Despite the ‘Beast from the East’ freezing the transport infrastructure of our sceptred isle, two hundred and eighty three intrepid psychiatrists, neurologists, psychologists, rehabilitation medics, elderly care physicians and assorted others gathered in March for the 31st Annual General Meeting of the British Neuropsychiatry Association (BNPA).
The first session focused on sleep – start as you mean to go on, one might think, but three exciting and dynamic speakers ensured that there was no excessive daytime somnolence in the Kings Place auditorium. Russell Foster opened proceedings with a masterful and comprehensive overview of the neurobiological mechanisms of sleep. This set the scene beautifully for Kirstie Anderson, who gave a clinical perspective; providing a wonderfully dynamic and practical approach to the diagnosis and management of sleep disorders. While pharmacotherapy has a significant and appropriate role in sleep medicine, there is an increasing emphasis on cognitive and behavioural approaches, which can be curative. This is especially true of insomnia, and the session concluded with Eus van Someren giving a truly fascinating talk on the cognitive science of this highly prevalent and economically costly disorder, with an occasional segue into the cringing social embarrassment of bad karaoke.
After some light refreshment, the audience returned for a special session on shell shock, as we approach the centenary of the end of World War I. Simon Wessely kicked off with an historical review worthy of BBC4, covering the birth of a new epidemic disorder, the fumblings towards a therapeutic response (which differed starkly between the officers and enlisted men) and the eventual official prohibition of the diagnosis. Through the use of powerful archive video and dissection of clinical criteria, Prof Wessely effectively persuaded us all that, despite the prevailing cultural representations, shell shock shared little with modern ideas of post-traumatic stress disorder (PTSD) and was instead rather like what we would now term functional neurological disorders. To emphasise the contrast between the disorders, Chris Brewin then gave an up-to-the-moment talk on the past, present and future of PTSD. The audience were confronted with the clinical heterogeneity of this disorder, which is reflected in divergent diagnostic criteria, presenting a significant challenge to any proposal for one-size-fits-all management.
A hearty lunch was accompanied by further viewings of archive shell shock footage on big screens, providing a unique window into the birth of divergent therapeutic strategies for functional neurological disorders. After this, the highlight that is the BNPA poster session walkaround attracted great interest. We had a wonderful array of thirty posters on display this year. The high quality resulted in a hard time for judges picking winners for the poster prize, but agreement was reached that the awards should go to Reza Kiani, Dept Health Sciences, University of Leicester “A study of autism and congenital blindness in adults with intellectual disability”, Nadja Bednarczuk, Imperial College London, “Hemispheric Dominance: the link between Anxiety and the Vestibular System?”, and Isobel A Williams, Dept of Psychology, University of Sheffield, “Reduced resting vagal tone in patients with Functional Neurological Disorder is associated with emotion dysregulation and psychopathology”.
This year’s JNNP guest speaker is the 26th most cited scientist of all time with 184,263 citations; h-index 202 – for reference Sigmund Freud is number 1 with 482,648 citations; h-index 272! An artificial intelligence known as Semantic Scholar named him as the most influential brain scientist of the modern era (sorry Sigmund). The central idea, set out with clarity and brilliance by Karl Friston, is that the brain acts as a predictive engine at every possible level. What we see and hear is not a representation of our sensory input, but rather an interpretation in the context of our previous experience, biases and beliefs. When these predictive mechanisms go wrong they can account for an extremely diverse range of conditions including schizophrenia, tinnitus, functional neurological disorder, and non-fluent aphasia.
After further refreshment, the winners of the Alwyn Lishman award gave the members’ platform presentations. Lorenzo Caciagli presented the results of his neuropsychometry and fMRI study of cognitive dysfunction in frontal lobe epilepsy. João Miguel Fernandes then presented a novel non-verbal measure of social cognitive deficits in autism. Unfortunately, Sharon Savage was unable to make it through the snow, so Adam Zeman presented in her place on long-term follow-up of memory symptoms in transient epileptic amnesia.
Rounding off the talks for the day was the now-customary BNPA research update, in which we bring the audience up to speed with an of-the-moment topic. Nothing has attracted as much recent attention as new genetic therapies for Huntington’s disease. David Craufurd clearly separated the hope from the hype and provided us all with a clear impression of the current state of treatment development. Non-invasive brain-state modulation with transcranial magnetic stimulation and transcranial direct current stimulation shows potential for translation from research tool to clinical practice in a number of domains. Camilla Nord conveyed the excitement and controversy of this emerging field with such dynamism and enthusiasm that she was almost immediately co-opted to the BNPA committee – we welcome her as the new junior representative for psychologists.
The BNPA evening reception in the postal museum had it all. Pizza, Royal Mail history, unlimited bar, cockney knees-up, chocolate brownies, new friends and good times. If you didn’t make it this year, then etch the date in your diary for next year and practice your singing in the shower.
Day two commenced with a double-session on social cognition. Antonia Hamilton began by describing her beautiful studies of social cognition, in which children with autism performed better at goal-directed tasks by efficiently ignoring irrelevant experimenter actions that were copied by typically developing children. Boyd Ghosh gave an overview of under-recognised social cognition deficits in dementia, with special reference to how we should modify our information giving strategy to patients and relatives in frontotemporal lobar disorders including progressive supranuclear palsy. With Robin Dunbar stuck in Welsh snow drifts, Jeremy Schmahmann kindly stepped in with a double-length, comprehensive and clear description of the role of the cerebellum in emotion and cognition. So seminal has been his contribution to this field, that cerebellar cognitive affective syndrome is now known by many as Schmahmann’s syndrome.
After lunch and posters, the BNPA medal was awarded to Michael Trimble, who gave a valedictory lecture on the brain basis of musical cognition and emotion, with special reference to the works of Elgar. As the culmination of the gathering, Iain McGilchrist delivered the special guest lecture on hemispheric specialisation in the brain. As thought provoking and inspiring as The Master and His Emissary, the audience were enraptured and, despite the implications of snow and ice for homewards travel, the lecture theatre remained full to the end.