Why is this research important?
Psychosis is a serious mental illness, which can have challenging, debilitating, life-long consequences for patients and relatives. For many people, conventional treatments are effective and can help them lead perfectly rewarding lives. For others, conventional treatments don’t help with their symptoms. The current dilemma is that there’s no accurate diagnostic test available. Clinicians are trying, and often failing, to treat the symptoms without having the diagnostic tools and techniques to identify and understand the underlying causes. It’s why today’s treatments are effective for most people but only for some symptoms, leaving many of the more distressing symptoms beyond reach and seriously affecting the quality of life of patients and their families, friends and carers.
However, breakthrough research has shown that around 9% of people who have experienced a first episode of psychosis have the same antibodies in their blood as people with encephalitis. Vitally, we know that patients with encephalitis often make a full recovery when given appropriate immunotherapy. The trials being conducted now are investigating the potential of these immunotherapies to treat previously untreatable symptoms of psychosis in patients who share these antibodies.
Research suggests that a small but significant number of people suffer from psychosis or schizophrenia due to anti-NMDA receptor antibodies. Discovering a successful treatment for this would constitute a dramatic breakthrough – bringing relief to thousands of people who might otherwise spend a lifetime under the care of the mental health services. The prospect of such a revolutionary breakthrough is incredibly exciting.”
Phil Blunden – Research Nurse on the CRF trial
What are we doing?
The resources and expertise of the Clinical Research Facility (CRF) have enabled trials, for the first time ever, of immunotherapy treatments on psychosis patients in a hospital setting. To this end, we’ve worked across disciplines to train our mental health clinicians in administering intravenous infusions and monitoring patients throughout each 4-day drug delivery phase. The CRF provides the training, facilities, people, expertise and environment to enable a trial of this sophistication to take place within Oxford Health.
Over the last 2 years, over 1000 people with acute psychosis have been tested for the presence of antibodies. By mid-2020 that number will have risen to 2,500. Everyone who has tested positive for antibodies has been offered the opportunity to take part in a clinical trial where the effectiveness of a new immunotherapy treatment is tested. Other investigations are also being conducted, some BRC funded, drawing on multidisciplinary expertise from across Oxford University and elsewhere.
What do we hope to achieve?
The discovery of antibodies common to both encephalitis patients and a number of people with psychosis is really important. It’s a discovery with the potential to deliver life-changing benefits for the small but significant group of psychosis patients who don’t respond to conventional treatments.
Today, we are successfully treating people with immunotherapy and we are confident that we have the team, expertise and scalable resources to expand and accelerate this success in the future.
Somehow I had fallen from an active 22 year old, working as a carer and studying chemistry at Oxford University, to a very strange place. But this was a fall I might never recover from. And what caused it? Well, in a way, it was me – my own body attacking my brain. We had no idea what had caused the episode. Not knowing was just as bad as the actual experience. One day there was a knock on the door. I was asked if I wanted to take part in a research trial. They weren’t looking to make any diagnosis, simply to compare their new test for these things called antibodies against the old one. It was a research trial that would literally save my life.
So what have I learned through receiving treatment? Patience springs to mind. This illness is a path less trodden at the moment but some research is making powerful steps to change this. I’m still fighting this disease but know my story will end well. It’s a hard road but at least I know which one I’m on! “
Sarah Galloway who has lived experience of psychosis and our antibody mediated trial
