BNPA 2024 Annual Conference Report 

The 37^th Annual Conference of the British Neuropsychiatry Association took place on March 14^th and 15^th 2024. For the third year we were hosted at the Royal College of Physicians of London on Regent’s Park, 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 virtual delegates from across the globe.

The overarching theme of this year’s conference was “How do our situations and environment shape us”, which lead to exploration of a wide range of topics related to how “external” influences shape the experience of neuropsychiatric diseases and treatments. Alongside this was the usual excellent range of member presentations, as well as what many would argue remains the best feature of the BNPA; the opportunity to meet colleagues old and new from a wide range of professions and backgrounds with an interest in neuropsychiatry.  

Our first session was on environmental influences in neuropsychiatry. Lucy Vanes, Lecturer in Neuroscience and Psychology at King’s College London, started the proceedings with an overview of several lines of evidence (including epidemiological data and large neuroimaging datasets) relating to the role of neonatal brain development and home environment in shaping behavioural outcomes in later life following preterm delivery, highlighting the importance of modifiable environmental factors in this population. Professor Rohit Shankar from the University of Plymouth then spoke on Sudden Death in Epilepsy (SUDEP), exploring the biopsychosocial and environmental factors associated with SUDEP and discussing approaches to mitigate these. Professor Ruth Dobson of the Wolfson Institute of Population Health at Queen Mary University of London concluded the first section with a discussion of environmental influences on multiple sclerosis (MS). She took us through the complex environmental influences on both MS susceptibility and severity, and discussed how these factors interplay with social determinants of health in MS. 

Following a short break, we were delighted to host Professor Jesus Ramirez-Bermudez, Professor of Neuropsychiatry at the National Institute of Neurology and Neurosurgery of Mexico, delivering this year’s JNNP lecture on “Rethinking Neuropsychiatry: From Scientific Models to Clinical Narratives in the Latin American Landscape.” This wide-ranging talk addressed how place and environment not only shape the experience of disease, but also the practice of neuropsychiatry; and conversely, how neuropsychiatric practice and constructs can provide a bridge between psychopathology and neuropathology. He was particularly clear on the need for explicit theoretical underpinnings to clinical practice – something rarely talked about by empiricist British clinicians. I was also particularly attracted to the idea of neuropsychiatric “family trees”, and alongside the usual suspects was particularly interested to see Charles Sherrington – a fascinating physiologist (as well as a committed humanist) but rarely thought of in relation to neuropsychiatry! 

We then had our three Member’s Platform Presentations, presented by this year’s three Lishman prize winners. Matt Butler presented a mega-analysis of structural MRI in functional neurological disorder (FND), the result of an impressive international collaboration. The results showed some small but consistent anatomical correlates of FND, but the need for further work to understand the significance of these was highlighted. Grace Revill presented longitudinal data exploring the relationship between mild traumatic brain injury and subsequent psychiatric outcomes in a very large cohort of children aged 9-10 years. These were compared with matched controls with non-cranial orthopaedic injuries. The conclusion was that the association between mild TBI and subsequent psychiatric outcomes is explained largely by pre-existing mental health problems (a finding which could have wide implications for health policy as well as clinically). Finally, Katrina Thornber presented an evaluation of “HippoCamera”, a smartphone-based intervention which allows users to record visual and auditory cues for salient events, and then plays them back. In the condition of Transient Epileptic Amnesia, HippoCamera was associated with improved recall of autobiographical memory.  

After lunch we reconvened for an afternoon session on psychosis. Professor Ramirez-Bermudez discussed the diagnosis of psychosis through the specific framework of autoimmune psychosis, exploring different frameworks for understanding the experience and diagnostic category of psychosis, as well as considering the implications of autoimmune psychosis on the scientific understanding of conscious experience. This was then followed by two case presentations from Dr. Abhi Sharma and Dr. Janet Butler. Both cases were at the boundary between psychiatry and neurology, and provoked lively debate.  

Professor Belinda Lennox of the University of Oxford then delivered the BNPA medal lecture on “Autoimmune psychosis and the challenge for psychiatry”. The challenge in this case was put to us as the fact that there has been little meaningful progress in identifying underlying biological features of psychotic disease since the time of Kraeplin and Bleuler. The lecture then focused on the intermediate area of patients with psychosis positive for antibodies, but without other manifestations of autoimmune encephalitis, and converging lines of evidence that these patients may respond to immunotherapy. Highlighted throughout was the need to breach the physical, cultural and professional divides between psychiatry and neurology; a key aim of the BNPA. 

Perhaps on slightly more familiar ground we were then very pleased to welcome Adam Handel of the Oxford Autoimmune Neurology group discussing the psychiatric manifestations of autoimmune encephalitis. This lecture covered some of the specific psychiatric manifestations of autoimmune encephalitides, and related the psychopathology back to the underlying immunology as well as discussing the implication on treatment.  

Much (or indeed almost all) of the above work would not have been possible without the pioneering neuroimmunological work of Angela Vincent, and we were very pleased to be able to present her with the BNPA lifetime achievement award at the conclusion of our first day, prior to the evening’s entertainment hosted by the RCP. 

The second day of conference focused initially on the relationship between perceptions of disease and disease constructs and Artificial Intelligence. 

Next up was Joseph Kambleitz, head of the KambeitzLab for Prevention and Prediction in Mental Health at the University of Cologne. His talk, “Beyond labels: Potential and challenges of artificial intelligence (AI) for improved diagnostic and treatment in Neuropsychiatry” explored the application of artificial intelligence approaches within neuropsychiatric disease categories, as well as how AI technology may subvert those categories. Current limitations were explored, including ethical concerns and issues with applying models across diverse populations. 

The next three talks explored the use of AI and technology with reference to specific clinical areas. Professor Zoe Kourtzi, Professor of Computational Cognitive Neuroscience at the University of Cambridge, spoke on her work using AI to improve prediction of clinical outcomes in neurodegenerative disorders and how this might be applied for better brain health in future. Ben Seymour, Professor of Clinical Neuroscience at the University of Oxford gave a fascinating talk on “Pain in Brains and Robots”, conceptualising pain as analogous to a control system in engineering. He took us through both how such models can be applied to autonomous robotic systems, but also how the use of such systems has led to insight into the relevant neural circuitry in humans, before extending this conception to chronic pain states, which may be understood as a form of inappropriate homeostatic response. Finally, Dr. Daniel Blackburn, Consultant Neurologist at the University of Sheffield, explored the use of automated language analyses as a diagnostic tool in early cognitive impairment and other neurological disorders, taking us through the development and application of the CognoSpeak^TM system, as well his work with Somali community groups to apply CognoSpeak^TM in diverse settings.  

The final session focused on how environmental, and specifically cultural and social, factors can influence neuropsychiatric conditions. Lucy Foulkes of Oxford University presented the hypothesis that extensive public efforts to raise awareness of mental health problems may have paradoxically contributed to an increase in reported mental health problems, presenting a range of qualitative and quantitative evidence to support this position. In a possibly more specific example of this phenomenon, Professor Tamara Pringsheim of the University of Calgary gave an excellent overview of the recently described phenomenon of “Functional Tic-Like Behaviours”, setting out the evidence on the distinguishing clinical features, social and psychological predisposing factors and emerging evidence of a positive response to treatment of distress and comorbid anxiety and mood disorders.

Finally, we welcomed Derek Bolton, Emeritus Professor of Philosophy and Psychopathology from King’s College London who delivered this year’s ANPA/BNPA lecture on “Neuropsychiatry without Reductionism: Application of a Biopsychosocial Model”. Tying together many of the themes of this year’s conference, his talk traced the path from Charcot, Alzheimer and Kraeplin via Freud and the cognitive revolution of the 1960s to the formulation of the biopsychosocial model by Engels almost 40 years ago, before addressing the empirical question of to what extent reductionism of the psychosocial to the biological is challenged or constrained by such models, and was a perceptive and fitting conclusion to the conference.

We were very pleased to have a record number of abstract submissions this year, so many that there were an unprecedented three datablitz sessions. The presentations were of uniformly high quality and spanned the whole spectrum of categories from case reports to large meta analyses, as well as covering a wide variety of clinical areas. The winners of the datablitz prizes were as follows: 

• Laura Convertino – “Modelling NMDA receptor activity in focal epilepsy: A Resting State Study of EEG Effective Connectivity” 
• Sarah Ashley – “Head Circumference Trajectories in Autism and Psychotic Experiences
• Veronica Cabreira – “Development of a Self-Help CBT based Digital Intervention for Functional Cognitive Disorder” 
• Anam Waqar – “Imaging Psychosis: Quantifying Abnormalities found on MRI head scans in First Episode Psychosis” 
• John Ward – “The Value of Liaison Neurology within an NHS Mental Health Trust: A Service Evaluation”
• Rohan Kandasamy – “Changes in Heart-Brain Integration Precede Psychogenic Pseudosyncope” 

Next years’ Annual Meeting will be held on March 13^th and 14^th 2025 in London.