University of Cambridge scientists have welcomed the new psychiatry diagnostic manual that will have a strong impact on how autism is diagnosed. In a paper out this month they discuss not only the benefits but also the challenges faced in research by the new changes.

The new edition of the widely used manual in psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), will be published in May 2013. In the latest issue of the prestigious journal PLoS Biology, researchers at the Autism Research Centre, University of Cambridge comment on the changes and implications to autism, now defined using the umbrella term “Autism Spectrum Disorder” (ASD).

“Highlighting the dimensional nature of autism, and improving the organization of symptom descriptions, are excellent features of the new manual,” said Dr. Meng-Chuan Lai, lead author of the commentary. He added that this unitary diagnostic label, together with an individualized assessment of needs for support, an important new feature, will be potentially beneficial in securing required levels of support for individuals with a diagnosis of ASD.

Dr. Michael Lombardo, a co-author on the commentary, expressed the team’s reservations about the impact of such revision may have on autism research. “Autism is extremely heterogeneous and is expressed differently in different individuals. While going back to one omnibus label of ‘ASD’ is beneficial in many ways, it may not be the best prescription for how research into causal factors should proceed. Understanding the driving factors behind the massive heterogeneity in autism requires a way of thinking for future research that goes beyond just one omnibus label.”

Professor Simon Baron-Cohen, Director of the Autism Research Centre and another co-author, agreed: “To make progress in autism research, and ultimately to improve clinical practice, we need to move forward to the identification of subgroups within the autism spectrum.”

The authors argue that potential subgroups may be identified by a more extensive use of “specifiers”, such as different developmental patterns, different cognitive profiles, different genetic and environmental correlates, different co-occurring conditions, and even the differences arising from sex/gender. They suggest that all of these could aid subgrouping. They also argue that some clinical subgroups previously recognized, such as Asperger Syndrome, are still valuable categories that need further research.

Dr. Bhismadev Chakrabarti, the other author of this commentary underlined the key message: “In a world that is moving toward individualized treatment, the identification of specific subgroups is a vital step forwards.” 

 The authors were supported by the following funding agencies during the period of this work: the European Autism Interventions – A Multicentre Study for Developing New Medications (EU-AIMS consortium); the UK Medical Research Council; the Wellcome Trust; the Waterloo Foundation; the British Academy; the NIHR CLAHRC for Cambridgeshire and Peterborough NHS Foundation Trust; and the Autism Research Trust.

~Official Press Release~

A new science festival called ‘Pint of Science’ is set to hit Cambridge later this month.  It allows cutting-edge researchers to give public talks about their work in the relaxed setting of local pubs. Broad topics for discussion will include the brain, the body, and biotechnology. 

A number of researchers from the Department of Psychiatry will be participating in the ‘brain’ lecture series which will take place at The Portland Arms on Chesterton Road. Dr Karen Ersche will be speaking about her recent work which tries to understand why some people become addicted to drugs like cocaine while some do not. Other speakers will explore why some people with addictions relapse after receiving treatment, how effective psychiatric treatments are at present, and the portrayal of mental health stigma in hip-hop music.  

All Pint of Science events are free to attend but require online booking. Further details of talk dates and ticket reservations can be found here. The event is proudly associated with the Cambridge Science Festival.

Lindsay Chura has recently submitted her PhD and gives a summary of her findings and highlights below.

Lindsay Chura at the Cambridge Science Festival

Can you give us a short background into what you have been studying these last few years? 

I have been working on the importance of an area of the brain called the corpus callosum.

My PhD research investigated brain structure in both typically and atypically developing children.  Within the field of autism research, the corpus callosum has emerged as a brain region of interest in recent years. My research focused on this structure.  The corpus callosum is a part of the brain that links the brain’s ‘hemispheres’, or halves, together.

In the first year of my PhD, I extended the work of the Foetal Testosterone Longitudinal Study to investigate the effects of foetal testosterone (FT) on corpus callosum size and asymmetry in a cohort of 28 typically developing children whose exposure to FT had been previously measured before they were born via amniocentesis.  MRI brain scans revealed that although there was no relationship between foetal testosterone and overall corpus callosum size, increasing testosterone was linked to increasing asymmetry of the callosum.  This investigation was the first to examine whether foetal testosterone influences human corpus callosum development. These findings have implications for understanding the early organisational effects that this hormone has on foetal brain development.

My research moved to The Cambridge Family Study of Autism.  I investigated corpus callosum size in a large cohort (n=132) of male and female adolescents with ASC (n=52), their unaffected siblings (n=40), and unrelated typically developing controls (n=40).  The structural findings from my research indicated that larger differences exist between adolescents with autism in terms of callosum size than scientists thought.

What made you want to do a PhD?

The rigour inherent in the scientific method makes the PhD process both challenging and exhilarating.  I came to study at Cambridge by way of the United States and Australia where I led research studies in the fields of psychiatry and reproductive endocrinology.  Those experiences helped me to the understand the intricacies of experimental design.  Neuroscience is a rapidly changing field and being involved in an area of research as dynamic as autism is very exciting. 

What was the best day during your PhD? 

I believe that research is a reciprocal process. I organised a feedback celebration event last November for all of the families that participated in the Cambridge Family Study of Autism.  It was an opportunity to share findings from the study and to listen to their feedback.  Each child I met through my research opened my eyes to a different aspect of autism, and I have been humbled by the sincerity and perseverance with which they approach the hills and valleys of life.  The lessons I take away from this research go far beyond what can be contained in the pages of my dissertation.

What do you hope to do next?

My PhD training in psychiatry has helped me to see great truth in the old proverb “it takes a village to raise a child”.  Hand in hand with advancing the scientific understanding underlying the pathophysiology of neurodevelopmental and psychiatric disorders, there is a pressing need for increasing access to support services for affected individuals.  The potential for therapeutic interventions to make the greatest impact hinges on different segments of our society coming together – from the medical community to policymakers, parents and teachers – to work toward the common goal of supporting individuals with conditions such as autism.  

Autism Research Centre

Supervisors: Professor Simon Baron-Cohen and Dr. Michael Spencer

Funded by the Gates Cambridge Scholarship Trust

Studied at Trinity College, Cambridge

The 25th Cambridge Neuroscience Seminar was held on 26th March with a broad programme ensuring that the talks were of interest to members from across the neuroscience disciplines. The one day symposium, with the theme ’From Sensation to Action’, was hosted by the Department of Zoology. The organising teams from Zoology and Cambridge Neuroscience, including Dr Dervila Glynn, Professor Simon Laughlin, Dr Berthold Hedwig, Dr Matthias Landgraf and Dr Brian McCabe, provided a dynamic day of talks finishing with a celebratory dinner for all attendees at Downing College.

The first plenary lecture of the day was delivered by Prof Johan Bolhuis of Utrecht University, in association with the British Neuroscience Association. This lecture was dedicated to the memory of Professor Sir Gabriel Horn, in recognition of the late Cambridge zoologist’s vast contribution to neuroscience. The lecture was attended by Lady Horn and his daughter and was a particularly apt start to proceedings as Gabriel was a founding member of the Cambridge Neuroscience network, which now has over 730 members, many from Psychiatry. Professor Bolhuis’ lecture began with a touching dedication to his friend and former colleague, and described the influence that Gabriel had on his research, which focuses on birdsong and song learning. The audience were intrigued to hear that in terms of vocal learning, humans are actually more consistent with bird learning than with fellow primates.

Prof Johan Bolhuis

The mid morning session focused on sensory systems and was sponsored by Neusentis, a Pfizer research unit. These four talks covered a wide range of topics, touching on almost all the themes of neuroscience. Dr Bob Carlyon from the MRC Cognition and Brain Sciences Unit kicked off the session with an amazing demonstration of the problems with currently available cochlear implants, showing through a snippet of Ella Fitzgerald, the lack of pitch that people using these implants experience, followed by a discussion of his lab’s attempts to alleviate these issues. Professor Lorraine K Tyler, head of the Cambridge Centre for Aging and Neuroscience, then discussed the appropriateness of the classic models in explaining language functioning, after which Dr Berthold Hedwig (Zoology) moved to slightly smaller organisms, presenting findings on auditory systems in insects. Dr Mario De Bono (MRC Laboratory for Molecular Biology) closed this session, describing behaviour in worm colonies. The audience were intrigued to see videos of worms interacting and the effect of oxygen levels on socialising. After watching worms socialising, delegates attended lunch and a poster viewing session.

Professor Silvia Arber of the University of Basel and Friedrich Miescher Institute, started off the afternoon with a talk about the organisation and function of motor systems. Professor Arber’s talk discussed the importance of motor behaviour to the function of the nervous system, and recent progress in understanding the neural circuits that underpin motor behaviour, including the role of the spinal cord. This plenary lecture was then followed by two very different but vibrant talks from Cambridge Neuroscience young investigators. Zoologist Dr Jimena Berni continued the focus on motor systems with a tour of exploratory behaviour in drosophila larvae. This was followed by Dr Victoria Leong from the Centre for Neuroscience and Education who presented her research on children’s reading, and the role of rhythm in learning to read.

The final session was focused on development and regeneration in motor systems and included really interesting work from Dr Steve Edgley from the Department of Physiology, Development and Neuroscience and Professor Roger Barker from the John Van Geest Centre for Brain Repair. Dr Edgley presented the neural basis of controlling hand movements, the role of plasticity in these pathways, and the strategies to restore hand function after damage. Professor Barker presented findings from long term large scale studies of patients with Parkinson’s disease, describing the development of the condition, and crucially, the heterogeneity betweens patients. Presenting data from community based cohorts, Professor Barker hypothesised that there are two paths of PD progression and that stratifying patients in this way is important to assessing the outcomes of therapeutic trials including gene therapy and cell transplant. The Cambridge Neuroscience Public Lecture in association with the Cambridge Science Festival and the Medical Research Council was given by Professor José del R Millán who told the audience of the his work at the Centre for Neuroprosthetics at the Ecole Polytechnique de Lausanne. Professor Millian’s engaging talk focused on efficient brain-machine interaction and the implications for humanity of brain-controlled robotics. This memorable talk provided a great and accessible way of closing the focus on motor systems at the conference.

The next Cambridge Neuroscience event will be in September (16th-17th), with speakers including Professor Ed Bullmore.

A senior research associate from the department has won a top award.
 
The Mental Health Research Network (MHRN) has presented its 2013 Associate Award to Dr Emilio Fernandez. Emilio is the Clozapine Clinic Lead and the Good Outcome Schizophrenia Clinic lead for the local MH Trust (Cambridgeshire and Peterborough NHS Foundation Trust).
 
MHRN supports research studies carried out in England with the help of people who use, and work within, NHS services.
 
Dr Fernandez said: “I am delighted to have been given this award. To have been nominated and awarded was a very nice surprise.
 
“I would like to thank everyone at MHRN for this fantastic honour. This isn’t just for me though, I would like to share it with all my colleagues for all their wonderful work and their incredible support.”
 
The Clozapine clinics monitor and assess people with schizophrenia who are taking the medication, clozapine, to treat their condition. Clozapine has been shown to be successful in the treatment of psychosis in some patients, but all those taking it require regular monitoring.
 
The medical teams at the clinics are involved in research locally and with other centres across the UK.
 
Dr Fernandez added: “This award will inspire us to continue our work looking at the treatment of people with schizophrenia and the effects of clozapine.
 
“I am proud of the service we provide and the research which has been done so far, and we will continue look for ways to improve patient safety and care.”
 
Dr Fernandez was also the winner of the Research, Innovation and Education Award in the recent CPFT Staff Awards. A short video explains this award.
 
For more information on CPFT’s Clozapine Clinics click here. 

Adapted from a piece by CPFT, with thanks.

Why not use pills to get smarter? This was the topic of an extraordinarily engaging event entitled ‘Smart Pills, anyone?’ that took place at the Cambridge Science Festival 2013. Fully booked and attended by more than 150 people,  ‘Smart Pills, anyone?’ was chaired by Alok Jha (science correspondent at The Guardian) and included presentations by a panel composed of Prof Barbara Sahakian, 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  students from local schools.

The event started with a role-play by the Naked Scientists. Hannah Critchlow and Sarah Castor Perry theatrically jumped straight into the play, with the backdrop of bemused-looking scientists and students on the panel. The session was opened in a rather unexpected way  with Hannah and Sarah adopting roles of advertisers commissioned to set up a global marketing strategy for cognition enhancing ‘smart pills’. Describing the pros and cons of this strategy, they discussed the main medical and ethical issues about using ‘smarts pills’ over the counter: is enhancing your performance during exams ethical while other students do not? Should these pills be restricted to selected groups of patients (those with cognitive problems) or professionals (surgeons, pilots)? What about the short, and long term safety issues? And, if it works, when would you stop using it? Could they become addictive?

Ben Johnston from the Bristol based Graphic Science, presented the Wellcome Trust-funded ‘Smarter UK’, a project for discussing the use of these drugs among college students. So far, more than 12,000 college students have attended their workshops all over the country. He stressed the importance of engaging in discussion at schools and the positive outcomes of these sessions.

Prof Sahakian delighted the audience with the science behind smart pills. Prof. Sahakian is a world expert on studying the effects of these pills in human cognition and the ethical dilemmas involved. Her talk cited the astonishing figure that 90% of modafinil, one of the most successful ‘smarts pills’, is sold off-label. Evidence for the efficacy of these pills on working memory tasks (those brain actions involved in the intellectual performance) were presented, but also the physical and psychological risks and the ethical dilemmas, as she has also extensively discussed in her two books. Prof Sahakian’s book,  ‘Bad Moves’, is out in April. 

Limelight was on the local GSCE/’A’ levels students: Natasha, Jon, James and Kalpesh, from the Nene Park Academy (Peterborough); Jessica, Bethany, James, Julia, from the Manor School (Arbury, Cambridge) and Hugo, James, Jimmy and Alex from the Simon Balle School (Hertfordshire). These students passionately defended the use, the caution stand-by and the totally against attitude, respectively, towards the use of the smart pills. The debate was engaging and posed several unsolved questions: what is the difference between these drugs and ‘common’ enhancers such as caffeine? What is the risk for the developing brain? And what about the cost? Would they

Microsoft Images

only be affordable to some people and therefore increase the social gap and lead to an unfair society? Of course, Cambridge students claimed that more research is needed. The debate concluded with the question of fairness again: These drugs are designed for people 

The audience’s perceptions about the Smart Drugs were asked before and after the event. Answering the questions with a hand held device, about 40% would use smart pills if they were safe, whereas a consistent third of the audience would never use them. The majority objected to their use by college students, as long-term side effects are still unknown. However, the great majority agreed that the use of these drugs would be the norm in the future, although it is unclear when.

Adapted from a piece written for the British Association of Psychopharmacology by Dr Emilio Fernandez-Egea with permission.

The Cambridge Science Festival 2013 hosted the public event ‘Focusing ADHD’ (Attention Deficit Hyperactivity Disorder) on 14th March 2013. Panel members included Dr Sam Chamberlain, Senior Clinical Research Fellow at Department of Psychiatry and Dr Ulrich Muller.

‘Focusing ADHD’ took place at the Babbage Lecture Theatre and attracted approximately 400 people. Keypads were provided to the audience for a set of interactive questions during the event. Just over a third of the audience had been diagnosed with ADHD or had a relative or friend who had been diagnosed with ADHD.

In his introduction, Professor Trevor Robbins emphasized the different levels of understanding ADHD. He defined these levels as follows: the psychiatric level including the diagnosis and phenomenological aspects of the ADHD, the psychological level incorporating behavioural traits, the brain level in relation to changes in neurons and neural connections, and finally the genetic level regarding heritability and genetic variations making people vulnerable to ADHD. Professor Robbins explained that brain research spanning these levels is crucial for understanding the mechanisms underlying ADHD and its effective treatment.

In his talk on the historical background to ADHD, Dr Muller discussed clinical observations suggesting the existence of ADHD date from as early as the 18th century. He also mentioned that the drugs available for ADHD are among the oldest drugs in psychiatry and their safety profiles are well known.  Dr Muller reviewed cross-cultural epidemiological research showing that the prevalence of ADHD in children and adults are quite similar across countries all over the world. He emphasized that consequences of untreated ADHD can be severe, including a higher rate of co-morbid psychiatric conditions, increased risk for drug abuse and criminality.  As an expert on psychopharmacology, he explained the mechanisms of medication on brain structure and showed how these effects can be observed as changes in brain functioning measured by functional and pharmacological neuroimaging.

Dr Sam Chamberlain covered research on the cognitive impairments of ADHD and how these relate to everyday functioning. Regarding the big controversies covering ADHD treatment, he made practical and clear comments on the benefits and side effects of currently available treatments for ADHD. Firstly, he referred to the NICE  Guidelines which suggest psychosocial interventions, namely cognitive behavioural therapy and group based interventions for mild to moderate cases of ADHD in children. He also emphasised the importance of  ‘choice of treatment’ for adult patients. He clearly showed that the level of evidence for the efficacy of methylphenidate treatment is robust and meta-analysis of randomised controlled trials also exhibited a clear benefit of this group of drugs. Dr Chamberlain also illustrated recent findings on the comparing the effect sizes of drug treatments in psychiatric and other medical conditions. Perhaps surprisingly, stimulant drug medication had an effect size comparable to that of many other medical treatments for distinct diseases or disorders. 

The last panel speaker was Mr Terry Laverty who was himself diagnosed with ADHD at the age of 33. Mr Laverty related his personal story and how he had used his experience in the support group ADDapt Ability. Terry shared moving stories from childhood, including bullying through his primary school and teenage years. He had suffered from depressive mood and at the time neither he nor his psychiatric team realised the link between his emotional problems and ADHD symptoms.  During his degree, Terry found himself enjoying surfing and eventually became a surf instructor.  Through ADDapt Ability Terry campaigns about under-diagnosis of ADHD. He said: “You can only be helped if you are bad enough, otherwise your problems are overlooked until you reach a stage of crisis”.

The event ended with a stimulating discussion between panel members and the audience, with the audience having had the opportunity to tweet in questions before the event.

Adapted from a piece written for the British Association for Psychopharmacology by Dr Muzaffer Kaser, Psychiatrist and PhD Candidate at Department of Psychiatry.

Both the Postgraduate Taught Experience Survey (PTES) 2013 and Postgraduate Research Experience Survey (PRES) will shortly be opened to our students to feed back about their experience on our postgraduate programmes. For the first time this year, the University will be running both surveys simultaneously.

• The PTES target list is drawn from all postgraduate certificates, diplomas, or Masters course with a taught element,  that is, MPhils examined by thesis and oral-only are excluded.
• Postgraduate students on a Research only programme will be eligible to take part in the PRES.

The surveys and students’ participation are really important to the University. PTES and PRES are the only national surveys to gather taught and research postgraduate students’ opinions about their experience at university. It lets us gather information systematically about students’ experience on their postgraduate course, compare our results against the national average, and help us start exploring where we might enhance their experience and the appeal of our courses in future. No league tables are produced; the ethos of the survey is very much about informing educational enhancement.

The results are only valuable if our students take part. PTES last ran at Cambridge in 2012, with a response rate of 48.2%; the 2011 PRES achieved a response rate of 53.9%.  With the help of Faculties and Departments we hope this year to improve on this and reach 50% for PTES and 60% for PRES.  Please can we ask you to make your students aware of the survey and why completing the survey is important.

Both surveys will open on 4^th March and will run until 16^th May. They shouldn’t take more than 15 minutes to complete. All eligible students will receive an email early next week asking them to complete the relevant survey, and containing their own username and password to gain access (as well as follow-up reminders throughout the survey period until they have completed it).

To find out more about PTES and PRES 2013, please visit http://www.heacademy.ac.uk/surveys, or contact Sophie Dubillot (sophie.dubillot@admin.cam.ac.uk).

Researchers in the Department of Psychiatry have found that adult survivors of childhood brain tumours are at risk of developing apathy as a consequence of the surgical treatment they receive for their condition. Apathy is often described as a state of indifference where emotions like excitement or sadness are inhibited. This finding is a cause for concern as apathy often damages people’s ability to function in their everyday lives. The research was led by Dr Howard Ring and has recently been published in Neuro-Oncology.

The Marin Apathy Evaluation Scale was used to test 117 adults who were diagnosed with a posterior fossa brain tumour before the age of 5 years.  The posterior fossa is a region at the back of the brain involved in movement and co-ordination.  When a tumour grows in this area it can block spinal fluid from flowing correctly which causes pressure on the spinal column. Data from 60 of their siblings was also collected. 

A total of 35% of the brain tumour survivors met the threshold score for clinically significant apathy in comparison to 18% of their siblings. Female sex and having only a part of the tumour surgically removed were found to predict the likelihood of a person scoring highly on the apathy scale.

The presence of apathy was not correlated with the incidence of depression, which is surprising as these conditions are frequently found to co-occur.

Cliodhna Carroll, who was the research assistant on the study, commented that “these findings have implications in terms of the assessment, management and treatment of apathy in long-term survivors. Follow-up of these children should include screening for apathy with a view to early intervention and treatment. It may be helpful for parents of these children to recognise this as a potential side-effect of posterior brain tumours and their treatment.”

This research was funded by the Brain Tumor Foundation and Cambridgeshire and Peterborough NHS Foundation Trust through their flexibility and sustainability funding.

The Cambridge Science Festival is almost upon us! This year the festival runs between the 11th – 24th March and promises a fantastic array of invigorating events and talks open to the public.  

Focusing on ADHD (14th March)

Poor concentration, hyperactivity and impulsivity are common in people with ADHD. These symptoms may be distressing and cause difficulties in daily life, but what causes them? How can they best be treated? The 2013 Cambridge Science Festival will include a panel discussion around these issues, driven by the audience’s questions. The panel will include amongst others Professor Trevor Robbins CBE FRS, Dr Sam Chamberlain, and Dr Ulrich Muller.

 The event is organised by Dr Petra Vertes and will take place on the 14th March 2013 (5:30-7pm). It is free but requires booking. 

Any questions? If you’d like anything discussed, tweet before the event using the #csfadhd  hashtag.

Benedict Cumberbatch is Science Festival Guest Director

Actor Benedict Cumberbatch has been interviewed about his interactions with Prof Barbara Sahakian and his role in the Festival. Cumberbatch discusses his love of science with the Naked Scientists and how he ended up becoming guest director of the 2013 event. You can listen to this here.

To discuss your thoughts on Benedict’s interview, use the #csf2013 on Twitter.