Theme lead: Paul Harrison
Deputy theme lead: Elizabeth Tunbridge
► About the theme
Unfortunately, although we have some effective psychological and drug treatments for most mental disorders, many patients are left without a treatment that works for them, and even when the treatments work, side effects are common.
The lack of significant new treatments in recent years is disappointing, and the continuing burden of mental disorders in adults is unacceptable. Improvements in the understanding, prediction and treatment are an urgent priority. Our BRC Theme is tackling these issues, and helping to achieve transformational change, for the benefit of people with mental disorders, their families, and the public.
► What are our aims?
- To transform our approaches to adult psychiatric disorders, especially mood disorders and schizophrenia.
- Innovate new treatments and how to evaluate them.
► How are we achieving this?
- Implementing more rapid and evidence-based diagnosis. Our ‘digital phenotyping’ approach uses smartphones, apps, and other new technology to better measure and understand adult psychiatric disorders. This has the potential to make diagnoses more rapid, more accurate, and more meaningful.
- Ensuring better prediction of course and treatment response. These same technologies can help us better predict whether a person will get better or worse, and to predict which treatment will suit them best. We are working with mathematicians and other scientists to help us make the most of the data and gain new insights. Our experimental medicine studies are revealing biomarkers suggestive of response to specific drug therapies in depression. We are extending this potential to other disorders, and to psychological treatments.
- Enabling more effective and cost effective treatments. At the heart of our BRC is our work to identify new targets for treatments, and to inform the development and testing of new drugs aimed at these targets. We are doing this by combining the digital methods with other state-of-the-art approaches, and work both with healthy volunteers and carefully selected patient groups.
- Involving patients and public. We are mindful of the need to fully engage users and carers in this enterprise, and work actively with our colleagues in the PPI Theme to ensure we do this well, and do it thoroughly. We also appreciate that there are important ethical issues involved in this kind of research (for example, capture of sensitive information via smartphones) and so work closely with the Ethics Theme.
- Transforming the nature of psychiatry. Underlying this theme is our strong belief that psychiatry needs to take full advantage of new approaches and technologies, applied with the same methodological rigour and on the same scale, as is occurring in all other branches of medicine. This is essential if there is to be transformational change in our ability to identify new treatment targets, understand therapeutic mechanisms, and evaluate new interventions – and thereby ultimately revolutionise outcomes. Our theme, and our BRC as a whole, is intended to be a flagship for this contemporary vision of psychiatry.
► What activities does the theme support?
- We fund staff (e.g. project manager, lab manager, pharmacist) to support research in various ways (e.g., advise about experimental design; provide standard protocols, help with data analysis)
- We provide core facilities to make research easier or cheaper (e.g. sample collection, hormone assays)
- We fund staff to carry out research (e.g. research assistants, clinical academics)
- We provide pilot funding to help young researchers develop and test their research ideas
► An example study from the theme
‘Voltage-gated calcium channels’ (VGCCs) are important in the heart and blood vessels, and VGCC blocking drugs are widely used to treat high blood pressure. Now, various lines of evidence suggest that VGCCs are important in the brain too, and may play a role in several mental disorders. By the same token, VGCC blocking drugs might have an unappreciated role to play in their treatment.
We are investigating this question in several complementary ways. Firstly, we have carefully reviewed all the existing evidence to provide the strongest base on which to do further studies. Secondly, we are conducting an experimental study in which people receive a VGCC blocking drug, or a matched dummy pill, to see what effect it has on their mood, sleep, and memory, and are using two sorts of brain scan (MRI and MEG) to see how the drug affects the activity of the brain. Thirdly, using new molecular and genetic methods, we have found that VGCCs in the brain are surprisingly different from those in the heart. Exploring these differences further may tell us more about their involvement in mental disorders, but may also allow design of VGCC blocking drugs which are modified to be better suited for psychiatric indications. An introduction to this area can be found here.
For researchers interested in working within the Adult Mental Health theme, please contact Liliana.Capitao@psych.ox.ac.uk (project management/brain imaging) or Margarita.Chibolina@psych.ox.ac.uk (lab studies, biosamples).