27th Annual General Meeting of the British Neuropsychiatry Association

The 27^th BNPA meeting, at the UCL Institute of Child Health (ICH, founded 1946), Guilford Street, Bloomsbury, brought together neuropsychiatrists, neurologists and psychiatrists in the varied themes of social cognition and impulse control, the presymptomatic treatment of Alzheimer’s disease, innate autoimmunity in neurodegenerative disease and antibody-mediated CNS autoimmunity with neuropsychiatric symptoms.

The meeting opened with the theme of ‘new developments in cognition’. The first three speakers discussed social cognition. David Skuse (ICH) opened the meeting and showed how oxytocin and vasopressin affect the rewarding value of social interactions. He explained one of his intentions in his recent study of common oxytocin receptor polymorphisms and their influence on face recognition memory (in family members of people with autism)¹ had been to do the same for social cognition as the famous ICH growth charts had done for height. Roland Zahn (Institute of Psychiatry) described his work in mapping the neuroanatomical correlates of moral behaviour (defined in part as both social knowledge and the motivation to act upon this knowledge), for example the neural signatures of guilt².

Sarah-Jayne Blakemore (UCL) described the development and neuroanatomical correlates of ‘social scripts’ in healthy adolescence and their eventual automation, and the remarkable influence of peer-pressures on risk taking in adolescence³. Eileen Joyce (UCL) presented the evidence for a ‘limited general resource’ of cognition in the major neuropsychiatric condition schizophrenia⁴. The emerging and recurring theme of inflammation in neurodegenerative diseases (touched on by Nick Fox in the JNNP lecture and Catherine Slattery in a platform presentation) was introduced by James Nicoll (Southampton) who discussed the long term follow up data and far-reaching insights from the Aβ42 (Elan Pharmaceuticals) immunisation trial⁵.

The JNNP guest lecturer this year was Nick Fox (UCL) who presented the ‘plausibility and perils’ of the presymptomatic treatments for Alzheimer’s disease, and in the design of their treatment trials⁶. He presented evidence for the 10 years of atrophy before clinical presentation in most cases, accelerating atrophy, and the promise of novel imaging techniques, including Tau-PET imaging with ¹¹C-PBB3. This excellent lecture is available on-line courtesy of the JNNP: http://goo.gl/95sVXB.

The junior members’ platform presentations were of a high quality and covered an analysis of the innate immunity microglial-expressed gene TREM2 and its variants in Alzheimer’s Disease and other dementias (Catherine Slattery, UCL), a case control study of post-ictal psychosis (Georgy Pius, Salford), and the association between joint hypermobility, autonomic hyperactivity and neurodevelopmental disorders (JA Eccles, Brighton). In the research update, David Okai (Institute of Psychiatry and Oxford) reviewed Impulsive Compulsive Behaviours in Parkinson’s disease, and the evidence for cognitive behavioural therapy⁷. Hugh Rickards (Birmingham) presented a review and personal view on the efficacy of cholinesterase inhibitors in a range of neuropsychiatric disorders, highlighting the deficits in many of the trials and meta-analyses to date.

The neuropsychiatric manifestations of inflammatory brain diseases and encephalitis were the themes of the second day. Neil Scolding (Bristol) gave an overview on the approach to diagnosing inflammatory CNS diseases, focusing on CNS vasculitis (including amyloid related angiitis), CNS lupus, Behçet’s disease and neurosarcoidosis. He emphasised the importance of excluding mimics and retaining general medical knowledge relevant to recognising multi-system diseases, and the importance of neuropathology in making a diagnosis⁸. Jeremy Isaacs (National Hospital for Neurology and Neurosurgery), surveyed the field of ‘the old and the new’ paraneoplastic syndromes – including illustrative vignettes of CV2-antibody associated chorea and Ma₂ antibody associated hypersomnolence – and the role of PET imaging in looking for tumours. Tom Solomon (Liverpool) presented illustrative cases of CNS infections with psychiatric presentations: subacute sclerosing pan-encephalitis, HSV encephalitis (with NMDAR antibody mediated ‘relapses’, HIV dementia, TB meningitis and syphilis. In the BNPA Medal Lecture, Angela Vincent (Oxford) gave an update on the novel cell surface antibody CNS syndromes, introducing some novel antibodies, and how these syndromes have expanded to include those with psychiatric presentations, in particular the NMDAR encephalitis syndrome⁹.

A highlight of the meeting, in the final afternoon, was the Wellcome Trust Debate: ‘This house believes that neurology and psychiatry should be one medical discipline’. Chaired by Peter White (QMUL), the motion for was argued by Geraint Rees (@profgeraintrees, UCL) and Joel Winston (@Joel_Winston, UCL), and the motion against by Simon Wessely (@WesselyS, IOP) and Ben Robinson (@psych_trainees, Maudsley). In the final analysis, 68 members of the audience voted for the motion, 60 against, and 3 abstained. The debate and ensuing discussion were entertaining and provocative. Ideological and philosophical concerns were pitted against the pragmatics of professional organisation and service delivery, though all were agreed that cross-over training was a good thing for trainees in psychiatry and neurology and that the means should be available now for this to happen¹⁰. This was an enjoyable event, with a warm atmosphere and lots of discussion in the coffee breaks. Twenty four posters covered the above and other themes, including musical hallucinations and functional disorders. At the conference dinner at the Magic Circle, near Euston, we were treated to a tour of the museum by magician and pickpocket (‘Man of Steal’) James Freedman, who demonstrated the art of controlling and directing our attention. Podcasts from interviews with some of the speakers are continuing to appear on the JNNP website: feeds.bmj.com.

References

1. Skuse DH, Lori A, Cubells JF, Lee I, Conneely KN, Puura K, Lehtimaki T, Binder EB, Young LJ. Common polymorphism in the oxytocin receptor gene (OXTR) is associated with human social recognition skills. Proceedings of the National Academy of Sciences of the United States of America 2014;111(5):1987-1992.
2. Moll J, Zahn R, de Oliveira-Souza R, Krueger F, Grafman J. Opinion: the neural basis of human moral cognition. Nature reviews Neuroscience 2005;6(10):799-809.
3. Blakemore SJ, Robbins TW. Decision-making in the adolescent brain. Nature Neuroscience 2012;15(9):1184-1191.
4. Joyce EM. Cognitive function in schizophrenia: insights from intelligence research. The British journal of psychiatry : the journal of mental science 2013;203(3):161-162.
5. Boche D, Denham N, Holmes C, Nicoll JA. Neuropathology after active Abeta42 immunotherapy: implications for Alzheimer’s disease pathogenesis. Acta neuropathologica 2010;120(3):369-384.
6. Liang Y, Ryan NS, Schott JM, Fox NC. Imaging the onset and progression of Alzheimer’s disease: implications for prevention trials. Journal of Alzheimer’s disease : JAD 2013;33 Suppl 1:S305-312.
7. Okai D, Askey-Jones S, Samuel M, O’Sullivan SS, Chaudhuri KR, Martin A, Mack J, Brown RG, David AS. Trial of CBT for impulse control behaviors affecting Parkinson patients and their caregivers. Neurology 2013;80(9):792-799.
8. Gilkes CE, Love S, Hardie RJ, Edwards RJ, Scolding NJ, Rice CM. Brain biopsy in benign neurological disease. Journal of Neurology 2012;259(5):995-1000.
9. Coutinho E, Harrison P, Vincent A. Do neuronal autoantibodies cause psychosis? A neuroimmunological perspective. Biological Psychiatry 2014;75(4):269-275.
10. Zeman A. Neurology is psychiatry–and vice versa. Practical neurology 2014.