SINAPPS - Study of Immunology in Antibody Positive Psychosis - Investigating the role of immunotherapy and autoimmune antibodies as a cause of psychosis
SINAPPS2 - tests the efficacy of immunotherapy for antibody-mediated psychosis. Recruitment (Sep 2017 - Dec 2021), funded by the Medical Research Council (MR/N019067/1)
We undertake research across the translational spectrum, ranging from basis science studies, through to trials of new treatments and approaches for psychosis, right through to researching clinical services and their effectiveness. We work closely with the Oxfordshire Early Intervention in Psychosis Service in Oxford Health NHS FT. This service provides high quality, multi-discliplinary care for people experiencing first episode of psychosis and their families. We also lead the Early Intervention Psychosis network for the NHS in the South of England, providing the opportunity to speed up the translation of new research findings into routine clinical care. You can find out more about our current studies below.
We have found that some people with psychosis have particular antibodies that are known to cause another serious brain disorder - encephalitis. It is possible that these same antibodies are also causing psychosis in some people, and we are undertaking research to establish whether this is the case.
We undertake clinical trials of immune therapies in people with psychosis, and experimental medicine studies to examine the interaction between the immune system and the brain.
We propose that in some patients the cause of psychosis may be antibodies binding to neuronal membrane targets (NMDAR, LGI1, GABA-A and other), especially NMDA receptors, in the brain. The hypothesis underlying the SINAPPS2 trial is that these antibodies may be pathogenic and responsible for isolated psychosis (antibody-mediated psychosis).
We are currently conducting the SINAPPS2 trial to test whether immunotherapy is an effective treatment for antibody-mediated psychosis. It is a randomised phase II double-blinded placebo-controlled trial of intravenous immunoglobulin and rituximab in patients with antibody-mediated psychosis. Patints (1670 years old) with antibody-mediated psychosis are invited to one of the NHS hospitals participating in the study, where they are assessed and assisted by a team of SINAPPS2 clinicians and researchers. Eligible patients are randomly allocated to receive either intravenous immunoglobulin combined with rituximab or placebo treatment and they will be followed for at least 12 months.
Oxford Predicting Outcome in First Episode Psychosis (OX-POP)
The impact of psychotic illness on an individual's quality of life can be debilitating and life limiting, and psychotic illnesses are large contributors to the global burden of disease. Over the last 20 years, a new approach called Early Intervention in Psychosis (EIP) services have been developed to treat people who are experiencing their first episode of psychosis. EIP services are now the gold-standard treatment for early psychosis throughout the world.
EIP services are time-limited, which means that after two or three years individuals are transferred back to primary care or standard adult mental health services. We know that individuals can have vastly different illness trajectories following first episode of psychosis, yet there is little research into the immediate and long-term outcomes of people after they leave EIP, their interaction with health services and measuring, predicting and validating clinical decision making tools to help determine poor outcomes to this group of individuals.
Neuronal Antibodies and Electrophysiology
We are investigating ways in which Electroencephalography (EEG) can be used to improve diagnosis and work out the best treatments for individuals with psychosis. EEG is a safe, non-invasive test which is used routinely in the NHS for other disorders. It involves placing sensors on the scalp which can detect the faint electoral signals coming from the brain. in particular, we are trying to find out whether there are differences between the EEG recordings made from people with psychosis who have antibodies to brain chemicals compared with those who do not. If we find that there are such differences, it will help to decide which people with psychosis will benefit from immune suppressant treatment.
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