UOW ’s Research into Schizophrenia and Better Treatments

Written by Dr Elisabeth Frank
Schizophrenia Research Institute (SRI)
School of Health Sciences, University of Wollongong

 

“Schizophrenia is a devastating brain disorder that affects up to 1 per cent of the population worldwide…” is a frequently used statistic in publications on schizophrenia research. Whereas worldwide seems far away, it is a fact for our community; over 2,000 people in Wollongong alone have schizophrenia.

Schizophrenia is a chronic psychiatric disease, which has its onset mostly in the late teens or early twenties. It significantly impairs normal brain function; the neurodevelopmental hypothesis of schizophrenia assumes that it is a consequence of disrupted brain development in early-life.

Clinically, schizophrenia is divided into positive, negative and cognitive symptoms. What this means for patients is paranoia, hallucinations, a retreat from reality; total social isolation is often the result. The emotional burden on sufferers, families and friends is considerable, and the disease is estimated to cost the Australian community $2 billion every year.

There is currently no cure for schizophrenia; and though there are antipsychotic drugs, they are insufficient. Patients are medicated at high doses over their entire lifetime and the drugs cause serious immediate and long term side effects.

For these reasons and more, research into schizophrenia and better treatments is critical.

At UOW, several centres and researchers from various scientific fields are engaged in cooperative research on schizophrenia. Many of the basic and clinical researchers are found under the roof of the Illawarra Health and Medical Research Institute (IHMRI) and are associated with the Schizophrenia Research Institute (SRI).

The Centre for Translational Neuroscience (CTN) has a special focus on schizophrenia. Under the lead of Professor Xu-Feng Huang and based at IHMRI, the majority of the 30 research fellows and research students are working to uncover the neurochemical and genetic underpinnings of schizophrenia as well as neurophysiological consequences of antipsychotic drug treatment.

Studying samples from patients in Australia and China, human post-mortem brain tissue and rodent models, we use sophisticated state-of-the-art biochemical, genetic and intracranial techniques to explore neurochemical mechanisms of the disease in vitro and in vivo.

For example, the NHMRC-funded research team of Professor Xu-Feng Huang, Dr Kelly Newell and Dr Teresa Du Bois examines the glutamatergic NMDA receptor, since it is highly relevant for adequate neurodevelopment. Our second neurodevelopmental target and studied in its interaction with the NMDA receptor is the neuronal growth factor Neuregulin-1, which was identified in human genetic population studies as a major candidate for schizophrenia risk.

In a NHMRC-funded linkage project, Dr Mei Han and Dr Francesca Fernandez are screening schizophrenia patients in Beijing for mutations in this gene in correlation with symptomatology and neurochemistry. By comparing this to a Neuregulin-1 model at UOW, my SRI-funded research team is making discoveries in the novel field of neuroimmunology, which has only recently been unravelled for its aetiological relevance for schizophrenia.

 The severe side effects of antipsychotic drugs are also being investigated at the CTN. Currently available drugs have limited efficacy and are associated with a range of side effects. The NHMRC-funded research team of Professor Xu-Feng Huang investigates antipsychotic action on neurochemistry in relation to side effects like weight gain and metabolic disorders. The NHMRC-funded research team led by Dr Chao Deng is studying the functional selectivity of antipsychotics in treating schizophrenia.  These projects are expected to lead to better treatments for schizophrenia patients with reduced side effects.

 The schizophrenia research projects underway at our centre complement and collaborate with many others at the University. Working with researchers from IHMRI, the School’s of Health Sciences, Psychology and Nursing, the Graduate School of Medicine, the Illawarra Institute for Mental Health (iiMH) and the Brain and Behaviour Research Institute (BBRI), we further our understanding of disease development and treatment through combined approaches.

 We have close collaborations with the School of Psychology, where Dr Nadja Solowij, Dr Emma Barkus and several collaborators have attracted major funding for their research on the role of cannabis in the risk for schizophrenia. In a new collaborative project, an Illawarra schizophrenia patient cohort has been established. Patients will be studied by clinical and basic researchers from several schools and centres from a psychiatric, psychological, drug-compliance, dietetic, genetic, lipidomic, neurochemical and neuroimmune perspective. This will not only be a unique project due to its inter-disciplinary approach, but has the potential to directly feedback to patients and carers in the Illawarra community. Determining factors that predict a good treatment response as well as indicators for side effects of drug treatment will allow us to improve the choice of drugs used as well as to better monitor indicators for, and therefore potentially prevent, deleterious side effects in our patients.

 Linking as well with researchers from the School of Chemistry and Intelligent Polymer Research Institute (IPRI), and having access to their highly developed tools, gives us the opportunity to explore novel ways to target discovery, drug development and drug application. This is additionally supported by our cooperations with pharmaceutical companies.

 Our investment into schizophrenia does not end at the lab bench. In addition to our scientific investigations, our researchers also engage in community awareness and education around schizophrenia. With the support of IHRMI and SRI, our researchers and students have organised and contributed to a Schizophrenia Awareness Event and Mental Health Expo; and the Illawarra Mental Health Round Table which brings together major stakeholders of schizophrenia research and care in the Illawarra.

Schizophrenia is a devastating disease, but many researchers at UOW are working actively together to improve prevention, diagnosis and treatment of schizophrenia, and finally help patients and carers lead a better life. 

More information:
www.uow.edu.au/health/healthsciences/ctn/
http://ihmri.uow.edu.au/nmh/schizophrenia/index.html
www.schizophreniaresearch.org.au

Cancer. A simple cure is complex

A/Prof. Marie Ranson

As a society we enjoy better health than previous generations and we are living longer as a result. Yet paradoxically cancer incidence is on the rise. Is this because of our polluted environment, increased obesity and stress levels? To some extent it is, but the main risk factor for cancer is our increasing lifespan. Fortunately, survival rates are also increasing due to earlier detection and more effective, less toxic treatments.

Healthy cells in adults only divide to replace themselves with new cells when there is a need to do so or when they have reached the end of their pre-programmed life span. They are good citizens, responding appropriately to their neighbouring cells and their environment. They are also self-sacrificing. If for example a small piece of their DNA becomes damaged beyond the point of repair, say after nasty sunburn, those cells will self-destruct rather than reproduce damaged copies of themselves. The result is that the top layer of your skin peels  and the underlying skin cells receive a signal to replace this lost layer of skin. But as we age, the ability of our cells to fight continual damage to our DNA (caused by environmental factors such as sun, pollutants, and even by what we eat), decreases. This increases the chance that cells will not die when they should. They may also divide uncontrollably to form an abnormal mass of cells, known as a tumour, which can often be removed surgically. Unfortunately, sometimes cells within the tumour invade nearby tissues and spread to other parts of the body forming secondary tumours. This potentially lethal process is called metastasis and is the subject of intensive research to find effective treatments.

Why is cancer so difficult to cure? While we understand the basic hallmarks of cancer, we also know that there are numerous permutations giving rise to more than 100 different types of cancer. There are also differences in the same cancer type between patients, and the patient’s own immune system can help or hinder the progression of a cancer. Finding a simple cure, akin to using antibiotics to treat infections, requires a deeper understanding of genetics, how the immune system works and how we age. Here at the University of Wollongong the Illawarra Health & Medical Research Institute (IHMRI) brings together a network of biologists, chemists, physicists, clinicians and radiologists dedicated to improving our understanding of cancer so that we can develop improved methods of prevention, detection and treatment.

Traditional treatments such as chemotherapy rely on balancing the attack on cancer while minimising damage to healthy tissues and organs, but this can still cause unpleasant side-effects. One outcome of our research in the Illawarra aims to improve patient comfort by reducing the debilitating side-effects of drugs used in chemotherapy.

Future treatments will be more individualised. By screening each patient’s cancer for characteristics that will allow therapy to be customised to that patient, new generation drugs designed to target only cancer cells will be used. 

In the meantime, combination chemotherapy strategies have improved outcomes for several types of cancer. According to the National Cancer Institutes, USA, “ Treatment for this disease has become so effective that 80% of patients with metastatic testicular cancer can now be cured. Thirty-five years ago, 95% of these patients died, usually within 1 year of diagnosis”. So in fact, for at least a few types of cancer, there are cures.

Our work continues and this has been facilitated by the generosity of local organisations and donors.

Associate Professor Marie Ranson is the Foundation Scientific Director for the Cancer Research Program at the Illawarra Health and Medical Research Institute and teaches in the School of Biological Sciences at the University of Wollongong.

New Approach to Dementia Care

Dr Nancy Humpel

Dementia is one of the fastest growing sources of major disease burden in Australia and will overtake coronary heart disease in its total wellbeing cost by 2023. Without a significant medical breakthrough, the prevalence of dementia is estimated to increase from around 257,000 people in 2010 to about one million in 2050.

Dementia is a term that encompasses a range of conditions characterised by impairment of brain functions including language, memory, perception, personality and cognitive skills. Dementia is a fatal condition and there is currently no cure.

This distressing disease is presenting a significant challenge to the nation’s health system, and needs to be tackled on many research and clinical fronts. One of these is the support and training provided to residential aged care facility (RACF) staff.

In 2010 it is estimated there are approximately 82,000 residents in these facilities across the country who suffer from dementia. Due to the characteristics of the disease, caring for people with dementia is particularly demanding. To better cope with future demands, there is a clear need to support care providers and staff in RACFs through the development of sustainable models of care.

One area that clinicians and the research literature suggest needs addressing in dementia is the recognition of, and approach towards, end-of-life care. In many cases, staff in aged care facilities do not feel empowered or confident to initiate a change in the direction of care towards a palliative approach.

From research to date, it is evident that funding additional staff members for each of the many facilities may help provide the human resources needed to tackle the issue, but that is neither sustainable financially nor in terms of staff recruitment.

Rather, the ability of existing staff within aged care facilities to recognise the end-of-life stage, and to make appropriate, shared decisions about taking a palliative care approach, needs to be enhanced. This has been recognised via a $600,000 grant to the Illawarra Health and Medical Research Institute to deliver the REACH Out In Dementia Project.

The purpose of this project is to implement, and assess the impact of, an evidence-based best practice palliative approach in providing care to late stage dementia residents in aged care facilities. It will educate care providers, staff and families of residents about the clinical features which might predict an opportunity to move in the direction of palliative care.

There is already an abundance of evidence of the quality of life benefits that taking a ‘comfort’ palliative care approach can bring at end of life stage. On the other hand, there is also evidence of many barriers to providing this approach.

A major factor leading to avoidance of the necessary end-of-life conversations with residents and families in aged care facilities may be that health care providers feel unskilled at this task. They are unlikely to initiate end-of-life discussions when they believe they lack the needed interpersonal skills.

Although this type of conversation would help identify the resident’s wishes about their ongoing care, education alone may be insufficient to fully empower doctors and care providers to initiate the needed changes.

Addressing the barriers to initiating end of life conversations is where the REACH project stands out from previous work, and is leading in this area of research.

While the project aims to ensure a more appropriate approach for residents with late stage dementia, what are the implications for reducing the burden on an already overstretched health care system?

Currently, many residents with end stage dementia frequently end up in the Emergency Department. This could be a result of staffing shortages within these facilities or other reasons, none the less the ‘casualty ward’ is clearly not the ideal place for end-of-life symptom management.

With an improved model for end of life care delivered in the residential aged care facility by professional care staff and GPs, the number of dementia patients presenting at emergency could be reduced significantly and residents can spend their final days in their own home.

For these reasons, the experience of professional care staff and GPs will be pivotal to the program that is implemented and the collaboration between researchers and clinicians in the REACH Out In Dementia project. This focus on end stage dementia is what sets the project apart from others underway in the delivery of dementia care.

There has been plenty of enthusiasm from both RACFs and GPs in the local area to participate in the project and to embrace new models of care. This will include psychological education and workshops to improve their interpersonal and confidence skills when communicating with residents who have dementia and their families.

The project will take a collaborative approach involving REACH nurses working with RACF staff, visiting clinicians, and residents and families at 12 aged care facilities in the Illawarra and Shoalhaven over the next nine months. It will also trial the provision of a local guideline called the REACH Toolkit to empower them to care holistically within the facility.

Designed with a range of features and training resources to ensure acceptable and sustainable change within the participating aged care facilities, it is also critical that the program developed is transferable to other facilities in the region and across the country.

With so many people and their families living with dementia now and into the future, we hope this project will make a positive and significant impact on their lives. This will come through a more consistent and open approach to discussing and recording the person’s, and their family’s, desires for ongoing care as the person approaches the end of life.

Making a difference will require the experience and willingness of RACF staff and GPs to recognise the need for a new model, and to participate and support its implementation. Already, the collaboration has been fruitful.

Finally, the literature on geriatric care will be enhanced with the reporting of results from the project implementation and evaluation. We hope the REACH Out In Dementia project will impact and improve the care of our elderly across the nation for many years into the future.

*Dr Nancy Humpel is the Project Manager of the REACH Out In Dementia Project (Recognise End-of-life And Care Holistically in Dementia) based at the Illawarra Health and Medical Research Institute. Her PhD was in health behaviour change and she has extensive experience in the management of clinical trials and other cancer and health related projects. The REACH Out In Dementia Project is funded by a grant from the Commonwealth Department of Health and Ageing.

Everything I need to know about my health is on TV – but most of it is wrong

Professor Sandra Jones, Director of the Centre for Health Initiatives, UOW

The average Australian home has 2.6 people & 2.8 televisions. We watch TV for more than 2 hours a day, and between 7.00pm and 8.00pm, 44% of us are watching TV. We spend 16 hours each week on the Internet, 9 hours listening to the radio, 5 hours watching DVDs, 3 hours reading the newspaper and 2 hours reading magazines. There is now so much media in our lives that we often use them at the same time, with almost two-thirds of Australians watching TV while they use the Internet.

Much of what we know – or think we know – about our health comes from watching television, reading newspapers and magazines, and surfing the Internet. However, decades of research into health information in entertainment programs, news coverage, and advertising shows that most of this information is confusing, misleading or just plain wrong.

If you talk to many people about autism they will tell you that it is caused by vaccination. This is not correct. There have been lots of well-designed and carefully controlled studies that have proven for certain that the MMR vaccine does not cause autism. So, why do so many people believe that vaccination ‘makes children autistic’? Most of them saw it on TV or read it in a book.

Those scientific studies were published in leading academic journals, so they were probably read by a few thousand academics. When television stations around the world broadcast an episode of Eli Stone in which the fictional lawyer represented a mother suing a pharmaceutical company for ‘causing’ her child’s autism more than 5 million Americans and more than 1 million Australians were watching. When Jodi Picoult wrote in ‘House Rules’ that vaccination caused the young Jacob to develop autism almost overnight, millions of people around the world were reading (and even more will watch if they make it into a movie). In America, an actress named Jenny McCarthy is attracting a huge amount of media coverage, even appearing on the Oprah show. Ms McCarthy is not a doctor or a scientist – she is Jim Carrey’s girlfriend – but when she claims that vaccination causes autism, millions of women around the world will be convinced not to vaccinate their children.

So why does this matter? It matters because high rates of vaccination had virtually eliminated diseases like mumps, measles and whooping cough in countries like Australia. Each time stories like this appear in the media, parents stop getting their children vaccinated. Some of these children will develop preventable diseases and become extremely ill. Others will spread the infection to babies who are too young to be immunized and some of these babies will die.

Cancer is another popular topic for news and entertainment media. Women’s magazines frequently provide in-depth coverage of celebrities’ battles with cancer. Soap operas kill off characters by having them develop fatal cancers, or show their strength by having them survive cancer (often so they can be struck down with another fatal disease in the next season). Newspapers and magazines tell us every month of another ‘cause’ of cancer, and at the same time report another ‘scientific breakthrough’ that will eliminate cancer.

Unfortunately, much of what the media tells us about cancer is misleading or just plain wrong. The biggest risk factor for breast cancer is increasing age – the older you are the greater the risk – but readers of women’s magazines are regularly presented with stories of very young women with breast cancer and, as a result, many women believe that risk is highest when they are young.

Why does the media get it wrong? Sometimes its because journalists, editors or authors sensationalise stories to get our attention. Sometimes its because scientists and researchers provide the media with confusing or misleading information. Sometimes its because there is conflicting evidence, with ‘experts’ arguing for different points of view.

 So what can we do to sort the good information from the misinformation? Professor Jones will be speaking at the Uni in Brewery on 25^th August from 5:30 at the Five Islands Brewery. In her presentation she will discuss some of the misinformation in the media, reasons why the media gets it wrong, and how we can more critically interpret the information we receive. For more information visit http://www.uow.edu.au/research/unibrewery/UOW075583.html

PhD student Kate Williams – Values as predictors of well-being in emerging adulthood

PhD student Kate Williams

Values are stable, general beliefs about what is desirable; goals are the specific objectives towards which our values guide us. Asking people to clarify and act upon their values can improve outcomes in public health, education and clinical psychology.  But are all values equally beneficial?  One view is that success at any personally important goal will improve well-being.  Others argue that it doesn’t matter what one aims for, as long as one does it for the ‘right’ reasons.