The 36th Annual Conference of the British Neuropsychiatry Association took place on March 2nd and 3rd 2023. It was a pleasure to return to the Royal College of Physicians of London on Regent’s Park for the second year running, where we were joined by over 150 psychiatrists, neurologists, psychologists and others with an interest in the interaction between brain and mind, as well as many more virtual delegates from across the globe. A wide range of national and international speakers over two days explored a huge range of topics relating to the meeting’s overarching theme of “Our Perception of the World and its Effect on Health”, accompanied by a fantastic range of poster presentations and lively in person discussion and networking.
The first session focused on neurodegenerative disease, covering the spectrum from diagnosis and new individual drug treatments to prevention and understanding quality of life. Our first speaker was Professor Peter Garrard of St. George’s University of London, who spoke on the utility of “Language as a biomarker in dementia”. He reviewed the concept that neurodegenerative dementias may have a presymptomatic signature in spontaneous speech, including some famous examples such as the novelist Iris Murdoch and Ronald Reagan, and that this may hold diagnostic potential. The specific case of the neurodegenerative syndromes which selectively impair language was then discussed, before introducing the new “mini linguistic state examination”, a novel bedside linguistic exam which can effectively subclassify variants of primary progressive aphasia. Next, Professor Robert Howard of UCL delivered the BNPA medal lecture entitled “Should we be preparing to give new dementia treatments to our patients?”, covering the long history of attempted drug development for Alzheimer’s disease since the approval of cholinesterase inhibitors almost twenty years ago, before focusing on the newly approved amyloid antibodies. This talk covered the trial evidence for efficacy of these treatments, which suggests that the benefit is less than the generally accepted minimally clinically important difference, as well as highlighting the need for specifically designed trials to assess claims of disease modification. Dr. Naaheed Mukadam of UCL then took us from treatment to prevention, posing the question “Can we prevent dementia?”. Taking a global perspective, she reviewed the evidence for modifiable risk factors for dementia throughout the lifecourse and discussed estimates of the total burden of preventable disease, before reviewing the more mixed evidence for specific interventions. Finally, Professor Linda Clare of the University of Exeter concluded the session with a talk on “Understanding quality of life in mild to moderate dementia and what we can do to maintain or enhance it.” This talk covered the evidence from the IDEAL study, a large cohort study assessing over 1500 patients with mild to moderate dementia. This has provided a wealth of insight into factors which predict quality of life in dementia, and particularly relevant to the theme of the meeting was the finding that when modelled together, of the multiple domains associated with quality of life the psychological domain dominates, suggesting that other domains influence quality of life through their effect on psychological well being. These insights have led to useful interventions for promoting quality of life in dementia, including the IDEAL “living with dementia map” and toolkit.
Following refreshments we reconvened for the member’s platform presentation; three talks from this year’s Alwyn Lishman prize winners. Peter Dudley and Jan-Paul Marquez presented their work on “Functional seizures and their misdiagnosis and mimics: A review of video-telemetry referrals and case outcomes in a tertiary epilepsy centre”, a large case series of referrals for video telemetry EEG with the thought provoking result that 5% of patient with an initial diagnosis of functional seizures were reclassified as epileptic after monitoring. Nathan Pevy presented his work on “Predicting the cause of transient loss of consciousness using an automated analysis of interactions with a virtual agent”, showing how an automated analysis of descriptions of TLOC can improve diagnostic accuracy. Finally, Verónica Cabreira talked on the “Development of a screening checklist to diagnose functional memory symptoms: a Delphi study”, introducing a novel 11 point clinical tool for the assessment of patients with potential functional cognitive disorder.
The afternoon session, on the theme “How do we see the world around us; autism, frontotemporal dementia, functional neurological disorder and the effect of perception”, was varied and fascinating. It began with two case presentations from Dr. Kit Stone and Dr. Chris Kipps illustrating the complex interactions between autism, functional neurological disorders (FND) and frontotemporal dementia and how these can present very differently across the lifespan, and giving some clinical context for the subsequent talks. First was the JNNP lecture by Professor Sue Fletcher-Watson of the University of Edinburgh on “Autism and Neurodiversity: a new paradigm”. This was a powerful and incisive talk, contrasting “core deficit” models of autism with a neurodiversity paradigm. She presented data showing (amongst other findings) how the classic social and communication “deficits” associated with autism are far more context dependent than usually understood, and disappear when individuals with autism interact with one another, before building on this data and the work of neurodivergent scholars to address some of the myths around neurodiversity and explore how a neurodiversity paradigm can improve support and services. Richard Cole then discussed the current evidence of links between autistic traits and functional neurological disorders, exploring similarities in neural network alteration, shared constructs such as alexithymia, changes in interoception and sensory over-responsivity, and common predisposing and perpetuating factors, followed by Tim Nicholson’s overview of sensorimotor features in autism, reviewing both the core features and evidence for a broader range of sensorimotor features beyond these, before discussing potential mechanisms (including analogies with those in functional neurological disorders) and therapeutic implications. Finally, it was a privilege to hear Professor John Hodges, recipient of the BNPA Lifetime Achievement award, speak on the links between frontotemporal dementia (FTD) and autism spectrum disorders (ASD). His wide ranging talk covered the history of research into FTD and how differences in social cognition in FTD overlap considerably with those seen in autism, before introducing the idea of the “phenocopy” syndrome of those with FTD like changes in cognition which do not progress over many years, and how this might represent the effects of environmental or social change on an ASD-like phenotype as well as shared genetic risk factors between FTD and ASD. The session concluded with a lively and engaging panel discussion, continued during the evening’s entertainment at the Magic Circle.
The first session of day two had a variety of talks exploring how our preconceptions, perceptions and beliefs shape how we process information and how these processes can go wrong, or conversely be used therapeutically. Professor Sander van der Linden of the University of Cambridge started with a fascinating and topical talk on “Psychological inoculation against misinformation”. If we consider that misinformation can spread between individuals in a manner reminiscent of viral contagion, and once spread it is difficult to correct, then the possibility of a “vaccination” to combat misinformation is a logical next step. Professor Van der Linden took us through a variety of lab and field based experiments showing that such “pre bunking” – exposing people to weakened doses of misinformation in a controlled manner – can strengthen resistance to subsequent misinformation and took us through some of the real world implications of this. Dr. Devin Terhune and Professor Mark Edwards of King’s College London then gave a joint talk on “Placebo, suggestion and FND – interactions and clues to pathophysiology”. Building very nicely on some of the talks from the previous day, they showed us how abnormal beliefs and attention conceptually function as key processes in FND, placebo and nocebo effects, and suggestion effects such as hypnosis. They discussed the mechanisms of these three entities, and explored the degree to which suggestion and placebo might be used as models for FND as well as touching on the long history of the clinical use of placebo and suggestion effects in functional disorders. Next, Dr. Johannes Jungillingens of the University Hospital Knappschaftkrankenhaus unified many of the concepts from the preceding talks with a bravura talk on “A new science of emotion: Implications for functional neurological disorder”. Within the framework of constructed emotion theory he built a model of the pathophysiology of functional neurological disorder linking predictive processing with energy dysregulation, miscategorisation of emotions and how life experiences and alexithymia can link to this framework. Finally, Dr. Matthew Burke joined us remotely from Toronto for a talk on “Our evolving understanding of placebo effects: implications for research and practice in neuropsychiatry”, showing how placebo effects are no longer a poorly understood entity but rather a biologically based phenomenon which can modulate and interact with neuropsychiatric disorders and highlighting the fundamental implications of this on the design and conduct of research studies in neuropsychiatry and medicine more broadly.
The final session of the conference was a joint one with the American Neuropsychiatric Association, on “Neuropsychiatry in Extreme Situations”. Dr. Dorothy Wade explored this theme in the context of the intensive care unit (ICU) with a talk entitled “The Psychological Scars of Intensive Care”. Survival from critical illness is often linked with adverse psychological and neuropsychiatric outcomes, and Dr. Wade gave an overview of current research into how psychological and practical interventions can ameliorate this. Dr. Peter Hughes then spoke on the role of “Psychiatry in Humanitarian Emergencies”, drawing on his great experience in the delivery of psychiatric care across the globe (most recently in Afghanistan) to discuss the principles of emergency response, building back services hereafter, and situating these principles in the background context of the global burden of mental ill health. Finally, we were very grateful to be able to welcome Dr. Charles Dukes of NASA, who gave a talk on “NASA’s Behavioural Health and Performance Services for Long Duration Space Missions”. This fascinating talk gave us insight into the unique physiological and psychological stressors associated with long-duration space travel, and how NASA’s Behavioural Health and Performance Service is embedded into the entire process from astronaut selection, training, support during missions and aftercare to aim to prevent and mitigate the risk of psychological and psychiatric comorbidity.
Other highlights included two datablitz sessions in the marvellous surroundings of the Dorchester library, with a wide variety of presentations of universally high quality. The prize winners were:
Ashwani Jha – How the emotions of others capture our attention: a human amygdala disruption study
Merritt Millman – Predisposing, precipitating and perpetuating factors in functional neurological disorder: a pilot study
Saurabh Sonkusare – Direct neural recordings from human bed nucleus of stria terminalis link alpha activity in empathy and affect evaluation tasks with depression severity
Next years Annual Meeting will be held on March 14th and 15th 2024 at the Royal College of Physicians of London.