Research Lines and active trials
The right question is half of the answer.
We follow four main lines of research, which sometimes are intertwined due to the nature of the studies. Please join our newsletter to get updates about our projects and visit the blog section for detailed information about the key studies.
Active trials and studies are listed below and in the homepage.
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A significant decrease in goal-directed behaviour (apathy) characterises the long term stage in people with schizophrenia, reducing the chances of recovery. This line of research was my PhD in early 2000, aiming to understand the primary negative symptoms (with Kirkpatrick, Parellada and Bernardo). Over the years, I was more aware of the limitations of the current scales for measuring negative symptoms and apathy (work with Mane, Kaiser, Mucci, Robert and Wolpe). Starting with a collaboration with Husain, we are now fully embracing computational neuroscience to deconstruct the process of motivation, working with Noham Wolpe and Jones and colleagues in Cambridge. The aim is to find novel interventions for improving this unmet need.
Current project: CHANSS
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Running the Clozapine Clinic in Cambridge and Huntingdon since 2011 has given me lots of surprises. The greatest, the amount of time I spent treating compulsivity instead of psychosis (amazing, first time reported by the secretary Carme Colmenar in Barcelona back in 1999). From 2016, and working with Robbins and Worbe, I started to systematically assess OCD symptoms. It turned out that ~40-50% have clinically significant symptoms, which impairs wellbeing and function (with Parkin and Chen). With Biria and Robbins, we explored the role of cognitive dysfunction. More recently, we proposed a two stage process, in a delicate balance between psychosis, clozapine dose and pathological checking. More projects coming, mostly using the clozapine cohort.
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People diagnosed with schizophrenia die ~15-20 years earlier than the general population. A scandal. There are practical actions to take, see our editorial on clozapine and mortality, but we also explore a new idea.
What if schizophrenia per se increases the vulnerability to develop physical health problems? Working with Kirkpatrick and later with Garcia-Rizo, we termed this vulnerability as accelerated ageing hypothesis, which allows to design studies to test it.
Before medication, we found shorter telomere, pre diabetes, lower testosterone and other markers of biological ageing. Other researchers have explored extensively this hypothesis using imaging, oxidative stress markers and epigenetic markers.
More to come in this line.
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Clozapine is the only antipsychotic licence for treating resistant psychosis. It also decreases mortality and suicidal ideation. Despite this, it is overly underused (in UK, it is prescribed to ~ 1 out 4 people that should be prescribed). Shocking.
There are several international initiatives to improve it use. We also use the clozapine database to improve the quality of life of people treated with clozapine (eg sedation, hyper salivation)
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Over the years, I felt the need to raise the voice on several issues. I use the editorial work to discuss topics that I am interested in. For instance on reducing the stigma of clozapine or considering the pros and cons of stopping the mandatory blood test on clozapine.
History and art are a passion to me. When I have time, I write essays on these topics, which allows me exploring ideas in a different format. See the pieces on Nijinsky, Fischer, and Robins.
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We lead two large cohort studies for people on clozapine treatment. We are happy to discuss collaborations.
Clinical and Research Database, from clozapine treated patients treated in Cambridge since 2012. See this link for more details and collaborations.
The GASS validation in Spanish is in set up, with the seed to become a large cohort for understanding clozapine side effects.
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There are a bunch of studies in which we happily collaborate without leading it. From participating in consensus, provide intelectual input or just supporting recruitment. I think these activities are as important as the lead projects, because they create a sense of community. .