Day 1: Psychedelics, psychosis, psychopathy— and prizes

This was one of the BNPA’s largest meetings to date, made up of delegates ranging from young trainees to esteemed BNPA members.

The meeting began with a moving BNPA Medal Lecture, delivered by Professor Andrew Lees (Professor of Neurology at University College London and the National Hospital for Neurology and Neurosurgery, Queen Square). Professor Lees spoke about ‘Soulful Neurology’, walking us through his training as a young neurologist who found unlikely inspiration in William S. Burroughs. This was ‘altamirage’: his unusual interest in Burroughs spurred him to explore clinical ideas that were (at the time) off-the-beaten-path, ideas which became part of his enormous contribution to neurology and Parkinson’s disease.

Watch ACNR’s documentary about the life and work of Andrew Lees

The first session of the day was on psychedelic drugs and neuropsychiatry: then and now, chaired by David Okai and Camilla Nord. The session began with an historical overview of psychedelics in psychiatry, given by author and cultural historian Mike Jay, who upended the notion that psychedelics for psychiatry began with LSD in the mid-20th century. Instead, the story he recounted began with a much earlier history of mescaline use around the world. Professor Valerie Curran (UCL), world-renowned for her psychopharmacology research, spoke next about some of her most recent work on the cognitive and neural mechanisms of cannabis. A powerful message was that the two subcomponents of cannabis (THC and cannabidiol) may have opposing properties when it comes to addiction: THC potentially increasing, and cannabidiol decreasing the addictiveness of cannabis. Over the past few decades, the ratios of these two subcomponents have changed in street cannabis; today, cannabis contains a far higher proportion of THC. Following on from this highly topical research, our final speaker of the session was a scientist at the forefront of psychedelic treatment development, Dr Robin Carhart-Harris (Imperial). Dr Carhart-Harris spoke about his recent empirical and theoretical advances in treating major depression with psychedelics (in particular psilocybin). He put forward a theory that single transformative experiences like psychedelics can alter expectations of the world, causing universal changes in the cognitive processes altered by mental health disorders. An upcoming study of his will put this theory to the test in a head-to-head trial comparing psilocybin and SSRIs for depression treatment.

Next, we heard about psychotic phenomena from three very different viewpoints, in a session chaired by Tim Nicholson and Vaughan Bell. Professor Paul Fletcher (Cambridge) began with an introduction to predictive coding models of psychosis, a hugely influential perspective that places psychosis in the Bayesian brain framework, theorising that disruptions in the balance of prior expectations and sensory evidence can manifest as hallucinations and delusions. Dr Dominic Ffytche (King’s/SLaM) continued this session by asking us to begin to examine ‘perceptual phenomena at the margins of hallucination’ in neurodegenerative disease; his work demonstrates that visual hallucination phenomena are an important marker of clinical prognosis, and should be tracked as the disease progresses. Lastly, we heard about the applied work of Professor Dan Freeman (Oxford), with whom we got to experience some of his group’s virtual reality applications, an exciting prospect for psychosis treatment, and which also seems effective for other mental health conditions, such as phobias: in a game context, patients are much more willing to directly encounter their fears, greatly helping exposure therapy.

Following some excellent poster presentations by members, we gathered back to hear the three Lishman Prize lectures by Drs. Akshay Nair (UCL), Susannah Pick (King’s), and Jonathan Rogers (UCL), chaired by Boyd Ghosh and Thomas Cope. First, Dr Rogers comprehensively reviewed catatonia in a large demographic, clinical, and laboratory dataset, finding no evidence for a systemic inflammatory response in catatonia, though interestingly catatonia was associated with low iron levels. Next, Dr Nair won the prize for his work in Huntington’s disease, finding aberrant striatal value representation in HD gene carriers, which he showed 25 years before disease onset. Lastly, Dr Pick presented work on interoception and state dissociative experiences in functional neurological disorders, applying an experimental model of dissociation (10 minutes of mirror gazing) for the first time in FND, and finding that increased dissociation was associated with lower interoceptive accuracy.

The interdisciplinary clinical case discussion, chaired by Thomas Cope, was presented by Drs. Esther Coutinho and Tom Pollak, who presented fascinating examples of two quite distinct cases of autoimmune psychosis from their jointly-run autoimmune neuropsychiatry clinic, highlighting the variety of ways autoimmune psychosis can present and progress, with recommendations for improved diagnostic and screening criteria.

The final and keynote speaker of the day was Professor Essi Viding (UCL), who walked us through a comprehensive overview of developmental psychopathy, and in particular the genetic and neural basis of conduct disorder traits. Professor Viding showed compelling evidence for neural differences in the processing of both negative and positive affective and social information in children with heightened symptoms of conduct disorder, including the interesting finding of reduced laughter contagion in boys at risk for psychopathy.

The BNPA evening reception then took place at the October Gallery, surrounded by beautiful art representing the trans-cultural avant-garde, including a piece by none other than William S. Burroughs, with whom we had started our day via Prof. Lees’ talk. At the reception, we awarded the first-ever BNPA Lifetime Achievement Award to our second BNPA president, Professor Maria Ron, the first female neuropsychiatrist in the UK (and likely internationally!).

Day 2: Pleasure, Parkinson’s, and perturbing the brain with neuromodulation

The second day of the BNPA meeting began with a talk by Professor Morten Kringelbach (delivered virtually as the speaker was self-isolating), chaired by our President, Valerie Voon. Professor Kringelbach (Oxford) told us about his extensive work on the neurobiology of pleasure, and its subtypes, including hedonia and eudaimonia. His more recent work takes a network approach, creating a dynamical systems model to better understand specific brain states.

Next, we had a highly participatory clinical case discussion, chaired by Annette Schrag and Marco Mula, on legal issues associated with impulse control disorders in Parkinson’s disease: Andrew Lees and David Okai recounted some of the recent cases in legal history concerning whether or not Parkinson’s disease (or treatment) could explain particular criminal behaviours.

Dr Rimona Weil (UCL) completed the session, presenting her extraordinary research on visual disturbances in Parkinson’s disease, including the finding that measuring the iron content of brain tissue can track dementia progression in patients with Parkinson’s; this finding has now been widely reported by the media.

Professor Peter Brown began our session on neuromodulation (chaired by Dr Voon and former President of the BNPA Chris Butler) with updates on closed-loop deep brain stimulation in Parkinson’s disease: that is, brain stimulation that ‘listens and responds’ to the surrounding area, rather than delivering a static level of stimulation to the brain at all times. Dr Butler (Oxford) next told us the exciting story of focused ultrasound stimulation, which he and his team have been developing in healthy subjects. A key message was that the potential applications of this extraordinarily focused, non-invasive technique are astounding – but we must first better understand its neural and cognitive effects. Dr Nir Grossman (Imperial) then told us about a second non-invasive deep brain stimulation technique that he has developed, temporal interference, which exploits the properties of electric fields to drive action potential activity in deep brain structures without effects on the cortex. Finally, Professor Tim Denison (Oxford) gave us a preview of what to expect in the future for neuromodulation from the perspective of an engineer, including how best to translate these exciting techniques to real-world patients.

Our final speaker of the conference was Professor Adam Zeman (Exeter), who told us about his discovery (or rather, re-discovery after Galton in 1880) of aphantasia: that in the population, there exist people who do not possess a ‘mind’s eye’ – who cannot voluntarily evoke mental imagery. Initially, this condition was thought to be quite rare, but it is now known that many members of the population have varying degrees of aphantasia (and even amongst those of us with mental imagery, there exists a long continuum for ease and specificity of visual imagination).

The BNPA Annual Meeting 2020 was absolutely a success, and we thank all our wonderful members and delegates for such an excellent conference. We were lucky to be one of the last scientific meetings to go ahead before social distancing measures were put in place as a result of the COVID-19 pandemic – so this year we feel particularly grateful to have heard our incredible line-up of speakers and facilitate the meeting of so many scientists and clinicians who represent the future of neuropsychiatry.

Watch recordings of all the talks given at the BNPA.