Advancing Mental Health Research Through GALENOS - Prof. Andrea Cipriani, Oxford Precision Psychiatry Lab, University of Oxford
Psychiatrist Andrea Cipriani discusses his work in clinical psychiatry and research, focusing on mood disorders and the importance of personalised treatment! He highlights the GALENOS project, which aims to synthesise existing data to improve mental health outcomes and chats about the need for a shift from a medication-centered approach to one that prioritises quality of life and community care. Andrea also advocates for collaboration between clinicians and community support systems to enhance patient care and reduce the stigma surrounding mental health treatment. Transcription and links to Andrea are below! 👇🏻
Reported by Torie Robinson | Edited and produced by Carrot Cruncher Media.
Podcast
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00:00 Andrea Cipriani
“There are so many reasons why we should try to avoid as much as possible, this kind of ultimate or extreme tools to help people and make the experience better. So, for instance, during the hospitalisation, invites the community team to meet the person to give this feeling of continuity, not you are allocated to one then to another as separate steps.”
00:24 Torie Robinson
I say that to be a great clinician-researcher, just some traits that you need are: you have to be a great listener, you have to be open-minded, you have to value patients and families or caregivers, you have to value empirical evidence, and you must be open to contradiction. Well, today psychiatrist Prof Andrea Cipriani and his project GALENOS - tick all of these boxes! Today, Andrea shares how he is Advancing Mental Health Research through his project GALENOS - the Global Alliance for Living Evidence on aNxiety, depressiOn, and pSychosis) - all closely related to/part of the epilepsies.
If you’re new and you haven’t done so already, please do like and comment on this episode and subscribe to our channel, so as to get more people learning about the epilepsies!
01:10 Andrea Cipriani
I'm a psychiatrist in this country in the UK. My job is called “clinical academic”. So, I see people with mainly mood disorders, treatment-resistant depression, or bipolar disorder, in the NHS at Oxford Health NHS Foundation Trust. But this is overall on average, sorry, 1 day a week for the rest of the time I do research. I have a lab of very talented researchers and clinicians and statisticians, methodologists; we call it “Oxford Precision Psychiatry Lab” within the University of Oxford because our aim is to use existing data, existing evidence, to personalise treatment for people with anxiety, depression, and psychosis.
02:11 Torie Robinson
Which are common factors or common symptoms, maybe one would say, actually, experienced with people with an epilepsy, hence the relevance in our conversation. Could you just tell us about GALENOS, just because I think that's a great example of what you just described.
02:27 Andrea Cipriani
Yeah, and that's the beauty of working in the UK I think is the NHS is a service that we provide -to everyone. But at the same time, in the UK, we have fantastic opportunities in terms of funding - and one of them is Wellcome [Trust], because it's a charity and they decided a few years ago to focus not only on mental health as a priority, but they also launched a program of research around evidence synthesis; so collecting existing data to identify mechanisms, what we call experimental medicine approach, behind diagnosis, behind treatment, behind risk stratification and personalisation, in depression, anxiety, and psychosis. So, I'm the director of this project called GALENOS (so the Global Alliance for Living Evidence on aNxiety, depressiOn and pSychosis) and what we are doing is to collect data around specific research questions identified by people with lived experience, and we combine data from human studies - but also from animal studies - with the overarching idea that if we want to identify a mechanism or distinguish a signal from “noise”, the data should contribute and complement each other if we combine data from different types of patients or different types of models - because each type design has their own biases. And the other interesting thing of GALENOS is the living nature; so, we update the evidence every 3 months (because new data are coming out), so automatically we input this new feedback into the system and produce new results. So, we started a couple of years ago and hopefully we will be able to continue for longer.
04:33 Torie Robinson
And so do you sometimes - due to this data that keeps coming in - are there sometimes things that change as in… so you may initially present some information in a certain way with a certain tone. And then what you'd already thought about was completely wrong because you had new information contradicting it. Does that happen or is that what you welcome?
04:54 Andrea Cipriani
Absolutely. This is the philosophy of the approach: to be driven by data and science, not opinions. And this is definitely something we expect because the evidence changes over time. I can give you some examples of reviews that we have done, for instance, there's one about new drugs for the treatment of psychotic symptoms, and one of the big questions was the initial studies didn't show a material effect or more efficacy compared to the standard antipsychotics already on the market. And one of the key points of GALENOS is to decide: shall the research go ahead or should we stop here? Because as we know, waste of money is a huge problem in research. And it was a very nice experiment because we have, embedded in GALENOS, the voice of people with lived experience, and presenting the results to people with lived experience of psychosis they said “Wait a minute, the side effect profile is very interesting for these drugs. (so, they're not really causing the nasty side-effects that usually antipsychotics do), so, there may be scope for these drugs, even if they are less effective than the standard antipsychotics, they may work with specific sub-population or they can be used as add-on treatment to other treatments because they have a more beneficial side-effect profile.”. And this is why we published the paper and say research should go ahead and just to encourage funders to put money in this independent research and assess the mechanism of these new drugs.
06:43 Torie Robinson
That's so interesting because it makes me think about anti-seizure medications. So, sometimes the side effects of those drugs can… well, sometimes people are lucky and don't experience side effects, but sometimes they can be pretty severe… but then sometimes we find out, for instance, like with lamotrigine, one of the side effects was that it could help mood stabilisation, right?
07:04 Andrea Cipriani
Mmm.
07:05 Torie Robinson
And so, there can be really positive side effects. Another thing it makes me think of is often people will say “The side effects of a drug are worse than experiencing the seizures themselves and so significantly impact my quality of life, that sod it, I don't want to use that.”. And so, yeah, it… and it… it can be, I think, very challenging from a clinician's perspective because you want to help achieve better quality of life, but often I think we can be trained to just or primarily look at one thing and that may be to control seizures. A bit like with people who primarily experience psychosis, I guess most clinicians, psychiatrists will look at “We want to avoid that psychotic episode, but what about the quality of life of the individual?”.
07:51 Andrea Cipriani
The problem is what is fundamentally wrong in the system is we have a medic-centred approach rather than having a patient-centred. And it's not only because as clinicians we try to control, if you want, the efficacy of the intervention and we often forget about the side effects, but the other big issue around this is I want to get rid of the “one-size-fits-all approach” - because we were discussing about side effects, but the side effects that may be burdensome for you may be different for me! You mentioned the mood stabilising effect of Lamotrigine, which may be positive, sedation is another thing that may be positive or negative, depending... I use, in my clinic, medication that can cause tremour and depending on your job… if you work as a PA, or something, you have to write; of course, that's very problematic… or if you have to drive… So, what we need to do is to listen to what people say in terms of preferences around side-effects and try to personalise the intervention. And monitor - because things may be wrong; so we can have an assumption, and then when we test this in an individual, things may go wrong, and this is why I see my clinical experience as a sort of “journey” we do with the patient and we are working together and walking in the same direction. It's not “I do my job, now it's your turn, bye bye.” and that's what we need to change. And the job you do, Torie, in terms of trying to disseminate this sort of “paradigm shift” revolution is what we really, well it's great but what we really need to aim for.
09:40 Torie Robinson
Thank you. And actually, I love the word you use there, a “revolution”; because really that's what it is. It is a complete and utter change of mindset that we need. Traditionally, I think in medicine, it's been “Well, darling, I do this and I tell you that, now that's it, mate.”, haha. No matter… and it's not looking at personalised medicine, it's not looking at a person as an individual. I think we're getting there, but we still need to sort of drive this message home that, in my opinion, that you will actually have (as a clinician) better satisfaction in your work if you more improve the quality of life of the service users, of the patients, the people with epilepsy or whatever disease it might be - often a combination (!) - that's going to make you feel better in, you know, bring more job satisfaction to you as well.
10:28 Andrea Cipriani
Yeah, and what you say is very true. And I see some changes. For instance, you mentioned quality of life: 20 years ago, when we did our studies, quality of life was not an outcome we collected during the study; now things have changed - sometimes it's the primary outcome of the study. So, I'm optimistic that down the line things will be different. Yes, I agree.
10:53 Torie Robinson
I know a chap. I actually we actually worked together. He has schizophrenia - and that's the only diagnosis I know of his that's the only one he disclosed to me But I wouldn't be surprised if there are other things too. And unfortunately, I see he just so happens to live near me and I will see him out on the street, he's unemployed. He has his own place, which is great, but he is doped up to the hilt. Like when I try and talk to him, he has to go [PAUSE] and then he can respond. And he, he has gained so much weight, like, and I know this is a common side effect of many… - especially antipsychotics, I think, right? - but also many, many anti-seizure medications… He’s so alone. And when I spoke to him, I said, how are things going? And he said, I just wish the charity shop was open again so that I could actually do something in the community. And so, I think that's kind of, like, where we need to look at the whole quality of life of people as well. It's not just about medications and trying to stop certain things, right? It's going…it's looking at community care as well, right?
11:47 Andrea Cipriani
As you say, physical health is crucial; it's not just controlling the symptoms, it's allowing these people to have better quality of life also in terms of physical health. And the rehab or giving back to the community, going back to the community, upscale what they can do - because it's a huge potential. Also, because people with lived experience, they have a knowledge that the model we use to say is “Train The Trainer”. So, if you think if we can - as we do in many, many instances now - collaborate together, and then each one goes back and then do the same with other communities or networks, that's a gigantic effect in the end; [a] multiplying effect in an exponential way. So, yes, quality of life in a broad sense, beyond medication, beyond treatments in general, is the way forward.
12:44 Torie Robinson
And that example completely… well, I say completely different disease -it's not; epilepsy and schizophrenia are closely linked, aren't they? But, you know, if I get better sleep, if I improve my mood, I decrease seizure likelihood. And, you know, if I'm fitter, you know, physically, I feel a bit better about myself, my mood improves. Well, and that's just the mental side of it, but also like… I'm sure you know more about, like, endorphins, and all this type of thing, the good feeling it gives you. So yes, it's so important to look beyond, I guess, from a clinician's perspective, beyond your office and what happens out there. So, community mental health teams can be really valuable?
13:25 Andrea Cipriani
Yes, it is something we have to do in the community, absolutely. And the other thing linked to this is prevention. So, now, we need to do our best to put in place things that reduce the risk of relapses.
13:38 Torie Robinson
Having that support network around you is crucial. Do you think that we've got more work to do; kind of building those connections between clinicians and community support workers and families and things like that?
13:51 Andrea Cipriani
We need to make this connection a real thing. 2 levels: one is, as you say, clinical work is not like a tennis match where my aim is to put the ball in your court and then it's your job, so, we need to work closely together and reinforce this. It's all our business is not just I do my job or homework and then it's done. So, but the other thing is the system because if you think that, okay, hospitalisation sometimes is needed, but it may… maybe, not always; a traumatic experience for people who are hospitalised. And this is a vicious circle. So, there are so many reasons why we should try to avoid, as much as possible, this kind of “ultimate” or extreme tools to help people and make the experience better. So, for instance, during the hospitalisation, invite the community team to meet the person to give this feeling of continuity, not you are allocated to one then to another as separate steps.
15:00 Torie Robinson
Totally. And I think that's something that just us as a species like, isn't it? It's regularity. It makes complete sense that to, yeah, to have this person, this person, this person… and having to explain yourself again over and over. Oh my gosh, it's so…
15:14 Andrea Cipriani
Hahaha! True!
15:16 Torie Robinson
annoying, haha! You must hear that a lot, but perhaps even experience it. It's like if a GP changes and you have to give your whole story… again. So no, well thank you very much for that insight. So appreciated. I think this, the psychiatric aspect is not looked at enough when it comes to the epilepsies and indeed other you know other conditions too. So, thank you so much Andrea.
15:36 Andrea Cipriani
Thank you. Thank you, Torie.
15:38 Torie Robinson
Thank you to Andrea with us for sharing his incredibly cool GALENOS project with us - which’ll help so many affected by anxiety, depression, and psychosis (and therefore so many who experience this as part of their epilepsy), plus the huge value that he places on personalised medicine, and community care!
Check out more about Andrea and his work on the website torierobinson.com (where you can access this podcast, the video, and the transcription of this entire episode) all in one place. And if you’re new and you haven’t done so already, please do like and comment on this episode, subscribe to our channel so as to get more people learning about the epilepsies!
See you next week!
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Andrea Cipriani is Professor of Psychiatry and NIHR Research Professor at the Department of Psychiatry, University of Oxford, Honorary Consultant Psychiatrist at Oxford Health NHS Foundation Trust and Clinical Lead of the Bipolar Disorder Research Clinic. He is currently the Director of the NIHR Oxford cognitive health Clinical Research Facility and of the Data Science Theme of the Oxford Health Biomedical Research Centre, he leads the Oxford Precision Psychiatry Lab and is the Editor in Chief of BMJ Mental Health.
His main interest in psychiatry is evidence-based mental health and his research focuses on the evaluation of treatments in psychiatry, mainly major depression, bipolar disorder and schizophrenia. His research in the methodology of evidence synthesis has now a specific focus on data science and precision mental health, trying to assess the validity, breadth, structure and interpretation of innovative statistical and machine learning approaches to better inform the decision-making process between patients and clinicians and personalise treatment in routine clinical care.
Professor Cipriani has published 456 articles (on Scopus), with Scopus h-index of 72. More than 20 of his papers are among the Highly Cited Papers in Web of Science (InCites Essential Science Indicators), and since 2009 he has published 13 original articles in The Lancet, eight of which as first or last author. He has been Highly Cited Researcher (Clarivate) for the past 5 years in the field Psychiatry/Psychology, and has been collaborating with international experts from other fields of medicine, especially neurology.
Working with a wide range of colleagues globally from different disciplines, Professor Cipriani developed and tested novel statistical techniques in evidence synthesis and applied clinical research that facilitate the translation of evidence synthesis into individualised routine clinical care and improve patients’ outcomes. For example, he validated innovative methods to identify specific patient characteristics that have an impact on treatment response, dose optimisation and premature treatment discontinuation in depression, bipolar disorder and schizophrenia, and for the first time in mental health ranked evidence-based interventions using comparative effectiveness research to guide clinicians to choose the best pharmacological treatment for each patient. He is the Chief Investigator of PETRUSHKA (£2m) and PRADA (£5m), two international randomised controlled trial that aim to personalise pharmacological treatment for adults with major depressive disorder in the UK, but also with sites in Brazil, Canada, Nigeria and Pakistan. With the WHO, he co-authored a manual on psychopharmacology, which provided evidence-based information to guide and influence health care professionals in low- and middle-income countries. As part of the WHO Gap Action Programme, this manual was distributed as a reference source to assist general practitioners in using evidence-based medicines for mental disorders in routine clinical practice.
Professor Cipriani is also the Director of GALENOS (www.galenos.org.uk) and on the Editorial Board of the Lancet Psychiatry.
Since moving to the UK in 2013, he has been a regular and sought-after speaker at public engagement events locally, nationally, and also internationally. He was part of the expert reference group of the Royal College of Psychiatrists for developing Choosing Wisely in the UK, aiming to promote conversations between doctors and patients to understand and share decisions on the basis of the best evidence. He has presented and discussed his research on live television (BBC, Australian Broadcasting Corporation News), recorded documentaries (BBC One Panorama, Danish Broadcasting Corporation), radio (BBC Radio 4, BBC World, BBC Oxford, LBC) and newspapers in the UK and internationally. -
GALENOS https://www.galenos.org.uk
University of Oxford andrea-cipriani
The Oxford Precision Psychiatry Lab (OxPPL) evidence-based-mental-health
NIHR andrea-cipriani
ORCiD 0000-0001-5179-8321
Twitter/X and_cipriani