Gonna attempt to do a twitter summary of @ProfDavidNutt 's very engaging public lecture tonight at #BAP2018 "Not all in the mind - the brain science of mental illness"...
(not live because of low phone battery! let's hope i can read my own notes...)
Nutt: as a medical student, inspired/challenged/fueled by attack on medical psychiatry by Szaz. More recent attack (again in the form of a book vs publication) by his friend Johan Hari. Sometimes feels like more of a religious debate than scientific. #BAP2018
Nutt: three main drivers for scientific advances in brain science of mental illness - imaging, molecular neuroscience and genetics. Chose to focus on imaging because it lets us get to where we want to be. Example of brain tumours - can *see* what's causing problems. #BAP2018
Nutt: One thing we can do is measure brain volume. And one finding in area is that alcohol reduces brain volume - in fact, one of the most destructive things to the brain and the ONLY drug we can categorically say changes size and shape of brain. #BAP2018
Nutt: Key problem of relapse in addiction. One approach to addiction - abstinence. Risky because relapse can kill when lose tolerance. Another approach - dealing with underlying addiction, prevent relapse. Major factors in relapse stress, impulsivity and reward #BAP2018
Nutt: Nalmefone, 1st ever drug licensed to help control drinking (but probably haven't heard of because rarely prescribed) - an opiate antagonist which dampens activity in dopamine pathway that is usually activated in reward. #BAP2018
Nutt: Also studying other available opiods never used in addiction. NK1 antagonists eg aprepitant, reduces brain response to stressful images in opioid abstinent groups. Recent MRC funding for clinical trial in heroin addiction. #BAP2018
Nutt: OCD one of most disabling and hard to treat disorders. Early PET studies show increased metabolic rate in pathway from front of brain to motor regions, controlling drive to act. Numerous replications since. Treatments for OCD reduce this hyperactivation. #BAP2018
Nutt: Anxiety disorders, inadequate GABA (calming neurotransmitter). Inspired by epilepsy studies showing lack of GABA to inhibit seizures. Similar findings in panic attacks. Lowest orbitofrontal binding in healthy controls still higher than highest in panic disorder. #BAP2018
Nutt: PTSD is the challenge of our time. More soldiers from Iraq and Afghanistan kill themselves than die in war. Another anxiety disorder with inadequate ability to inhibit and control brain - unable to suppress memories #BAP2018
Nutt: Benzos don't treat PTSD but MDMA does. 2 single doses show persistent remittance for 3 years, in those who had failed two other treatments. This finding prompted a revolution in our thinking. #BAP2018
Nutt: C4 Drugs live was some of the first ever serious science funded by TV. First asked to do cocaine live on TV. Nutt said already researched enough. So they asked what Class A drug he would want to be done live?! MDMA! Never properly imaged. #BAP2018
Nutt: C4 Drugs live found MDMA augmented BOLD response in bilateral fusiform gyrus to best memories and attenuated response in left anterior temporal cortex to worst memories. Reduces blood flow in hippocampus and amygdala. #BAP2018
Nutt: those with PTSD often turn to alcohol/many alcoholics traumatised. Frida Kahlo - "tried to drown my sorrows but they learned to swim". Treat alcoholics with MDMA? Ongoing BIMA study in Bristol, 3 so far, could be powerful innovative. #BAP2018
Nutt: despite media claims that no evidence for serotonin link to depression, evidence since 1957. In particular, lower 5HT1A receptor density which seems to lead to overactivity. Serotonin critical - if deplete using tryptophan depletion, remitted patients relapse. #BAP2018
Nutt: Depressed patients have negative affective valence. See the world as nasty and treacherous. Which it is! But the truth doesn't help! SSRIs help shift the affective valence to optimism bias of healthy controls. #BAP2018
Nutt: Numerous functional networks in brain. Default mode network of particular interest - sense of self, self determination, Freuds "ego". Overactive in depression, more activity if higher rumination - excessive self reflection leads to struggle to do anything else #BAP2018
Nutt: How to treat depression? SSRIs suppress this overactivity of default mode network. Can we disrupt instead? Brain is constantly approximating and imposing structure and reconstructing. In depression, imposing negative maladapative view. #BAP2018
Nutt: Psilocybin leads to lots of decreases in brain activity - no more default mode network! Reports of enduring sense of wellbeing after use in healthy peopleB. #BAP2018
Nutt: Got MRC grant to test psilocybin in treatment resistant depression. Took 1 year to get ethics, 30 months to get drugs, 32 months for regulatory approvals. So 32 months of 36 month granted to get started...! Regulations pointless and extraordinary. #BAP2018
Nutt: Results of psilocybin safety trial in TRD. 50% remit in 1 week, though some relapse. Predictors of best response are low anxiety, and profound experience. Participants describe as "wiping clean", "reset button". Now multicentre trial started. #BAP2018
Some questions for Nutt.
Q - Any downsides eg 3 day slump? A - didn't find, perhaps 3 day slump from hyper activity, drinking usually combined with MDMA
Q - Thoughts on advanced meditation having similar effects. A - yes, but takes 25 years rather than 25 seconds! #BAP2018
Q - Any downsides eg 3 day slump? A - didn't find, perhaps 3 day slump from hyper activity, drinking usually combined with MDMA
Q - Thoughts on advanced meditation having similar effects. A - yes, but takes 25 years rather than 25 seconds! #BAP2018
Q - Likelihood of approval for MDMA/psilocybin? A - Optimistic. We know they're very safe! Ongoing trials which FDA and European equivalent have said will approve if positive findings. Medical cannabis results in UK shown positive shift to rational approach to drugs #BAP2018
Hopefully the above thread provides a summary of (most of) the key points from the #notallinthemind talk by @ProfDavidNutt at #BAP2018, for any that couldn't attend! More pictures and quotes from people on the hashtag.
