattentive (more common in girls), Predominantly Hyperactive / Impulsive (more common in boys) or Combined type (Inattentive and hyperactivity/impulsive), but these are not fixed subtypes and they can change with time in individual patients. For instance, hyperactivity usually disappears as children approach adulthood, although a feeling of ‘restlessness’ persists.
Alzheimer’s Disease International estimate 35.6 million people living with dementia worldwide in 2010, increasing to 65.7 million by 2030 and 115.4 million by 2050. In the UK currently up to 820,000 people are living with dementia.
A neuropsychiatry seminar entitled ‘Understanding excess’ was hosted by the University of Cambridge on 14 March 2012. It was one of the many free events celebrating the Cambridge Science Festival around the theme of ‘breaking boundaries’; reflecting the year of the Olympic and Paralympics games, and showcasing the boundaries that are being broken in science, technology, engineering and mathematics.
The following recordings were made at the British Association for Psychopharmacology summer annual meeting 2011 during the Plenary Session on Mental Health, Neuroscience and the Wellbeing of Society. The participants were international leaders in the field of mental health, neuroscience and the wellbeing of society. The BAP was very fortunate to have not only a group of eminent speakers, but also leaders with vision for important new developments in the field. The audience feedback indicated that the talks were outstanding and there was a very high quality of discussion. As a tribute to the excellence of the speakers the audience filled the room and there was standing room only. Due to the importance of the participants’ talks and the demand by the members of the BAP we have made these recordings available. The first recording is an introduction to the panel topic and the participants, and the following recordings are the talks by the individual speakers of the panel.
The British Association for Psychopharmacology (BAP) organised a session at the 2011 Cheltenham Science Festival that explored Schizophrenia. The session, held in the town hall on 8th June, proved extremely popular with a ‘full house’. Professor Kathy Sykes, Festival Director, chaired the session that comprised presentations by three speakers, Marjorie Wallace, Dr Peter Haddad and Professor Gavin Reynolds. Following the presentations there was a lively question-and-answer session which continued in an informal manner in the ‘talking booth’. Members of the audience raised many pertinent questions and several discussed their personal experience of living with schizophrenia or having a relative who had been affected by the illness. These personal testimonies were extremely powerful and highlighted a range of issues including both positive and negative experiences of NHS care, stigma and how some sufferers had strived to successfully overcome their illness and lead as full a life as possible. The session was a great success both in terms of the number of attendees, the audience interaction and the quality of the presentations and discussion. A summary of the three presentations is provided below.
British Association for Psychopharmacology (BAP) in association with Society of Biology proudly sponsored an informative and educative public engagement event titled “Understanding Excess”, a discussion on compulsive and addictive behaviour at this year’s Cheltenham Science Festival.
People who are impulsive tend to act before thinking. There are many varieties of impulsivity from the premature expression of behaviour before sufficient information is gathered (‘reflection impulsivity’) to the tendency of accepting small immediate or likely rewards as opposed to larger but delayed or unlikely rewards (‘choice’ impulsivity). It is also on occasion associated with aggression. In conceptual terms it is helpful to categorise impulsivity into ‘stopping’ and ‘waiting’ subtypes. In the former case this is assessed by the inhibition or cancellation of a response that has already been started. This is different from ‘waiting’ impulsivity which is best described as a dislike or intolerance of delayed rewards.
Although there are a number of treatments available to help people stop smoking (the most common being nicotine replacement therapies, such as patch and gum, and varenicline in the UK), these are only moderately effective. While they can double the chances of long-term abstinence from smoking in those attempting to quit, this is against a very low basic success rate. Therefore, most smokers (even those taking medications to help them stop and receiving good behavioural support) who attempt to stop eventually relapse to smoking.
3,4 Methylenedioxymethamphetamine (MDMA or ecstasy) was first synthesised and patented in 1912 as a precursor of other pharmacologically active compounds by the E. Merck company in Germany. It was examined by the US military in the 1950s, presumably as a chemical warfare agent since it is chemically related not only to other amphetamines but also mescaline. However the first report that it was psychoactive in humans was a paper in 1978 by Shulgin and Nichols. It rapidly became a well known ‘designer drug’; that is a compound with a chemical structural and pharmacological similarity to existing and illegal recreational drugs but, by being novel and not specifically listed, had escaped legal control. In 1985 the US Drug Enforcement Agency (DEA) classified MDMA as a Schedule 1 drug due to its high abuse potential and lack of known clinical use. The drug rapidly became illegal in most other countries but despite this its popularity surged often being taken at ‘rave’ or ‘techno’ dance clubs and parties. The peak of use came in the late 1980s and 1990s and a recent survey has suggested a marked decline in its popularity.
Cannabis has long been associated with poor memory, but new research suggests that the strain of cannabis makes all the difference1. In a test of memory, only users of 'skunk'-type strains exhibited impaired recall when intoxicated, whereas people who smoked hashish or traditional herbal cannabis performed equally well whether they were stoned or sober. These findings suggest that an ingredient more plentiful in some types of cannabis than in others may help to reduce memory loss.
Bipolar disorder or manic–depressive illness is characterized by the serial occurrence of repeated episodes of depressed and elevated mood. There are two main forms of Bipolar Disorder. In Bipolar I disorder elevated mood episodes are severe (referred to as “mania”) in Bipolar II disorder elevated mood is less severe (called “hypomania”) and there are frequent depressions. Bipolar I disorder is the best characterized and its treatments are the best studied. Less is known about how best to treat bipolar II disorder. A range of psychotropic medicines are available that can effectively treat manic/hypomanic episodes and/or depression. In addition medications are available to help prevent episodes of illness. The BAP bipolar guideline, revised in 2009, provide a detailed review of evidence?based supporting these treatment options along with recommendations for their use.
There has been a great deal of misinformation in the press in recent years about the value of antidepressants. Some publications and newspaper articles have claimed that they don’t work any better than placebo and even then only in more severely depressed patients. This is a highly misleading interpretation of the evidence which is extensive and shows clearly that antidepressants do work, even in the less severely depressed people.
Anxiety is part of the normal response to stress and is usually short-lived and controllable. It probably allows someone to respond better to a perceived threat or danger (and is sometimes called the ‘fight-or-flight’ response). Anxiety symptoms are important when they are particularly severe, last longer than expected, occur in the absence of stress and impair everyday life. Anxiety symptoms can be physical (or ‘somatic’) and due to over-arousal (such as shortness of breath, a racing heart and excessive sweating), or psychological, such as feeling frightened, troublesome worrying or being irritable.
Doctors can diagnose anxiety disorders when a patient has had a certain number of symptoms for more than a specified time, providing these symptoms cause much distress and impair everyday life. There are several different anxiety disorders, which share many psychological and physical symptoms but each disorder has its own characteristic features. For example, recurrent unexpected ‘panic attacks’ occur in panic disorder, whilst recurring troublesome ruminations and repeated checking habits occur in obsessive-compulsive disorder.
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