1 00:00:00,060 --> 00:00:03,390 Welcome to the Oxford Psychiatry Podcast series, I'm Charlotte Allen, 2 00:00:03,390 --> 00:00:08,760 and today I'm here with Dr. Belinda Lennox, who's a senior lecturer in the Department of Psychiatry. 3 00:00:08,760 --> 00:00:15,330 She's recently moved from Cambridge to Oxford and her work focuses on the causes and treatment of psychotic illness. 4 00:00:15,330 --> 00:00:19,620 She's currently involved in a study of people with first episode psychosis. 5 00:00:19,620 --> 00:00:22,230 Welcome, Belinda. Hi. Hi. 6 00:00:22,230 --> 00:00:30,060 Before we talk about your research, could you tell me a bit about your career so far and maybe why you chose to do psychiatry in the first place? 7 00:00:30,060 --> 00:00:38,220 Yeah, OK, so I'm a clinical academic, so I'm a consultant psychiatrist and I see young people with psychotic illnesses. 8 00:00:38,220 --> 00:00:46,260 And then I also do research work in the same area. So I've actually trained in both areas sort of side by side. 9 00:00:46,260 --> 00:00:48,900 And actually psychiatry has always fascinated me. 10 00:00:48,900 --> 00:00:56,430 And it was the reason I went to medical school was being interested in psychiatry just seemed to me that it was most interesting parts of the body, 11 00:00:56,430 --> 00:01:04,290 interesting parts of medicine, and that psychiatry was the most fascinating bit of neuroscience. 12 00:01:04,290 --> 00:01:14,600 Really dealing with behaviour and feelings and thoughts was much more interesting to me than muscles and, you know, twitches or whatever. 13 00:01:14,600 --> 00:01:20,940 So say that you've confined clinical and academic training. How is that works for you? 14 00:01:20,940 --> 00:01:23,790 Yeah, so for me, it's worked quite well. 15 00:01:23,790 --> 00:01:32,130 I worked part time for 10 years, so I was sort of part time, the same part time at home, part time tradition and part time academic. 16 00:01:32,130 --> 00:01:35,970 So I'm quite used to sort of juggling things and doing bits and pieces during the week. 17 00:01:35,970 --> 00:01:46,110 And for me that works really well. And I think that not only is essential to have the clinical bits and the research, but side by side. 18 00:01:46,110 --> 00:01:50,790 But I think having some sort of space in your week where you're doing using very different 19 00:01:50,790 --> 00:01:56,670 skills and thinking about different problems actually helps both sides as well. 20 00:01:56,670 --> 00:01:59,550 So for me, I think it's been an ideal combination. 21 00:01:59,550 --> 00:02:06,120 But I know for some people it can be a bit frustrating when you want to be in the lab with your petri dishes or whatever it might be, 22 00:02:06,120 --> 00:02:11,670 and you have to go and run clinics. But for my research, it's absolutely ideal. 23 00:02:11,670 --> 00:02:16,380 And what inspired you to start off doing research? Because, as you say, it is quite difficult. 24 00:02:16,380 --> 00:02:21,420 You've got to juggle all these different things and what actually has led you to do it and kept you doing it? 25 00:02:21,420 --> 00:02:30,630 Yeah, well, I suppose quite early on it's really a recognition of how limited we are in our understanding of these sort of major illnesses that have 26 00:02:30,630 --> 00:02:40,080 such a devastating impact on large numbers of people and that the only way to improve treatments and improve outcomes is to do research. 27 00:02:40,080 --> 00:02:44,910 So it's absolutely critical that we worry about this, 28 00:02:44,910 --> 00:02:50,610 these illnesses and try using all sorts of different approaches to try and understand more and develop better treatments. 29 00:02:50,610 --> 00:02:56,010 So I suppose that's really what motivates me to do to do both things. 30 00:02:56,010 --> 00:03:00,750 That sounds like a great motivator for keeping you going when life's quite busy. 31 00:03:00,750 --> 00:03:07,960 Can you say a bit more about your current research and what you're doing? Yeah, so my research is all around early psychosis. 32 00:03:07,960 --> 00:03:15,990 It's around people developing psychotic illnesses and trying to understand what's happening and what might be causing that. 33 00:03:15,990 --> 00:03:20,790 So the particular area that I'm looking at at the moment is around immunology of 34 00:03:20,790 --> 00:03:27,270 psychosis and particular groups of people that might have antibodies against brain 35 00:03:27,270 --> 00:03:32,880 targets at the time that their psychosis starts and our growing understanding that 36 00:03:32,880 --> 00:03:36,720 that in some people these antibodies might be causing this psychotic illness. 37 00:03:36,720 --> 00:03:42,510 So therefore, by treating the antibodies, getting rid of them, we can also treat their psychosis. 38 00:03:42,510 --> 00:03:52,350 So it's quite a different approach to understanding the evolution of psychosis and potentially sort of new treatments for for people. 39 00:03:52,350 --> 00:03:55,590 It does sound like a very different model of the causes of psychosis. 40 00:03:55,590 --> 00:04:01,650 How many people would have this different type of psychosis compared to the more usual causes? 41 00:04:01,650 --> 00:04:03,660 Yeah, well, I mean, that's a good question. 42 00:04:03,660 --> 00:04:15,810 So, I mean, sort of lines of evidence from the sort of epidemiology in particular show a strong association with other autoimmune disorders. 43 00:04:15,810 --> 00:04:25,110 And, yes, saw some indications that there might be immunological causes to quite a percentage of people with psychosis. 44 00:04:25,110 --> 00:04:33,060 But these particular antibodies we found in about six percent of people with psychosis in our relatively small cohort study. 45 00:04:33,060 --> 00:04:36,690 So one thing we're doing at the moment is trying to increase the numbers, 46 00:04:36,690 --> 00:04:43,020 actually replicate that cohort study on a larger scale to sort of refine actually what you know, 47 00:04:43,020 --> 00:04:47,160 how many people would be affected, what is the prevalence of this disorder? 48 00:04:47,160 --> 00:04:53,280 So it's probably something between about two percent and 15 percent of people with psychosis. 49 00:04:53,280 --> 00:05:00,100 That's our best estimate at the moment. Okay, but with your clinical work, have you made any changes? 50 00:05:00,100 --> 00:05:06,130 Your services to encourage more people to get involved in research. Yeah, that's that's a good question. 51 00:05:06,130 --> 00:05:12,040 I mean, it's really sort of behind the reorganisation of our services at the moment, actually, 52 00:05:12,040 --> 00:05:18,040 is to raise the profile of research so that everybody with the onset of a psychotic illness will have the 53 00:05:18,040 --> 00:05:25,570 opportunity to be involved in the sort of cutting edge research and understanding the causes of this disorder. 54 00:05:25,570 --> 00:05:35,350 So we're sort of aligning clinical and research work so that everybody's sort of exposed to that and gets gets an opportunity 55 00:05:35,350 --> 00:05:43,600 to take part because everybody with the first episode of psychosis really should be screened for these antibodies, 56 00:05:43,600 --> 00:05:48,260 in particular because they could have an effect on the treatment that people receive. 57 00:05:48,260 --> 00:05:51,250 Yeah. So it sounds like the benefits go both ways, potentially. 58 00:05:51,250 --> 00:05:56,710 If more people get involved in the research, it's good for your study and also helpful for patients as well. 59 00:05:56,710 --> 00:06:00,820 Absolutely. And then we get a more representative idea of how many people are involved. 60 00:06:00,820 --> 00:06:06,040 It's not just those who are particularly unwell or those that have sort of unusual symptoms. 61 00:06:06,040 --> 00:06:13,030 It's actually a proportion of everybody that might be presenting to with these problems. 62 00:06:13,030 --> 00:06:20,140 OK, have you got any ideas about what sort of research you're going to do in the future or why you take these early studies? 63 00:06:20,140 --> 00:06:24,540 Oh, well, yeah, there's lots of things that I want to do. 64 00:06:24,540 --> 00:06:31,480 I suppose a particular area of development is actually broadening out the concept of of psychosis 65 00:06:31,480 --> 00:06:40,210 because we've been quite narrow in our view up to now of of people with a constellation of symptoms, 66 00:06:40,210 --> 00:06:47,170 a sort of a particular presentation. And so the establishment of early intervention in psychosis services, for instance, 67 00:06:47,170 --> 00:06:55,030 were particularly looking at preventing schizophrenia, people with enduring long standing psychotic illnesses. 68 00:06:55,030 --> 00:07:03,100 But it is our understanding now is it's much broader that actually people experience psychotic symptoms in a whole range of different ways. 69 00:07:03,100 --> 00:07:04,630 I mean, I don't even want to call them disorders. 70 00:07:04,630 --> 00:07:10,630 I mean, actually as a part of normal life, as a part of the sort of a response to difficult situations. 71 00:07:10,630 --> 00:07:15,580 So actually, we've got to be much more flexible and open minded, really, 72 00:07:15,580 --> 00:07:21,220 when people come to us with psychotic symptoms as to how we would both formulate them and 73 00:07:21,220 --> 00:07:26,200 how we would then offer treatment in a much more personalised and individualised way. 74 00:07:26,200 --> 00:07:32,410 So we're developing hopefully applying for funding and hopefully will be implementing 75 00:07:32,410 --> 00:07:39,670 a new sort of youth wellbeing focussed service for people with psychotic symptoms. 76 00:07:39,670 --> 00:07:46,570 So actually focussing on the difficulties that people present with rather than narrowly looking at symptoms that they describe. 77 00:07:46,570 --> 00:07:54,760 I think that's very interesting. You've talked then a bit about your career in clinical work and in research. 78 00:07:54,760 --> 00:08:00,880 Have you got any advice for anybody who's thinking about such a career? I would definitely recommend it. 79 00:08:00,880 --> 00:08:09,010 It has always been exciting, stimulating and you know, I've never not wanted to come to work in the morning, 80 00:08:09,010 --> 00:08:21,040 which I think is something I think it works particularly well for women that want to combine research, work with doing other things in their lives. 81 00:08:21,040 --> 00:08:26,680 I can be more flexible, but persistence and perseverance, 82 00:08:26,680 --> 00:08:33,370 because you I'm always being told that my applications aren't good enough or that my papers are rejected. 83 00:08:33,370 --> 00:08:42,280 You've got to you've got to be quite robust. Yeah. You've got to see the sort of the overall purpose of what you're doing in spite of. 84 00:08:42,280 --> 00:08:46,130 Yeah. In spite of negative feedback sometimes. Okay. Well that's hard. 85 00:08:46,130 --> 00:08:53,500 Yes. If anybody wants to find out more about your research or get in contact with you, how could they do that? 86 00:08:53,500 --> 00:09:05,620 So I've got a Web page on PubMed psychiatry website that has my contact details and details of the work that I've done in more details. 87 00:09:05,620 --> 00:09:10,090 Maybe that'll be the best place to start. OK, great. Well, thank you very much. 88 00:09:10,090 --> 00:09:12,384 That's been very helpful. Thanks.