A Visit to Bristol – By Jonathan Ipser

I visited the University of Bristol (UoB) in 2015 on two separate occasions, as part of the EUSARNAD Fellowship. My first visit was for 4 weeks in February. I was excited to go to Bristol, as I had previously been there for a Cochrane Anxiety, Depression and Neurosis Group (CCDAN) workshop in 2010, and had found the city to be vibrant and full of creative energy. My EUSARNAD host was Prof Marcus Munafo, the director of the Tobacco and Alcohol Research Group (TARG), located within the School of Experimental Psychology at UoB.

On my arrival at TARG, I was welcomed by Prof Munafo, and given a tour of their facilities, as well as introduced to the TARG research and support staff by Dr. Kate Button (now at the University of Bath). Lizzy Dann and Jasmine Khouja were particularly helpful in making sure that I had access to all the facilities I needed whilst there.

My first visit to Bristol was timed to coincide with a 2 day workshop entitled “Introduction to Network Meta-analysis” being held at the UoB, and which I attended with Taryn Amos, another EUSARNAD grant recipient and UCT doctoral candidate whose PhD thesis I am co-supervising. Network meta-analysis (NMA) allows one to make statements about the effectiveness of particular medications in treating anxiety disorders compared to any other medication, regardless whether they have actually been directly compared to these other medications in clinical trials. By drawing evidence from indirect comparisons (via a common comparator, such as placebo), Taryn will be using NMA to determine the relative ranking of medication agents in terms of their efficacy and tolerability in treating social anxiety disorder (SAD).

Taking a break from rowing down the Thames

Taking a break from rowing down the Thames

The two day workshop on NMA provided Taryn and I with a broad overview of this methodology, but more importantly, introduced us to some of the pioneers of this approach, including Dr Deborah Caldwell, who agreed in a subsequent discussion to become a consultant on the SAD NMA. I spent much of the remainder of my time in Bristol assisting with overseeing data entry for the SAD NMA. While in Bristol, I also discussed the possibility of collaborating with Dr Caldwell and Kate Button on developing a novel network cumulative meta-analysis approach, which could be used to track changes to the network of evidence supporting the efficacy of medications over time. This would potentially be useful in supporting decisions regarding when sufficient evidence has accumulated to obviate the need for further trials of that medication in treating anxiety disorders.

Taryn’s ultimate goal is to apply NMA to randomised controlled trials of pharmacotherapy across a range of  anxiety and related disorders (social anxiety disorder, posttraumatic stress disorder and obsessive compulsive disorder), enabling her to compare how the ranking of these agents differs between these disorders. The results of the NMA’s will be compared to standard Cochrane reviews of pharmacotherapy for these disorders. With this in mind, Taryn and I met with Jessica Sharp, the editorial director of CCDAN, to discuss progress on a Cochrane review of pharmacotherapy for SAD. In addition, whilst travelling to Bristol from London, I met with Prof. Andreas Cipriani at Oxford University, one of our collaborators on the PTSD NMA, to obtain further insight into how to apply NMA to the SAD clinical trial pharmacotherapy evidence base.


Clifton Suspension Bridge

My stay in Bristol during February was not all work, however. In addition to seeing Bristol’s famous Clifton suspension bridge, I also took the weekend off to go rowing on the Thames with a friend who stays in London.

I visited Bristol again in September, for two weeks. This time around, I met with Dr Caldwell to discuss progress on the SAD NMA, as well as to formulate a strategy for completing the project within the next year. In addition, I spent the time I was there identifying and extracting data from studies providing norms for neurocognitive tests that had been identified in studies assessing cognitive impairment in PTSD. This work is being conducted as part of a meta-analysis of the clinical impact of cognitive difficulties in individuals diagnosed with PTSD, to be submitted in partial completion of a PhD thesis by Sheri Koopowitz, another PhD study I am co-supervising

Although it rained for most of the two weeks I was in the city, the weekend was fortunately sunny, and so I was able go on a guided tour of the floating harbour in Bristol (see photo).


Bristol’s Floating Harbour

Thanks to the EUSARNAD program, I was able to gain far greater insight into the application of state-of-the-art quantitative data synthesis methodology, as well as form collaborative partnerships with key players in this area. It also helped me to establish ties to Prof Munafo and his team, a relationship that I plan to take full advantage of in future research into anxiety and stress-related disorders. 

Expanding the anxiety umbrella: a collaboration that began with EUSARNAD – by Nienke Pannekoek

It is not uncommon for people to jokingly use the term “hypochondriac” for someone when they are greatly exaggerating some seemingly trivial physical problem. In truth, as a result of my own ridiculous clumsiness, I’ll be the first to admit to probably having said “I’m crippled forever!” after again hitting my knee on a desk drawer/toe on a coffee table/hip on the corner of a shelve/shoulder on a doorpost/… (unfortunately, my list is endless).

Hypochondriasis pic 1

One generally does not associate ‘hypochondriasis’ with anxiety. Neither did I. But when I was on my EUSARNAD programme in Cape Town to work on the so-called MEGA-SAD project (international, multi-centre MRI database of social anxiety disorder), and professor Dan Stein suggested to write a book chapter about the classification of ‘hypochondriasis’, I took the opportunity to learn. When thinking about “anxiety”, excessive worrying about one’s health and a preoccupation of having a serious illness are probably not the first things that spring to mind. It turned out that whereas the focus lies with physical symptoms in ‘hypochondriasis’, anxiety is actually one of the core issues of this disorder.

But what does it mean to actually suffer from ‘hypochondriasis’? And what exactly is it, anyway?

In short, what typifies ‘hypochondriasis’ is the conviction that one is suffering from a serious physical illness, based on the misinterpretation of bodily symptoms. This leads to repeated consultation with doctors, even after appropriate medical evaluation and reassurance that no illness is present. This belief persists for a period of at least six months, and causes significant impairment in social, occupational, or other important areas of functioning.

Since the archaic origin of the term, first introduced by Hippocrates, the construct has undergone a vast change over the years – first from stemming from abdominal issues, to being viewed as a problem deriving from the nervous system (Freud’s influence), to its final concept as a mental disorder. It has been subjected to tremendous criticism, disagreement between experts, and ongoing debate about its classification. Even with the recent appearance of the DSM-5, in which the controversial and inaccurate use of the term ‘hypochondriasis’ has been abandoned (which is why I write it in quotation marks), the dispute remains unresolved.

Hypochondriasis pic 2

The disorder is, and has been throughout history, surrounded by a haze of issues. The symptoms patients present with are heterogeneous and show overlap with anxiety disorders, somatoform disorders, and obsessive-compulsive disorder. So where should it be classified? Also, the concept ‘hypochondriasis’ is stigmatised in society (“you are only imagining it”) as well as amongst clinicians, whose reassurance is dismissed and whose professional judgement is constantly doubted by their patient. Second opinions are often sought and GPs will be pushed for referral to specialists without the need for it from the clinician’s point of view. Poor patient-doctor relationships are often the result and lead to anger and frustration on both sides. Also, because of the focus on physical symptoms, it is very difficult for clinicians to recognise the mental origin of the disorder. All of the above makes it complicated to correctly diagnose someone as suffering from ‘hypochondriasis’. This has led to the realisation of a guide for clinicians, of which my chapter with professor Dan Stein is part. The book has only very recently been published, which prompted me to write a blog entry for the EUSARNAD website, not in the least because it is a concrete outcome from a collaboration established by EUSARNAD.

I had no idea how complicated and misunderstood ‘hypochondriasis’ is, and I was unaware of the controversy that has been around it for centuries – and still is. Unfortunately, mental health problems still come with a huge stigma, and in that ‘hypochondriasis’ seems to be one of the frontrunners.

Key to EUSARNAD is advancing research in anxiety by uniting researchers from all over the world and thus allowing them to collaborate closely and generate new ideas. EUSARNAD also enables individual researchers to gain wide-ranging, additional insights that go beyond the initial purpose of their exchange schemes; to think slightly out of the anxiety box – this book chapter is a clear example. From this opportunity to write the chapter I have not only learned about ‘hypochondriasis’, but I now also have a better appreciation of the heterogeneity and delicacy of psychiatric disorder in general. Within this niche, however small it may be, I am very grateful to have contributed to a book that can hopefully make the lives of clinicians a little easier in their understanding of the disorder, and most importantly, of their patients.

– Nienke

(For those interested, the book is now available! “Hypochondriasis and Health Anxiety: A Guide for Clinicians” – Editors Vladan Starcevic and Russell Noyes)

Würzburg to Cape Town, part two – by Maximilian Geiger

Six weeks have passed very quickly – and I am writing this from back in Würzburg. Browsing my notes, reports and photos, the amount and variety of experiences feels simply amazing.

My secondment started with a meeting with Dan Stein and the local MRI experts, Jonathan Ipser and JP Fouche plus Henk van Steenbergen another visitor from Leiden University. During this meeting I got a first impression of the work that is currently done in their workgroup at the Groote Schuur Hospital in Cape Town. Being still a little paralyzed and overwhelmed by South Africa, Cape Town and my new working environment, I was asked about my expectations and interests. I am more than happy that my reply was answered with the opportunity to work on some ‘real’ data in the field of social anxiety disorder.

During the first days Jonathan offered a lot of his time in setting up my workstation and helping me to get into the data. We discussed what research question and what approach would be most interesting. In retrospect I am very happy that we found a good balance between my previous skills and the opportunity to extend these skills. Here it was very helpful that Jonathan worked on a similar project and we could share experience.


During my secondment I also got in touch with the field of biology: Cape Penguin (Spheniscus demersus)

The comparison between functional connectivity in certain resting-state networks between patients with social anxiety disorder and healthy controls led to some interesting primary results. Unfortunately the time was too short to completely finish the analysis, and to answer some open questions, but I hope to continue working on this now I am back in Würzburg. I had worked on topics related to social anxiety disorder during my Bachelor’s thesis and Master’s thesis before. It is an interesting and multifaceted disorder but also debilitating. It was great that my secondment in Cape Town gave me the space and the opportunity to get back into the recent literature and relate this to my analysis. I also became aware of a lot of methodological and technical issues. In studying functional connectivity it is often not very clear and sometimes even controversial which approach in analyzing data one should follow, and it is a challenge to find the technique that is most valid in answering your research question. I think I picked up some very useful skills which will be very helpful in my future work.

Cape Town University attracts renowned researchers and I benefited a lot from exchanging thoughts and listening to interesting talks while I was here. Even though time was short I am very happy that I also got the opportunity to visit other mental health departments in Cape Town, to see the scanner facilities and learn a little about other imaging modalities such as DTI.

Six weeks South Africa is more than another filled page in your passport. Cape Town offers a beautiful nature and landscape and you get the possibility to get so close to all kinds of animals you would never believe. But on the other hand you never have to miss the vibrancy and cultural offers of urban life because it´s all there. My visit to Cape Town provided me with varied cultural and academic experience. I really enjoyed the possibility in exchanging thoughts and the freedom in following and focusing my interests in the project. It feels like I will benefit a lot from the techniques and skills I learnt during my stay and I am looking forward to working together with the researchers from Cape Town in the future.


Definitely the place to be in 2014: Cape Town

ECNP Workshop on Neuropsychopharmacology for Young Researchers, Nice, France – by Verity Pinkney

An audible sigh of relief announces take-off with the expectation of leaving the seemingly endless rain in Southampton behind to land in Southern France drenched in glorious sunshine. The European College of Neuropsychopharmacology (ECNP) invite to attend their annual Workshop for Young Researchers was met with excitement in our office when we realised that three of us (Ben Ainsworth, Joanna Miler and I) were lucky enough to have been awarded a place to attend. The three-day conference in Nice aims to give early-career researchers like myself a chance to present and discuss their research in interactive sessions and provides ample opportunity to network with likeminded students, postdocs and psychiatrists from all over Europe.


The Nice vista, captured from our hotel balcony

Within minutes of our arrival we began our networking experience and met Mathieu, a Frenchman from Montpellier who has traded France for Leicester to study for his PhD at De Montfort University. After a not-so-brief detour around central Nice and a visit to the wrong hotel we soon found ourselves in the Boscolo Plaza hotel lobby which buzzed with energetic researchers at the welcome reception.


Day 1 kicked off with a good selection of impressive talks covering a wide range of topics, from the use of proteomics in CNS disorders to animal models of fragile X syndrome. One talk in particular that caught my attention presented interesting fMRI data showing that threat-related brain function could be moderated by daily bright-light intervention; an area that offers exciting possibilities in how treatments of this type may work in Seasonal Affective Disorder. After a brief interlude for lunch, the quality of the talks continued throughout the afternoon and was followed by an evening of poster presentations, networking, French wine and the local cuisine.


The first couple of talks in each session were presented by distinguished scientists in their field of research. These were a great way to illustrate the positive impact a lifetime of research in Psychology and Psychiatry can have to an audience of fresh-faced scientists keen to consider this challenging career path. Saturday began with an inspiring talk by psychiatrist Thomas Schlaepfer who presented some exciting results on the use of deep brain stimulation to alleviate symptoms of severe, treatment-resistant depression. We then enjoyed a few hours of sea and sunshine, before going to two well-attended optional talks covering “how to write good papers” and two personal accounts of careers in industry and academia.


This was again followed by another enjoyable evening of poster sessions where we quickly got chatting with other PhD students who talked enthusiastically and knowledgeably about their work.

After a third morning jam-packed with a wide range of talks, very quickly it seemed that our time in Nice was over. This ECNP workshop gave me the chance to meet some lovely people from a variety of different research areas and also gave me a first-hand account of the vast amount of top quality research that is being undertaken across Europe every day. I now look forward to attending the ECNP Congress in October in Berlin and hope to see some familiar faces there.

For further information about ECNP visit http://www.ecnp.eu/.

(Ed’s note: Based on the quality of her research and her poster presentation in Nice, Verity was selected by senior ECNP scientists to present her research at the ECNP conference 2014 in Berlin – congratulations Verity!) 

Würzburg to Cape Town, part one – by Maximilian Geiger

Sunshine, twenty six degrees, a little windy and no clouds – when I arrived in Cape Town on Wednesday morning I seriously doubted that during my visit I would ever be able to spend only one hour in a dark office room working behind a flickering computer screen. About six months ago I was offered the great opportunity to take part in the exchange program of the European and South African Research Network for Anxiety Disorders (EUSARNAD). It did not take too much contemplating and weighting up before I knew that I definitely wanted to go.

"J Block" - where I will be spending time working with Professor Dan Stein

“J Block” – where I will be spending time working with Professor Dan Stein

After departing Frankfurt, I was very excited but also a little nervous about what life in Cape Town would be like. Not visible to me as a passenger sitting in the middle row, but as announced by the copilot we passed the Table Mountain and the Table Bay on our approach to Cape Town. I had to wait until I had solid ground under my feet before I got the first impression of South Africa. When I left Cape Town International Airport, which was extensively renovated before the FIFA World Cup in 2010, the first thing I saw was palm trees, rough beautiful mountains but from the highway in my rental car I also caught sight of parts of the housings of the Cape Flats. Cape Town is an amazing city integrated in the natural topography and built around the Table Mountain at the eastern shore of the Atlantic Ocean.

After passing fall and winter in Europe, it is hard to even think about working when you surrounded by this beautiful scenery. This of course changed dramatically when I met the resident researchers, who managed to be extraordinary productive and apparently overcome all the obstacles imposed by living in this beautiful city. I was very interested in meeting these people. Dan Stein, Jonathan Ipser and JP Fouche gave me a warm welcome on my first day. Even though I will be here only for four weeks they offered a lot of their time to introduce me to the clinic and my project. The idea is to compare the functional connectivity of fMRI resting-state networks of participants with an anxiety disorders and healthy controls. Considering that I will be here for such a short time I immediately started working. It is an exciting but also demanding task which will hopefully lead to some preliminary results or at least to some learning experience.

mx_cape point

Not in the dark back office at this particular moment!

Brain imaging data analysis is done far too often in the dark back office. At least from my office in the Department of Psychiatry and Mental Health at the Groote Schuur Hospital I can see the foothills of the Table Mountain massif which will hopefully be motivating and inspiring. I am looking forward to the upcoming next weeks in this unique city with lots of cultural and academic experiences with the EUSARNAD program.

Cape Town: the best city in the world – by Nienke Pannekoek

One month in Cape Town is not enough. It just does not cut it. It is not enough to enjoy the city and all it has to offer, but also not to really get started on a big, international collaboration. Just when you start to find your feet and get into the topic of your project, it is already time to go. It should not be much of a surprise that I jumped at the chance to return for another, extended period of 6 months to continue working on the social anxiety disorder mega-analysis at the Groote Schuur Hospital!

Together with Jean-Paul (JP) Fouché I was coordinating a big international project on which we had already been working since JP’s visit to Leiden, The Netherlands, in early 2012. At this stage, the social anxiety mega-analysis (or, as we like to call it, the mega-SAD) involves MRI data of subjects with social anxiety disorder and control subjects from 11 research centres in five countries. This does not just mean trying to get the data from all these sites in one place, but it also means dealing with the ethics committees of each centre, which takes time and patience. During JP’s visit to Leiden and my first visit to Cape Town last year, we had been doing some necessary preparatory work. It took us a while, but once we were in possession of all the data, we could really dive in and my six months were spent doing quality checks, troubleshooting, preprocessing, troubleshooting, creating the analysis designs, and more troubleshooting. Did I already mention that there was a lot of troubleshooting? All this resulted in a final dataset of a whopping total of 458 subjects! Each step forward got us more and more excited about the project, and the initial preliminary results look extremely promising.


JP Fouche and I have spent a lot of time working together since early 2012

Unfortunately I am no longer in Cape Town, but some final analyses are now running, and we are looking forward to start writing up the results very soon. Apart from working on the mega-analysis, I have had the pleasure of attending meetings, seminars and lectures, and some new and exciting collaborations have been established with my colleagues at the Psychiatry Department of the Groote Schuur Hospital.


The stunning backdrop of Table Mountain

Of course, living in the most beautiful city in the world (it didn’t get voted ‘best city in the world 2013’ by the Telegraph for nothing…) means that there is more to do than just work. My free time was spent hiking and running on and around the Mountain, wine tasting (and even a combination of both, in costume!) failed attempts to win quiz night, making many great friends, spending time on the beach in front of my house, and enjoying fantastic food in the Mother City. It has been a journey with many ‘firsts’. When you come from a cold and rainy country like The Netherlands, spending Christmas in the sun is such a strange experience! And to celebrate New Year’s Eve ON TOP of Table Mountain is something you only do once in a lifetime.


Working (slash-running-slash-wine tasting) with colleagues

One thing I will never forget is being in South Africa when the beloved Nelson Mandela passed away. Knowing beforehand that this was a possibility during my stay, I was not sure what to expect in the unfortunate event of his death. However, the unity that I witnessed in Cape Town was astonishing. I went to several events remembering Madiba, including an interreligious service that featured speakers each of a different faith, where all people had gathered as one to remember him. Apart from expressing profound sadness of his passing, South Africa paid respect and gratitude to the Father they loved. But there was also joy, and Mandela’s life was energetically celebrated. Several memorial concerts were organised nationwide, and I attended the one at the Cape Town Stadium. The speeches by politicians were moving and heartfelt, the artists were visibly proud to pay a musical tribute to Madiba, and the crowd was celebrating his life. The message of all speakers and performers was clear: South Africa must never forget this great man and build upon the foundations he laid for a better future.


The mega-SAD analysis is still in full swing and there are countless opportunities to continue this project. I am looking forward to presenting the results in the near future, and this is only going to be the first of many publications that can be based on the international database resulting from this exciting collaboration.

For me, this opportunity has meant more to me than I could have ever imagined. The project has been challenging and educational, and I have learned a lot. As for living in the Mother City, Cape Town has fully embraced me and I have fully embraced Cape Town. After my previous visit last year, I knew within 24 hours after arriving in Leiden that I would be back in South Africa a couple of months later. This time I do not know exactly when I will be back, but I can guarantee that it will not be long. Once one has experienced life in Cape Town, once simply cannot stay away!

– Nienke




Don’t fall asleep! Sleep Research and clinical experience exchange – by Gosia Lipinska

As I’m writing this I’m on the train back to Southampton and its almost 1am. The reason I’m coming home so late is not frivolous first year party escapades, rather it’s a late night in the sleep laboratory in Portsmouth. And that’s one of the reasons I’m here – to experience the running of sleep laboratories in an international context.

The sleep laboratory at the University of Cape Town is brand new. We managed to build it when our department moved from one side of the campus to the other. It has a control room, two dedicated sleep study rooms complete with beds, polysomnographs, intercoms and cameras. Members of the UCT Sleep Sciences team have trained locally but it’s important to know that our lab meets international standards. I’m here in Southampton to check whether our laboratory set-up and techniques of electrode placement and scoring polysomnography are correct, and to pick up some tips.


Queen Alexander Hospital, where I attended the night-time sleep studies and outpatients sleep clinic.

My experiences here so far have been incredibly positive. I’ve met with Dr Cathy Hill who is taking me under her wing to show me the world of clinical sleep disorders in children. I’m attending her clinic and a sleep course she’s giving later in my month’s stay. I am also going to get involved in writing a paper on sleep at high altitude and whether this affects cognitive functioning. I’ve also been working with the sleep technologist at Cathy’s laboratory – Johanna, who has been wonderful in helping me go through sleep scoring.

And now I’ve been to the Queen Alexander Hospital’s laboratory, which also sees clinical patients. There I’ve been working with a technologist, who’s actually from my home country, South Africa. We’ve been in the laboratory together doing sleep polysomnographic set-up. I’ve picked up some handy tips and have also been reassured that what I know is indeed useful.  Furthermore I’ve started to do some work with Dr Hazel Everit and a number of other collaborators on a Chochrane review of anti-depressant treatment in insomnia.

The team here at the University of Southampton has been incredibly welcoming and supportive. Professor Baldwin has shown me around and introduced me to many of his colleagues, and facilitated lots of meetings, case presentations and journal and film club meetings, which have been wonderfully stimulating.

Another big part of my time here is spent with Professor Baldwin seeing clinical psychiatric outpatient cases, which has been extremely valuable. As part of my clinical training back home, I’m seeing patients with brain injury. However, I don’t get to see a lot of psychiatric cases, so this exchange is filling an important clinical gap for me. I’m seeing a variety of cases including individuals who are diagnosed with anxiety and mood disorders. I may also see patients with psychotic disorders as well as observe a session of ECT (electro-convulsive therapy).

On a personal front I’ve also managed to catch up with some family here – taking long walks in the British countryside. We even managed to get a good day of whether in – perfectly sunny skies.

UK with mama Lin

So far it’s been an exciting time! Looking back at the 10 days I’ve been here I can’t believe how much has happened already and I’m excited for the upcoming 18 days – its certainly
going to be busy – just the way I like it!

– Gosia

Sheri swoops on Swedish Shores – by Sheri Koopowitz

Quicker than I could say ‘Smörgåsbord’, I was whisked away to Sweden- the land of pickled herring, the Vikings, ABBA, and Alfred Nobel- for my month long attachment.

the university (1)

Arriving at the University of Gothenburg

I was sent to the very scenic Gothenburg on the west coast. Autumn is a particularly beautiful season. I have never seen such beautiful hues of reds and oranges before! The stunning architecture and leafy city made for a wonderful and colourful backdrop to my month long stay.

The local architecture.

The local architecture.

Despite the icy cold weather, I had a very warm welcome when I arrived at the University of Gothenburg’s Department of Pharmacology. The department is most proud of their Nobel Prize winner, Arvid Carlsson, for his work on the neurotransmitter dopamine. After a tour of the department and a brief lecture on Carlsson’s work, it was down to business. I was offered two projects to join- a rat study and a genetics study. I said yes to both. I was particularly excited to work on the rat study as I had never been involved in any animal research. Apprehensive at first, I learnt how to habituate research rats to being held by humans (this was my first time holding a rat!). One particularly inquisitive rat decided to nibble on my finger, tearing the glove and breaking my fingernail in the process! But that didn’t discourage me- it was all in the name of science! Once the rats were habituated, baseline startle and freeze measurements were taken then the rats were fear conditioned and further measurements were taken. This was a great experience as I have never been exposed to this type of research before.

the department

The Department of Pharmacology, where I worked during my placement

My hosts were always friendly and helpful. For example, during fika (Swedish coffee break), everyone in the department would sit around a table drinking (strong!) coffee, eating kanelbullar (Swedish cinnamon buns) and talking about their research. It was during these fikas that I learnt the most. If someone ran into trouble with their research, everyone would give advice and suggest possible alternatives. No matter what the original topic of conversation was, it would always revert back to research.  It was an amazing academic environment to be in.


A ‘Kanelbullar’ the size of a plate!

My month-long stay has left a lasting impression on me. I’ve made new friends, acquired new knowledge, tried new foods, learnt a few Swedish words, and got horribly lost a number of times. It has been an amazing experience! Tack för denna möjlighet!

– Sheri

To the United Kingdom… and beyond! By Natalie Cuzen

In June 2012, jaded from my recent Master’s dissertation submission, I set off to the UK for my much anticipated EUSARNAD attachment. Much like Ben’s experience (EUSARNAD researchers clearly never miss a beat), on arrival I was transported directly to my base at the University of Hertfordshire in Hatfield – six months’ worth of luggage in tow – to attend a Good Clinical Practice seminar. I was unfazed by the day-long seminar, however, and instead delirious with excitement for what lay ahead.

QEII hospital, Welwyn Garden City - where the action happened!
QEII hospital, Welwyn Garden City – where the action happened!

My primary professional base was the Mental Health Unit at the Queen Elizabeth II Hospital in Welwyn Garden City, a short bus ride (and disastrously long bicycle ride, as I would later discover) from Hatfield. Under the mentorship of Prof Naomi Fineberg, we established an ambitious study to examine the clinical and cognitive profiles of patients with comorbid obsessive-compulsive disorder (OCD) and alcohol abuse. Selecting this decidedly understudied clinical group, we knew from the outset that we had our work cut out for us – OCD patients are notoriously avoidant and hence difficult to maintain as research participants. Adding substance addiction to the mix calls for creative and tenacious participant recruitment and retention strategies.

I can say without doubt, however, that the value of the data that we collected on this elusive but clinically important group far outweighs any difficulties that we may have experienced in the process. Thanks to Prof Fineberg’s collaborative links at the University of Cambridge, we were able to include in our study a test that involved administration of small electric shocks – dubbed “irritating snaps”- to the wrists. Dubious as it may sound (and I admit that I was hesitant at first), the snaps were fairly innocuous with participants calibrating the shock intensity themselves. Encouragingly, preliminary data from this task, together with our other assessments, have already revealed some interesting interactions between habit, OCD and addiction, and we look expectedly toward the results of ourongoing work.

Lotte and I on ICOCS presentation day (in our apartment in Vienna)
Lotte and I on ICOCS presentation day (in our apartment in Vienna)

In the space of six months, and in between research endeavours, I had the opportunity to travel to Harrogate for the BAP meeting, Vienna for the ICOCS and ECNP meetings (where Lotte and I shared a fabulous rooftop apartment for a week), Winchester for a cultural awakening and jam making experience hosted by David Baldwin and Julia Sinclair, and the Scottish Highlands for a wholly unofficial but wonderfully fulfilling quest to my ancestral roots.

Jam making with David Baldwin and Julia Sinclair in Winchester
Jam making with Professor David Baldwin and Dr. Julia Sinclair in Winchester

In the time following my attachment, I’ve also presented some EUSARNAD work at IADS and NPSA in Cape Town, as well as at EPA in Nice. In an effort to explore the many historical towns within Hertfordshire during my stay, I tracked down a local cycling advocate group which happened to be lead by members both twice my age and my fitness level. As the honorary member of this group, I found myself on several reasonably short and civilised bicycle rides in the Hatfield-St Albans-Welwyn Garden City region, as well as one unexpected occasion (note: I am a novice and nervous rider at the best of times) where I was unintentionally swept away on a 80km round trip to Aspenden. On the upside, this resulted in a special mention in the group’s riding blog, and you can read about it here: http://www.southhertsctc.org.uk/Cycle/weekend-rides/blog/2012-ride-reports/nov-2012/26novhatfieldtoaspenden.

Predictably, the ten months since my return home to Cape Town could not hope to compare to the hype and travel abundance of my six month EUSARNAD attachment in the United Kingdom; indeed, my attachment set a rather lucrative travel benchmark. I can say, however, that my stay was an enlightening experience on many accounts, and that the personal and professional networks that sprang from my attachment have proved over and again to be mixing pots for new and exciting (ad)ventures.

Flowers in Harrogate, opposite the famous Bettys Tea Room

–       Natalie

The BAP Summer Meeting 2013 – The EUSARNAD perspective from Carlotta Palazzo

Young residents and psychiatric patients have a lot in common. A paranoid attitute towards their colleague, repetitive patterns, obsessive checking behaviours, intrusive thoughts (will my patient survive?!) and they both spend the summer near their usual hospital. Sometimes practically inside it. So I was particularly glad to leave my Department for a few days and attend the annual BAP summer meeting thanks (thanks!) to the University of Southampton. The BAP meeting was in Harrogate, a place with the right atmosphere for a novel by one of the Brontë sisters. I had never been that far north.

lotte brain

The conference gave me a chance to get away from my usual work

The British Association of Psychopharmacology support various educational programs so not surprisingly there were many researchers under 35 attending, among them some other EUSARNAD exchangees such as Ben Ainsworth and Andy Crawford. It’s a great opportunity to make friends and meet like-minded young researchers as well as gaining  wisdom from some of the more experienced members. One of my personal highlights of the meeting was the Blogging service, managed by Suzi Gage, a  PhD student from the University of Bristol whose blog appears in the Guardian website.


It’s impossible to attend all of the sessions, but I gave it my best go, including an introduction to computational modelling in psychiatry that left me pretty interested and with many doubts at the same time (and also a little dazed!). A session of particular interest to me anxiety disorders session was chaired by David Baldwin and David Nutt, hosting one of the EUSARNAD mentors as a speaker, Nick Van der Wee, with a talk on possible improvements in drug treatment in anxiety disorders. The whole symposium focused on experimental medicine with Gerry Dawson illustrating the P1vital programme and Sally Adams from Bristol showing the results of her group’s studies on cognition and face-processing.

The University of Southampton’s Matt Garner revealed the results on his development of an experimental model of GAD – I had the chance to see the CO2 model while in Southampton last summer and I was surprised about this efficient way to provoke an anxious state in healthy controls, which is useful for better understanding of GAD. The poster sessions were pretty crowded and someone even had an interest in my work (!) on the duration of untreated illnesses.


The Southampton University BAP Delegation, including EUSARNAD members Carlotta Palazzo, Ben Ainsworth and Professor David Baldwin (as well as some members-to-be)

During the last evening, a formal dinner was held in Harrogate theatre where many young researchers, both undergraduate and postgraduate, received awards and recognition for their achievements over the last couple of years. Later on, the Lifetime Achievement Award was  this year dedicated to Charles Marsden, who gave a great speech covering his impressive and eclectic career. Overall, it was a really interesting conference and I felt pretty lucky to have the chance to attend, and meet so many people who were previously just named authors on journal articles I read! And, let’s say it: how many of you guys have a photo taken by David Nutt?

– Lotte