News

Academic Writing Retreat for Nurses – September 2019

10 September 2019

Oxford Health BRC is supporting a three day Academic Paper Writing Retreat for Nurses planned for this September.

The retreat, also sponsored by the Oxford cognitive health Clinical Research Facility and the Oxford Institute for Nursing, Midwifery and Allied Health Research, is designed to provide uninterrupted time and space to write up a paper for submission to an academic journal. It is open to all nurse researchers working at Oxford Health NHS Foundation Trust; including clinical academics, PhD and professional doctorate students and postdocs.

As well as protected time for writing the retreat will also offer the opportunity for participants to network with fellow researchers and to access the support of mentors.

Eligible applicants are invited to register here until 26th July 2019.
Please contact tamara.lewin@psych.ox.ac.uk for further details.

gameChange clinical trial – how virtual reality could transform psychological therapy in the NHS

27 June 2019

A new clinical trial beginning on 1st July is testing a virtual reality (VR) based psychological therapy for people with severe mental health difficulties. gameChange is the largest ever clinical trial of virtual reality for a mental health disorder.

Over 400 NHS patients across England (Bristol, Manchester, Newcastle, Nottingham and Oxford) will take part in the trial, which will last 18 months and is funded by the National Institute for Health Research. The purpose of the trial is to find out whether VR therapy works. To do this, half the participants will receive the VR therapy and half will not. A comparison will then be made to see how the people who received VR therapy got on compared to those who did not receive the therapy.

“The gameChange VR therapy is for people with conditions such as schizophrenia whose fears have caused them to withdraw to such an extent that everyday tasks – such as getting on a bus, doing the shopping, speaking to other people – are a challenge. It aims to help patients re-engage with the world and go into everyday situations feeling more confident, calm and in control.”
Daniel Freeman, gameChange lead researcher, Professor of Clinical Psychology, University of Oxford and Consultant Clinical Psychologist, Oxford Health NHS Foundation Trust

There are currently 220,000 patients diagnosed with schizophrenia in contact with mental healthcare services in the NHS in England and Wales. Two-thirds of these patients have levels of anxious avoidance equivalent to people with agoraphobia. Automated delivery of therapy using VR has potential to transform NHS provision of psychological therapy for patients like these.

“I really hope that the therapy will be implemented in the NHS. This therapy can be delivered by peer support workers. That’s a real positive”
Debbie Butler, gameChange Lived Experience Advisory Panel

The VR therapy being tested has been created by designers and computer programmers working side-by-side with people with lived experience of psychosis. It is hoped that the treatment will lead to patients being more able to go into everyday situations and experience fewer/less severe psychiatric symptoms.

“Almost every aspect of the gameChange study has been designed in collaboration with people with experience of psychosis. The result is a study that we hope will be relevant, effective, and accessible and which focuses on helping people with day-to-day social situations”
Dr Thomas Kabir, Head of Public Involvement at Mental Health Charity The McPin Foundation

A VR café scene from the gameChange therapy including the virtual coach

This trial is being funded by the NIHR i4i mental health challenge award and it is also supported by the NIHR Oxford Health Biomedical Research Centre.

Key facts about:

gameChange trial

It tackles a serious issue: the social withdrawal of many patients with severe mental health difficulties
Whether a person has the VR therapy is decided by chance
Everyone in the trial completes an assessment at the beginning, which is repeated after 6 weeks and again after six months
Automated therapy means that if the treatment works it will be much easier to help many more patients

VR therapy

gameChange is an easy to use, step by step programme that allows a person to practise at their own pace being in a range of everyday situations
The therapy is provided in 6 thirty-minute sessions in VR
A virtual coach guides the person in how to overcome their fears
The virtual coach is animated using motion capture and voices of an actor and provides information on how to overcome anxiety.
The virtual coach is a calm presence and guides the user through the VR tasks to get the greatest benefit, performing an almost identical role to a real life therapist.
Patients are willing to enter VR simulations of anxiety-provoking situations because they know the simulations are not real, but what they learn transfers to the real world
At the beginning of the first session, the virtual coach explains the rationale behind the treatment, and the participant selects which one of six virtual reality situations:
- Café
- GP waiting room
- Pub
- Bus
- Street scene
- Newsagent
Each scenario has five levels of difficulty (e.g. the number and proximity of people in the social situation increases) and participants work their way through each level of difficulty

A press release relating to the trial can be found here.

Analysis of antidepressant dosage highlights need for new clinical guidelines

27 June 2019

Analysis published earlier this month in The Lancet Psychiatry shows that a lower dose of the most commonly used second-generation antidepressants achieves the best balance of effectiveness and tolerability in the acute treatment of adults with major depression.

The study, funded by the National Institute for Health Research, has important clinical implications for guidelines and the daily use of antidepressants in real world settings. It focuses on the most frequently prescribed antidepressants in the UK, including five SSRIs (selective serotonin reuptake inhibitors: citalopram, escitalopram, fluoxetine, paroxetine and sertraline), venlafaxine and mirtazapine. Data from almost 20,000 participants was used to assess efficacy, acceptability and tolerability over a median of 8 weeks treatment.

Optimal acceptability and dose-efficacy for the SSRIs was in the lower licensed range between 20 mg and 40mg fluoxetine equivalents. For both venlafaxine and mirtazapine optimal acceptability was also in the lower range of their licensed dose. However, for venlafaxine efficacy increased up to 150 mg and for mirtazapine dose-efficacy increased only up to about 30 mg.

“When I see patients in my clinic and we agree on prescribing an antidepressant for their depressive episode, the big challenge is not only to prescribe the right medication but also to find the best dosage for each individual, optimising efficacy and reducing side effects. Current practice guidelines provide conflicting recommendations”
Professor Andrea Cipriani, NIHR Research Professor

In the UK the NICE (National Institute for Clinical Excellence) guidelines state that there is no dose dependency within the therapeutic range of SSRIs, in the US guidelines from the American Psychiatric Association recommend slow titration up to the maximum tolerated dose. This new evidence suggests neither of these methods are correct.

“For the majority of patients receiving SSRIs a small increase in dose can be beneficial in terms of efficacy and overall acceptability. It is very interesting (and reassuring) that these results from clinical studies are in line with basic science investigations in psychopharmacology. Mental health research is pushing the boundaries of discovery science and where there’s clear evidence of potential benefits it’s important that this be reflected in the clinical guidelines used by thousands of people every day.”
Professor Andrea Cipriani, NIHR Research Professor

The systematic review and dose-response meta-analysis is based on the largest and most comprehensive dataset of double-blind, randomised controlled trials, published and unpublished. The study was carried out by an international team of experts led by the University of Oxford and was funded by the National Institute for Health Research in the UK, together with the Japan Society for the Promotion of Science and the Swiss National Science Foundation.