Monthly Archives: August 2012

Cumberland Lodge Conference…#1

I won a bursary a few months ago to attend the ‘Life beyond the PhD‘ conference at Cumberland Lodge, Great Windsor Park. Time has crept up on me and I’m currently blogging from slap bang in the middle of lots of green…its quite peaceful compared to the hustle and bustle of London. I’m also rather enjoying not being woken up by a rogue, intoxicated student on their way home at 4am, or Bin men at 5am.

So.Much.Green

Any way!

Its a multi-disciplinary conference, where we literally have students researching Poetry to Psychiatry, there’s even one person studying Comic books. Needless to say its a bit of a culture shock to everyone. Despite that its been fascinating to talk to such a diverse range of people…my room mate is a Marine Biologist who’s been to both the Arctic AND Antarctic, had penguins literally chilling outside her lab, and gets to go diving on a monthly basis. Wow.

We get to hear from  people who have completed their PhD and come out the other side to become, for the most part, functional human beings in real jobs, whether they be academic or not. Its really quite interesting to see where a PhD can take you…I’m still on the fence about what to do, but its good to know I have options.

I’ve also learned to think about my Impact (REF 2014 is looming!), my digital profile (check my LinkedIn and Twitter) and hooked myself up with an academia.edu account and downloaded Mendeley. Finally I’ve worked on my speech and breathing skills from a bona fide RADA grad. Phew.

But the big challenge doesn’t come until tomorrow…

Tomorrow is the big presentation.

I’ve not spoken to anyone in any capacity greater than an informal chat about my PhD. But tomorrow I have to speak about my project, coherently, for 10 minutes in front of 30 people…30 non-experts… 30 PhD students from all over the UK who may still think Schizophrenia is ‘multiple personality disorder’ (blasted STIGMA!!)…its back to basics.

If you can’t explain it simplyyou don’t understand it well enough’ – (possibly from Einstein) 

Here’s hoping I understand my PhD well enough to explain it to all the non-experts.

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‘How can you treat someone who denies their mental illness?’

I’ve been longlisted for the Max Perutz Science Writing Award, (my name’s published online and everything!!) check out my entry below. The question was Why does my research matter?

Wish me Luck!!

Max Perutz Science Writing award

Imagine you feel healthy and believe you look fine, but you’re forced to go to the doctors, take medication and stay in bed because others believe you’re ill with flu and in ‘denial’. It would be quite confusing, wouldn’t it?

This denial, or lack of awareness, of illness may seem a strange concept in physical health issues; however it is quite common in mental illnesses such as Psychosis and Schizophrenia. In fact, it is believed that in up to 80% of cases patients with these conditions are unaware that they have a mental illness. This means that when patients have unusual mental experiences such as hearing voices or holding paranoid beliefs, they are unable to understand them as symptoms of an illness. Lack of awareness often leads to problems for patients as it can result in resistance to medications (why take medicine when you don’t think you’re ill?) and so causes increased levels of distress. It also causes problems for doctors when attempting to administer treatment – clearly patients who don’t want to take their medication are going to be more difficult treat. If treatment plans are not followed, patients can end up requiring longer stays in hospital and their chances of relapse and readmission are increased. As well as being unpleasant for patients to be stuck in hospital, it also costs the hospital more money. Even when patients are allowed to return home, they often require a certain degree of care; while a loved one can provide this, often a lack of awareness can cause a greater burden and distress for these people as well.

It makes sense to try and increase a patients awareness of their illness, because that way we can reduce their distress, increase their willingness to take the recommended medication,and increase their chance of recovery. Some research has linked better patient awareness with lower mood, however we don’t yet know if the depression results in increased awareness or vice versa. Other than this there is not much evidence to suggest what causes this lack of awareness, or much agreement on ways to improve it.

This is where my research comes in. My PhD focuses on a possible link between lack of awareness and thinking processes called ‘metacognition’. Metacognition sounds complicated, but really it’s just ‘thinking about your own thinking’. If someone has high metacognitive abilities, they are good at knowing about their own ‘mind’. For example, if someone with high metacognitive abilities has a poor memory they are likely to admit it when asked. This person will probably also take precautions to avoid their poor memory being a problem, such as making lists of things to do. Interestingly, patients with poor illness awareness are quite bad at rating their own skills and memory. When compared to ratings made about them by a close relative, patients will often rate their memory, everyday skills and problem solving deficiencies as being much less severe than they really are.

The task we are using to measure metacognition is a relatively new instrument, and has only previously been used in healthy, non-psychiatric participants. It works by asking people to rate how confident they are that they have answered correctly on each trial, so they are rating their awareness of their performance. In the non-psychiatric population these confidence ratings have a strong relationship with the volume and connections of specific regions in the frontal area of the brain, where increased confidence in accurate performance is related to increased volume and connections. This is especially interesting because lack of awareness in patients can be related to reduced volume and connections in similar frontal areas of the brain.

My work therefore proposes that patients who have a lack of awareness about their mental illness will also have lower metacognitive skills, which could be related to their brain structure in the frontal areas of the brain. This research is exciting, because if our prediction is correct it opens up new opportunities for treatment.

Research into metacognition in school children has shown that ‘metacognitive training’ can increase children’s ability to think about their thinking. If lack of awareness in patients with Schizophrenia is related to metacognitive ability, then we could potentially offer a similar type of training to improve their metacognitive skills. The big advantage to improving these skills is that it could result in patients better understanding their unusual mental experiences as symptoms which can be relieved with treatment.

This research is in its infancy, but the results could lead to treatment options that greatly improve patients’ quality of life and the overall outcome of their treatment at a substantially reduced cost.

Who wants to be a millionaire….metacogntion edition

I just found this awesome article written about one of my PhD collaborators, Steve Fleming, using a really good analogy for metacognition as being like playing ‘Who Wants to be a Millionaire?’.

I wont ruin it for you…but its a good read! (and explains my PhD task much better than I ever could!)

http://www.brainfacts.org/sensing-thinking-behaving/awareness-and-attention/articles/2012/metacognition/

ECP