PSYSCAN - Newsletter July 2017


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2nd Newsletter (July, 2017) Browser version | Unsubscribe

Introduction by Prof. Celso Arango

A Progress Report

Publications

PSYSCAN in short: WP3 & WP6

Interview with a PSYSCAN Principal Investigator

The team

PSYSCAN forthcoming meetings

PSYSCAN contact

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Introduction
by Prof. Celso Arango


Prof. Celso Arango

Welcome to the second PSYSCAN Newsletter!

It’s incredible how much progress we have made since our previous newsletter. Fourteen sites are now recruiting and 90 patients have already been enrolled in PSYSCAN. The work of this consortium led by Prof McGuire is fast-paced, as teleconferences, e-mails, training and various dissemination activities are happening constantly. The research project has created a great deal of expectation and, as it has been presented at some of the best international scientific forums, many clinicians are eager to learn the initial results. The acronym PSYSCAN is becoming quite the topic at psychosis meetings!

We can feel confident that in the coming years we will meet all our objectives, mainly the development of neuroimaging-based tools that will inform clinicians on the management of patients with psychotic disorders.

This newsletter will keep you up to date on our efforts and achievements. In this second newsletter, we have included a brief progress report regarding recruitment for first-episode-psychosis and ultra-high-risk cohorts. In addition, some publications related to the project are presented and the objectives of two work packages are described. As in our previous newsletter, we have included an interview with a PSYSCAN Principal Investigator, Dr Eric Chen, who tells us about his experience with UHR patients.

All the PSYSCAN researchers are working together to achieve the ambitious objectives that have been set. We hope that you will find this newsletter interesting. If you have areas of interest not covered here, feel free to contact us at: dissemination@psyscan.eu. A Twitter account has been created for PSYSCAN where interesting content related to the project is published regularly, so we invite you to follow us, We look forward to bringing you more news and interesting facts from this exciting FP7 project!

Yours sincerely,

Celso Arango

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A progress report-WP5

FEP Cohort

  • 97 patients have been included in the FEP cohort.
  • 14 of the 16 sites are open to recruitment.

UHR Cohort

  • 23 patients have been included in the UHR cohort.
  • 14 of the 16 sites are open to recruitment.

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Publications

Clinical utility of magnetic resonance imaging in first-episode psychosis.

Falkenberg I, Benetti S, Raffin M, Wuyts P, Pettersson-Yeo W, Dazzan P, Morgan KD, Murray RM, Reis Marques T, David AS, Jarosz J, Simmons A, Williams S, McGuire P.

The aims of this study were to assess the logistical feasibility of routine MRI and to define the clinical significance of radiological abnormalities in patients with FEP. Radiological reports from MRI scans of two FEP samples were reviewed; one comprised 108 patients and 98 healthy controls recruited to a research study and the other comprised 241 patients scanned at initial clinical presentation plus 66 healthy controls. Radiological abnormalities were reported in 6% of the research sample and in 15% of the clinical sample (odds ratio (OR) = 3.1, 95% CI 1.26-7.57, χ2(1) = 6.63, P = 0.01). None of the findings necessitated a change in clinical management. This study suggests that rates of neuroradiological abnormalities in FEP are likely to be underestimated in research samples that often exclude patients with organic abnormalities.



Br J Psychiatry. 2017 May 4. pii: bjp.bp.116.195834     DOI: 10.1192/bjp.bp.116.195834.

Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis.

Fusar-Poli P, Rutigliano G, Stahl D, Davies C, Bonoldi I, Reilly T, McGuire P.

91199 patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder were included in this clinical register-based cohort study. A practical web-based individualized risk calculator tool was developed using a prognostic risk stratification model based on preselected variables, including index diagnosis, age, sex, age by sex and race/ethnicity. The risk calculator was externally validated, showing good performance and potential clinical usefulness for the transdiagnostic prediction of psychosis in secondary mental health care. This tool may eventually facilitate the implementation of an individualized provision of preventive focused interventions and improve outcomes of first episode psychosis.



JAMA Psychiatry. 2017 May 1;74(5):493-500.     DOI: 10.1001/jamapsychiatry.2017.0284

Improved individualized prediction of schizophrenia in subjects at familial high risk, based on neuroanatomical data, schizotypal and neurocognitive features.

Zarogianni E, Storkey AJ, Johnstone EC, Owens DG, Lawrie SM.

The authors examined the predictive accuracy of support vector machine (SVM) in later diagnosing schizophrenia (SCZ), at a single-subject level, using a cohort of high risk (RH) individuals. Baseline structural MRI, schizotypal and neurocognitive data from 17 HR subjects, who subsequently developed SCZ and a matched group of 17 HR subjects who did not make the transition, yet had psychotic symptoms, were included in the analysis. Classification accuracy was 94% when a self-completed measure of schizotypy, a declarative memory test and structural MRI data were combined into a single learning algorithm; higher than when either quantitative measure was used alone. The discriminative neuroanatomical pattern involved gray matter volume differences in frontal, orbito-frontal and occipital lobe regions bilaterally as well as parts of the superior, medial temporal lobe and cerebellar regions. The findings suggest that an early SVM-based prediction of SCZ is possible and can be improved by combining schizotypal and neurocognitive features with neuroanatomical variables.




Schizophr Res. 2017 Mar;181:6-12.     DOI: 10.1016/j.schres.2016.08.027.

Diagnostic and prognostic significance of Brief Limited Intermittent Psychotic Symptoms (BLIPS) in individuals at Ultra High Risk.

Fusar-Poli P, Cappucciati M, De Micheli A, Rutiglano G, Bonoldi I, Tognin S, Ramella-Cravaro V, Castagnini A, McGuire P.

This study was designed to address the baseline diagnostic relationship between BLIPS and the ICD-10 categories and examine the longitudinal prognostic impact of clinical and sociodemographic factors. Eighty individuals who met BLIPS criteria were included. At baseline, two-thirds (68%) of BLIPS met the diagnostic criteria for ICD-10 Acute and Transient Psychotic Disorder (ATPD), most featuring schizophrenic symptoms. The remaining individuals met ICD-10 diagnostic criteria for unspecified nonorganic psychosis (15%), mental and behavioral disorders due to use of cannabinoids (11%), and mania with psychotic symptoms (6%). The overall 5-year risk of psychosis was 0.54. Recurrent episodes of BLIPS were relatively rare (11%) but associated with a higher risk of psychosis (hazard ratio [HR] 3.98) than mono-episodic BLIPS at the univariate analysis. Multivariate analysis revealed that seriously disorganizing or dangerous features increased greatly (HR = 4.39) the risk of psychosis (0.89 at 5-year). Bootstrapping confirmed the robustness of this predictor (area under the ROC = 0.74). The findings of this study indicate that BLIPS are most likely to fulfill the ATPD criteria (mainly acute schizophrenic subtypes) and about half of BLIPS cases develop a psychotic disorder during follow-up. Besides, recurrent BLIPS are relatively rare but tend to develop into psychosis and BLIPS with seriously disorganizing or dangerous features have an extreme high risk of psychosis.




Schizophr Bull. 2017 Jan;43(1):48-56     DOI: 10-1093/schbul/sbw151.

Sexual dysfunction and central obesity in patients with first episode psychosis.

Theleritis C, Bonaccorso S, Habib N, Stahl D, Gaughran F, Vitoratou S, Atakan Z, Kolliakou A, Gardner SP, Dazzan P, Marques TR, McGuire P, Greenwood K, Breedvelt J, Ferracuti S, Di Forti M, Murray RM, Smith S.

The aim of this study was to investigate the association between sexual dysfunction and obesity in a cohort of patients with first episode psychosis. Sexual function was assessed in a cohort of patients with first episode psychosis using the Sexual Function Questionnaire (SFQ). Anthropometric measures, including weight, BMI, waist, waist-hip ratio were investigated. Additionally, leptin and testosterone were investigated in male patients. A total of 116 patients (61 males and 55 females) were included. Of these 59% of males and 67.3% of females showed sexual dysfunction (SD) according to the SFQ. In males, higher SFQ scores were significantly correlated with higher BMI (Std. β=0.36, P=0.01), higher leptin levels (Std. β=0.34, P=0.02), higher waist-hip ratio (Std. β=0.32, P=0.04) and lower testosterone levels (Std. β=-0.44, P=0.002). In contrast, in females, SFQ scores were not associated with any of these factors. While sexual dysfunction is present in both female and male patients with their first episode of psychosis, only in males is sexual dysfunction associated with increased BMI and waist-hip ratio. The association between SD, BMI, low levels of testosterone and high levels of leptin suggest that policies that lead to healthier diets and more active lifestyles can be beneficial at least, to male patients.




Eur Pychiatry. 2017 May;42:1-7.     DOI: 10.1016/j.eurpsy.2016.11.008.

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PSYSCAN in short: WP1 & WP3
Prof. Mc-Guire

Work Package 1: Project Management

WP1 is led by Prof. Mc Guire and its main objectives are to ensure the proper overall management of the project, relating to both scientific as well as administrative/legal/financial aspects.
More specifically, WP1 manages the PSYSCAN project according to approved plans, guidelines and agreements as set in the EC Grant Agreement. WP1’s responsibility is to ensure scientific dialogue and communication across the consortium, and efficient administration in accordance with EC guidelines and requirements, as well as timely reporting.

Work Package 3: Data Analysis Software

Work package 3 (WP3) is led by Prof. Michael Brammer and Prof. Edward Bullmore and its main objectives are:

  1. Develop new software tools for machine learning for probabilistic classification and prediction; and new tools for large-scale network analysis of structural and functional neuroimaging data.
  2. Embed specialised new network and classification tools in modular computational pipelines integrated with IXICO data management system and general image processing tools.
  3. Provide a more definitive evaluation of network models of psychosis by systematic examination of the large prior datasets available; focusing especially on the identification of network markers of progressive disorder.
  4. Assess the “added value” of network metrics, by comparison to regional imaging metrics and non-imaging measures, as classifiers and predictors of psychotic disorder using machine learning.
  5. Evaluate predictive utility of network measures on a single patient’s functional magnetic resonance imaging dataset, compared to appropriate reference distributions of network metrics, as predictors or diagnostics in the clinical management of individual patients.

Dr. M. Brammer & Prof. Edward Bullmore
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Interview with a PSYSCAN principal investigator

Prof. Chen portrait
We interview today Prof. Chen, principal investigator of the Hong Kong University Psychiatry Department. The group he leads will be recruiting Ultra High Risk (UHR) patients.

Prof Chen, how did you become interested in the field of UHR patients?

One of the ways of improving outcomes of FEP patients would be to detect the illness early. Identifying UHR patients and providing good interventions would contribute to reducing DUP and improving outcomes. Furthermore, understanding the pathological changes behind the development of UHR and transition to the psychotic state would allow development of preventive intervention possible in psychiatry.

What is your previous experience on the topic?

I have been involved in some of the local research work on UHR and have been the local PI for Neuro Pro Study, a multicenter study initiated by Orygen, to look at the potential protective effect of Omega-3. Furthermore I have also be one of the advisers to the development of ARMS service in Singapore.

How are you expecting to recruit a high number of UHR subjects? What would you recommend the rest of the groups?

In Hong Kong, there is a territory-wide, government-funded early intervention program called EASY for individuals with early psychosis covering the whole of HK with a population of approximately 7 million. Although EASY mainly focuses on patients presenting with first-episode psychosis, we also receive a proportion of referrals presenting with attenuated psychotic symptoms or clinical features fitting the criteria for ARMS. Alongside, potential ARMS referrals can also be obtained from various sources including child & adolescent psychiatric units, other psychiatric outpatient clinics, community referrals from schools and NGOs focusing on youth mental health service provision. Nonetheless, regular education sessions / talks introducing ARMS recruitment to potential referrers, information materials including pamphlets, inclusion criteria / referral guidelines etc. will also be delivered to enhance the awareness of recognizing potential ARMS cases and the referral pathways.

In your country, what kind of medical attention do these individuals receive and how would you improve it?

For the time being, we offer case-management, pharmacological treatment (non-antipsychotic treatment) and psychological interventions based on the clinical needs of individuals with ARMS who are followed up in EASY program (3-year service). Development of a more specific psychological interventions e.g. CBT for ARMS would be important to further improve the quality of the clinical service.

How have you organized the work with your team? Could you introduce some of your team members?

Our research team has focused on early psychosis research which is in close collaboration with the EASY service in both university-affiliated hospital as well as the clinical teams in other catchment areas of Hong Kong. Aside from Prof Chen, the core members of our research team also include Dr. Sherry Chan, Dr. WC Chang, Dr. Edwin Lee and Dr. Christy Hui.

Which are, in your opinion, the main clinical questions that still demand answer in UHR treatment and research?

Main clinical questions regarding ARMS research include the following:

  • How to enhance prediction of psychosis transition and outcome in ARMS individuals by incorporating biological measures including neuroimaging and blood markers
  • Which intervention / treatment modalities are effective in improving the clinical and functional outcomes of ARMS individuals, and hopefully reducing the risk of subsequent full-blown psychosis development
  • How to further refine the clinical criteria in defining “ARMS”
  • What are the factors that protect those ARMS individuals from developing psychosis, i.e., to identify resilience / protective factors for psychosis development in ARMS

Thank you very much for your help, Prof. Chen! We hope that your team will keep on contributing with the project as successfully as they have done so far.

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The team

FEP Cohort

MAP FEP COHORT

UHR Cohort

MAP UHR COHORT
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PSYSCAN Forthcoming meetings

the theam

EXECUTIVE BOARD AND GENERAL ASSEMBLY MEETING

Date:   2nd September 2017

Time:   EB meeting: 13.00-14.00
            GA meeting: 14.00 -16.00

Venue: Le Meridien Etoile 81 Boulevard Gouvion Saint-Cyr, 75017 Paris, France
             Lemeridien.com/etoile

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Contact details
Principal Investigator-Sponsor
Philip McGuire
Institute of Psychiatry, Psychology, and Neuroscience
King’s College, London
16 De Crespigny Park
London SE5 8AF
United Kingdom
Phone: +44 207 848 0355
Email: philip.mcguire@kcl.ac.uk
Research Programme Coordinator
Simone Reinders
Institute of Psychiatry, Psychology, and Neuroscience
King’s College, London
16 De Crespigny Park
London SE5 8AF
United Kingdom
Email: a.a.t.s.reinders@kcl.ac.uk
Project Finance and Legal Manager
Holly Elphinstone
Institute of Psychiatry, Psychology, and Neuroscience
King’s College, London
16 De Crespigny Park
London SE5 8AF
United Kingdom
Phone: +44 (0)207 848 0927
Email: holly.elphinstone@kcl.ac.uk
Project Manager FEP
Erika van Hell
Brain Center Rudolf Magnus
Department of Psychiatry, A01.126
University Medical Center Utrecht
PO Box 85500
3504 GA Utrecht
The Netherlands
Phone: +31 (0)88 7556369
Email: H.H.Vanhell-2@umcutrecht.nl
Project Manager UHR
Stefania Tognin
Institute of Psychiatry, Psychology, and Neuroscience
King’s College, London
16 De Crespigny Park
London SE5 8AF
United Kingdom
Email: stefania.tognin@kcl.ac.uk
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