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Ground-breaking research brings new hope to patients with psychosis
16/12/2016

Treatment for some patients with psychotic conditions could be set to improve thanks to a ground-breaking research project taking place in conjunction with Norfolk and Suffolk NHS Foundation Trust (NSFT).

The Prevalence of Pathogenic Antibodies in Psychiatric Illness (PPiP) study is exploring whether some cases of psychosis are caused by the immune system attacking parts of the brain, and should therefore be treated with immunotherapy rather than antipsychotic drugs. It is hoped the research could revolutionise outcomes for these patients.

NSFT has been part of the national study since it launched in 2014. The first phase saw the Trust recruit 30 local patients presenting with psychosis for the first time, who were assessed before blood samples were taken. Four of these samples contained NMDAR antibodies, inferring that the psychosis could be caused by a treatable immune system disorder. These patients were then referred to Cambridge for more detailed investigation.

Elsewhere in the country, some patients with the antibodies present have been treated with immunotherapy rather than antipsychotic drugs. Some saw improvements within just two weeks, and were able to return to work within two months.

Dr Uju Ugochukwu, Consultant Psychiatrist (Great Yarmouth and Waveney) and Principal Investigator for NSFT, has been working closely with Joanna Williams, the Trust’s PPiP Coordinator, to recruit patients.

Dr Ugochukwu said: “We are really pleased that NSFT is involved in this exciting study, which could revolutionise treatment for some patients with psychotic illnesses.

“We didn’t expect to see positive results, so were surprised by our findings. However, these results could explain why some patients might not respond to antipsychotics.

“Immune system problems are something we should be looking out for, and we should offer all patients presenting with psychosis this test as a positive result could mean we could provide an alternative treatment which could potentially work more effectively.”

The findings of the first phase were published in The Lancet Psychiatry in December, and suggested that up to one in 11 cases of psychosis could involve antibodies attacking parts of the brain.

The second phase of the study, which will run until 2020, expands the remit of the research to include people experiencing either a first episode of psychosis or a relapse, as long as the episode has not lasted more than two years. NSFT is aiming to recruit a total of 109 patients to take part.

Prof Belinda Lennox, a Clinical Psychiatrist at the University of Oxford and the study lead, said: “I’m really grateful for the strong support from Uju, Joanna and all the NSFT staff and patients who have supported and promoted the study. It wouldn’t have been possible without them.

“The next important step for the research is to work out whether immune treatments are an effective treatment for people with psychosis and antibodies. To do this, the research team are starting a randomised controlled trial of immune treatment in people with psychosis and antibodies, starting 2017, and I’m delighted that NSFT are going to be working with us to recruit to this trial.”  

The study has been funded by the Medical Research Council.​