Welcome to the Oxford Psychiatry Podcast series, I'm Charlotte Allen,
and today I'm here with Dr. Belinda Lennox, who's a senior lecturer in the Department of Psychiatry.
She's recently moved from Cambridge to Oxford and her work focuses on the causes and treatment of psychotic illness.
She's currently involved in a study of people with first episode psychosis.
Welcome, Belinda. Hi. Hi.
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?
Yeah, OK, so I'm a clinical academic, so I'm a consultant psychiatrist and I see young people with psychotic illnesses.
And then I also do research work in the same area. So I've actually trained in both areas sort of side by side.
And actually psychiatry has always fascinated me.
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,
interesting parts of medicine, and that psychiatry was the most fascinating bit of neuroscience.
Really dealing with behaviour and feelings and thoughts was much more interesting to me than muscles and, you know, twitches or whatever.
So say that you've confined clinical and academic training. How is that works for you?
Yeah, so for me, it's worked quite well.
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.
So I'm quite used to sort of juggling things and doing bits and pieces during the week.
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.
But I think having some sort of space in your week where you're doing using very different
skills and thinking about different problems actually helps both sides as well.
So for me, I think it's been an ideal combination.
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,
and you have to go and run clinics. But for my research, it's absolutely ideal.
And what inspired you to start off doing research? Because, as you say, it is quite difficult.
You've got to juggle all these different things and what actually has led you to do it and kept you doing it?
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
such a devastating impact on large numbers of people and that the only way to improve treatments and improve outcomes is to do research.
So it's absolutely critical that we worry about this,
these illnesses and try using all sorts of different approaches to try and understand more and develop better treatments.
So I suppose that's really what motivates me to do to do both things.
That sounds like a great motivator for keeping you going when life's quite busy.
Can you say a bit more about your current research and what you're doing? Yeah, so my research is all around early psychosis.
It's around people developing psychotic illnesses and trying to understand what's happening and what might be causing that.
So the particular area that I'm looking at at the moment is around immunology of
psychosis and particular groups of people that might have antibodies against brain
targets at the time that their psychosis starts and our growing understanding that
that in some people these antibodies might be causing this psychotic illness.
So therefore, by treating the antibodies, getting rid of them, we can also treat their psychosis.
So it's quite a different approach to understanding the evolution of psychosis and potentially sort of new treatments for for people.
It does sound like a very different model of the causes of psychosis.
How many people would have this different type of psychosis compared to the more usual causes?
Yeah, well, I mean, that's a good question.
So, I mean, sort of lines of evidence from the sort of epidemiology in particular show a strong association with other autoimmune disorders.
And, yes, saw some indications that there might be immunological causes to quite a percentage of people with psychosis.
But these particular antibodies we found in about six percent of people with psychosis in our relatively small cohort study.
So one thing we're doing at the moment is trying to increase the numbers,
actually replicate that cohort study on a larger scale to sort of refine actually what you know,
how many people would be affected, what is the prevalence of this disorder?
So it's probably something between about two percent and 15 percent of people with psychosis.
That's our best estimate at the moment. Okay, but with your clinical work, have you made any changes?
Your services to encourage more people to get involved in research. Yeah, that's that's a good question.
I mean, it's really sort of behind the reorganisation of our services at the moment, actually,
is to raise the profile of research so that everybody with the onset of a psychotic illness will have the
opportunity to be involved in the sort of cutting edge research and understanding the causes of this disorder.
So we're sort of aligning clinical and research work so that everybody's sort of exposed to that and gets gets an opportunity
to take part because everybody with the first episode of psychosis really should be screened for these antibodies,
in particular because they could have an effect on the treatment that people receive.
Yeah. So it sounds like the benefits go both ways, potentially.
If more people get involved in the research, it's good for your study and also helpful for patients as well.
Absolutely. And then we get a more representative idea of how many people are involved.
It's not just those who are particularly unwell or those that have sort of unusual symptoms.
It's actually a proportion of everybody that might be presenting to with these problems.
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?
Oh, well, yeah, there's lots of things that I want to do.
I suppose a particular area of development is actually broadening out the concept of of psychosis
because we've been quite narrow in our view up to now of of people with a constellation of symptoms,
a sort of a particular presentation. And so the establishment of early intervention in psychosis services, for instance,
were particularly looking at preventing schizophrenia, people with enduring long standing psychotic illnesses.
But it is our understanding now is it's much broader that actually people experience psychotic symptoms in a whole range of different ways.
I mean, I don't even want to call them disorders.
I mean, actually as a part of normal life, as a part of the sort of a response to difficult situations.
So actually, we've got to be much more flexible and open minded, really,
when people come to us with psychotic symptoms as to how we would both formulate them and
how we would then offer treatment in a much more personalised and individualised way.
So we're developing hopefully applying for funding and hopefully will be implementing
a new sort of youth wellbeing focussed service for people with psychotic symptoms.
So actually focussing on the difficulties that people present with rather than narrowly looking at symptoms that they describe.
I think that's very interesting. You've talked then a bit about your career in clinical work and in research.
Have you got any advice for anybody who's thinking about such a career? I would definitely recommend it.
It has always been exciting, stimulating and you know, I've never not wanted to come to work in the morning,
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.
I can be more flexible, but persistence and perseverance,
because you I'm always being told that my applications aren't good enough or that my papers are rejected.
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.
Yeah. In spite of negative feedback sometimes. Okay. Well that's hard.
Yes. If anybody wants to find out more about your research or get in contact with you, how could they do that?
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.
Maybe that'll be the best place to start. OK, great. Well, thank you very much.
That's been very helpful. Thanks.