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Psychosis affects 3-4% of the UK population and is ranked as the third most disabling condition worldwide by the World Health Organisation. Research at the University of Glasgow has changed treatment and services for patients with psychosis by identifying therapies that improve emotional recovery and prevent psychosis relapse and by contributing to the development of early intervention services for individuals with a first episode of psychosis. This work has supported the inclusion of cognitive behaviour therapy (CBT) for psychosis in national clinical guidelines and the implementation of these guidelines via an expanded UK Department of Health programme. University of Glasgow research has also driven the development and expansion of local early intervention services for psychosis, the success of which has directly informed the current Scottish Government Mental Health Strategy.
Schizophrenia affects 1.1% of the adult population. It is one of the most debilitating of the psychiatric disorders, leading to costs of approximately £12Bn/year in the UK. Historically one of the major gaps in service provision has been any approach to prevention, whether primary or secondary. University of Birmingham pioneered the concept and practice of early intervention in psychosis, which is a key feature and indication of schizophrenia. This has gone on to have national and international impact on mental health care. This approach has been recommended in NICE Guidance, the Mental Health Strategy and is a requirement of the NHS Operating Framework for 2011/12. It has resulted in improved outcomes. Evaluation of this approach has found that is preferred by clients, reduces the suicide rate, reduces lost productivity due to illness and over three years the long term benefit of early intervention is between £17,427 and £36,632 per patient compared to standard care. In addition the success of early intervention in schizophrenia has impacted on wider mental health policy and practice, resulting in the development of similar approaches in other areas of mental health.
Studies conducted at Imperial College, over the last 20 years, have improved the rational, evidence-based treatment of schizophrenia. Our research has covered symptomatology, neurocognitive function, medication side effects, and comorbid substance use, and involved clinical trials of pharmacological and psychosocial treatments. We lead national quality improvement programmes supporting the implementation of psychopharmacological practice standards. Our work has impacted upon the understanding, clinical assessment and treatment of this condition in both first-episode patients and established schizophrenia, and has improved prescribing practice and the identification and assessment of side-effects.
Psychosis is a serious mental illness for which treatment can be aided by psychological therapies. Researchers at King's College London (KCL) demonstrated that family environment is key to recovery and developed and validated a family intervention for psychosis. Family intervention for psychosis is a recommended treatment in NICE guidelines (2009), as well as by the Patient Outcomes Research Team in the USA. The NICE guideline committee was chaired and advised by KCL researchers. Family intervention for psychosis is part of training programs for clinical staff and has changed NHS practice. The KCL-led website mentalhealthcare.org.uk disseminates this research to families of those with psychosis.
King's College London (KCL) researchers developed cognitive behaviour therapy for psychosis (CBTp), which is now a National Institute for Health and Care Excellence-recommended psychological intervention. CBTp is now part of routine NHS treatment and an estimated 25,000 patients in England and Wales receive it annually. Implementation of CBTp has been steered by KCL researchers' involvement with the Government's Increasing Access to Psychological Therapies — Severe Mental Illness initiative. The KCL model for CBTp has been used to develop clinics in Australia and the US and information on this therapy is disseminated via a KCL-led website.
Depression is a major public health problem producing substantial decrements in health and well-being, with 15% lifetime prevalence, affecting 350 million people worldwide. The Mood Disorders Centre (MDC) has improved treatment for depression by (i) understanding psychological mechanisms underpinning depression; (ii) translating this into innovative treatments and prevention interventions, evaluated in clinical trials; (iii) improving dissemination, delivery, and access to treatments. This research has improved patient care and quality of life, influenced national policy (NICE Depression Guidelines), informed national service and training provision (Improving Access to Psychological Therapies IAPT programme, with 680,000 people completing treatment 2008-2011) and achieved international impact on clinical practice.
Research at King's College London (KCL) showed that use of cannabis, especially high potency types such as `Skunk', increases the risk of psychosis. The work has demonstrated that adolescents who start early and carry some genetic vulnerability are at highest risk and that experimental cannabis administration alters brain function and induces transient psychosis. KCL research has led to increased public awareness of the adverse effects of cannabis use on mental health, in the UK and abroad, and sparked a public debate in the UK on the legal status of the drug ending with the Government reclassifying cannabis from Category C to Category B. KCL research on brain function has facilitated a collaboration with industry to develop new psychiatric medication.
People who develop psychosis (1% of population) typically experience lengthy delays (months to years) before treatment. Researchers at the University of Manchester (UoM) established a concrete and significant association between delay in treatment of the first episode of psychosis and outcome. We demonstrated that outcome of psychosis could be improved considerably if these lengthy delays were reduced. This research influenced policy and practice in the UK and abroad. Policy changes included the establishment of early psychosis teams dedicated to early detection and treatment (50 in England alone). Practice changes included amendments to clinical guidelines in the UK and abroad that now require clinicians to respond urgently to a first episode of psychosis. These changes to clinical practice have increased the proportion of patients with a short DUP from 55.6 to 77.4%.
Bulimic eating disorders are disabling conditions affecting approximately 5% of the population. Effective specialist treatment exists in the form of cognitive behavioural therapy (CBT), but only a minority of patients access this. Researchers at King's College London developed book-, CD-ROM-and web-based CBT self-care interventions for bulimic disorders that provide early effective treatment with outcomes comparable to costly specialist CBT. Locally, at the South London and Maudsley NHS Foundation Trust Eating Disorders Service, this has significantly reduced waiting lists. The research has had national and international impact with UK, German and US guidelines endorsing guided self-care as a first treatment step for bulimic disorders and the KCL manual and website are internationally recommended.
King's College London researchers have had a major widespread impact on medical care for people with dementia. They have demonstrated the limited benefit and considerable harm done by the use of antipsychotics in dementia patients. Their follow-on campaigning and policy work brought this major health issue to the forefront of the political agenda and led them to work with the Department of Health to create a best practice guide, now widely used nationally and internationally. In addition, they have worked with the BMJ to develop an e- learning package for General Practitioners. The combined impact of this work has made a major contribution to a 60% reduction in the use of antipsychotic drugs in people with dementia in the UK and major changes in practice internationally, preventing 1000's of unnecessary deaths.