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  • Behavioural and neurocognitive responses to sad facial affect are attenuated in patients with mania.

    5 February 2018

    BACKGROUND: The processing of facial emotion involves a distributed network of limbic and paralimbic brain structures. Many of these regions are also implicated in the pathophysiology of mood disorders. Behavioural data indicate that depressed subjects show a state-related positive recognition bias for faces displaying negative emotions. There are sparse data to suggest there may be an analogous, state-related negative recognition bias for negative emotions in mania. We used functional magnetic resonance imaging (fMRI) to investigate the behavioural and neurocognitive correlates of happy and sad facial affect recognition in patients with mania. METHOD: Functional MRI and an explicit facial affect recognition task were used in a case-control design to measure brain activation and associated behavioural response to variable intensity of sad and happy facial expressions in 10 patients with bipolar I mania and 12 healthy comparison subjects. RESULTS: The patients with mania had attenuated subjective rating of the intensity of sad facial expressions, and associated attenuation of activation in the subgenual anterior cingulate and bilateral amygdala, with increased activation in the posterior cingulate and posterior insula. No behavioural or neurocognitive abnormalities were found in response to presentation of happy facial expressions. CONCLUSIONS: Patients with mania showed a specific, mood-congruent, negative bias in sad facial affect recognition, which was associated with an abnormal profile of brain activation in paralimbic regions implicated in affect recognition and mood disorders. Functional imaging of facial emotion recognition may be a useful probe of cortical and subcortical abnormalities in mood disorders.

  • Administrative incidence of psychosis assessed in an early intervention service in England: first epidemiological evidence from a diverse, rural and urban setting.

    2 April 2018

    BACKGROUND: Early Intervention in Psychosis Services (EIS) for young people in England experiencing first-episode psychosis (FEP) were commissioned in 2002, based on an expected incidence of 15 cases per 100 000 person-years, as reported by schizophrenia epidemiology in highly urban settings. Unconfirmed reports from EIS thereafter have suggested higher than anticipated rates. The aim of this study was to compare the observed with the expected incidence and delineate the clinical epidemiology of FEP using epidemiologically complete data from the CAMEO EIS, over a 6-year period in Cambridgeshire, for a mixed rural-urban population. METHOD: A population-based study of FEP (ICD-10, F10-39) in people aged 17-35 years referred between 2002 and 2007; the denominator was estimated from mid-year census statistics. Sociodemographic variation was explored by Poisson regression. Crude and directly standardized rates (for age, sex and ethnicity) were compared with pre-EIS rates from two major epidemiological FEP studies conducted in urban English settings. RESULTS: A total of 285 cases met FEP diagnoses in CAMEO, yielding a crude incidence of 50 per 100 000 person-years [95% confidence interval (CI) 44.5-56.2]. Age- and sex-adjusted rates were raised for people from black ethnic groups compared with the white British [incidence rate ratio (IRR) 2.1, 95% CI 1.1-3.8]. Rates in our EIS were comparable with pre-EIS rates observed in more urban areas after age, sex and ethnicity standardization. CONCLUSIONS: Our findings suggest that the incidence observed in EIS is far higher than originally anticipated and is comparable to rates observed in more urban settings prior to the advent of EIS. Sociodemographic variation due to ethnicity and other factors extend beyond urban populations. Our results have implications for psychosis aetiology and service planning.

  • A quantitative meta-analysis of fMRI studies in bipolar disorder.

    20 March 2018

    OBJECTIVES: Functional magnetic resonance imaging (fMRI) has been widely used to identify state and trait markers of brain abnormalities associated with bipolar disorder (BD). However, the primary literature is composed of small-to-medium-sized studies, using diverse activation paradigms on variously characterized patient groups, which can be difficult to synthesize into a coherent account. This review aimed to synthesize current evidence from fMRI studies in midlife adults with BD and to investigate whether there is support for the theoretical models of the disorder. METHODS: We used voxel-based quantitative meta-analytic methods to combine primary data on anatomical coordinates of activation from 65 fMRI studies comparing normal volunteers (n = 1,074) and patients with BD (n = 1,040). RESULTS: Compared to normal volunteers, patients with BD underactivated the inferior frontal cortex (IFG) and putamen and overactivated limbic areas, including medial temporal structures (parahippocampal gyrus, hippocampus, and amygdala) and basal ganglia. Dividing studies into those using emotional and cognitive paradigms demonstrated that the IFG abnormalities were manifest during both cognitive and emotional processing, while increased limbic activation was mainly related to emotional processing. In further separate comparisons between healthy volunteers and patient subgroups in each clinical state, the IFG was underactive in manic but not in euthymic and depressed states. Limbic structures were not overactive in association with mood states, with the exception of increased amygdala activation in euthymic states when including region-of-interest studies. CONCLUSIONS: In summary, our results showed abnormal frontal-limbic activation in BD. There was attenuated activation of the IFG or ventrolateral prefrontal cortex, which was consistent across emotional and cognitive tasks and particularly related to the state of mania, and enhanced limbic activation, which was elicited by emotional and not cognitive tasks, and not clearly related to mood states.

  • First UK study of ketamine for people with severe depression

    4 April 2014

    Our Rupert McShane presents the first UK study of the use of ketamine intravenous infusions in people with treatment-resistant depression. 'Ketamine is a promising new antidepressant which works in a different way to existing antidepressants. We wanted to see whether it would be safe if given repeatedly, and whether it would be practical in an NHS setting. We especially wanted to check that repeated infusions didn't cause cognitive problems,' explains principal investigator Dr Rupert McShane, a consultant psychiatrist at Oxford Health and a researcher in Oxford University's Department of Psychiatry.

  • Congratulations to our winners of this year's Oxfordshire Health Services Research Committee Awards

    26 November 2013

    This year a record of three awards were given to projects in psychiatry:

  • Pictures: Department Strategy Day 2017

    24 January 2017

    Take a peek inside this year's strategy day: 'Taking stock and planning the next five years'.

  • Dr Bruno Holthof new Chief Executive of Oxford University Hospitals NHS Trust

    5 May 2015

    Dame Fiona Caldicott (Chairman, Oxford University Hospitals NHS Trust): "I am delighted to confirm the appointment of Dr Bruno Holthof as our new Chief Executive. This appointment marks the culmination of a comprehensive search and selection process, which attracted a high level of interest from a range of excellent national and international candidates."

  • Oxford Psychiatry Autumn School

    24 September 2013

    The first Oxford Psychiatry Autumn School was held on 16-18 September, at St Catherine’s College. Forty delegates attended from right across the UK, including Wales, Scotland and Northern Ireland, and included medical students and foundation doctors.

  • 2nd Course on Network Meta-Analysis (29th June – 1st July 2015)

    17 June 2015

    How to appraise, interpret and publish a network meta-analysis. A 3-day course for clinicians, researchers and policy makers, with formal lectures and group work

  • Peter Sargent appointed Head of School of Psychiatry

    2 May 2013

    Peter will be responsible for the specialist training of psychiatrists in the Oxford Deanery, covering Oxfordshire, Buckinghamshire and Berkshire:

  • Treatments offer hope for Chronic Fatigue Syndrome (CFS/ME)

    28 October 2015

    Professor Michael Sharpe and a team of researchers have found that cognitive behavioural therapy (CBT) and graded exercise therapy (GET) have long term benefits for people affected by Chronic Fatigue Syndrome.

  • "Updated map of the human brain hailed as a scientific tour de force"

    25 July 2016

    Timothy Behrens, a professor of computational neuroscience at Oxford University, comments in The Guardian on an exciting new map of the cortex - 'the most comprehensive so far'.

  • Five star performance at this year's BAP conference

    25 July 2016

    During July's heatwave, the Department of Psychiatry shone; winning awards, giving presentations and exhibiting an array of posters at the British Association of Psychopharmacology summer meeting in Brighton.