Welcome to the first PRONIA newsletter, coming this time from The University of Birmingham, UK. With these bi-yearly newsletters we hope to introduce to the PRONIA project and keep you up to date with our progress so far, our plans for the future, and what individual members of the consortium have been up to since the last newsletter. We will also report on past meetings and give announcements of upcoming events. In addition, each newsletter will focus in on one of our PRONIA team sites; this time The University of Birmingham, and our PRONIA team members here in ‘Brum’ (the local name for Birmingham).

The PRONIA project is a European Commission funded study with collaborators in the UK, Germany, Italy, Switzerland, Finland and Australia. The purpose of PRONIA is to develop a computerised tool which can predict the onset and course of early psychotic illness. Reliable and broadly accessible prognostic tools will significantly alleviate the burden of psychotic illness by enabling individualised risk prediction, and paving the way to the targeted prevention of psychoses. However, to date no reliable prediction tools have been developed.

Primarily we are interested in the prediction of frank psychotic illness in individuals who are currently considered to be at risk of developing psychosis. Using a combination of different data types we hope to identify markers of risk which will allow us to predict whether an individual will develop psychosis, as well as which stage of psychotic illness they are currently in, and what their psychosocial outcomes will be.

To achieve this goal, we are collecting information on psychopathology, structural and functional neuroimaging, neuropsychological, metabolic and genomic data, as well as information on other factors that could affect outcome, such personality, trauma, resilience and coping strategies. We collect this information from four different groups of people aged 16-40 years: those with recent onset psychosis, young people who are at-risk for psychosis, individuals with recent-onset depression, and healthy controls who have never experienced living with a mental illness. We then follow up participants at multiple time points over an 18 month period in order to monitor the development or remission of their symptoms. Finally, the data collected undergoes complex machine learning algorithms in order to develop reliable prediction tools.

The PRONIA consortium is comprised of 7 academic partners; University of Birmingham, UK, Ludwig Maximilian University Munich, Germany, University Hospital Basel, Switzerland, University Hospital Cologne, Germany, University of Turku, Finland, University of Udine, Italy, and Melbourne Neuropsychiatry Centre, Australia; and 4 private sector partners; Dynamic Evolution, GE healthcare, GE Global Research, and GABO:mi.

We’re currently celebrating PRONIA’s first birthday, and after a year of hard work building a solid infrastructure PRONIA has begun to recruit her first participants!

The project began just over a year ago with the kick-off meeting in October 2013 at the Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany. During this meeting, data acquisition instruments and protocols, including clinical, neuropsychological, MRI, and blood sampling were discussed. During the early part of 2014 these were then finalised.
Our colleagues at The Ludwig-Maximilian-University (LMU) Munich, The University of Cologne and Dynamic Evolution in Germany worked to develop and optimise the PRONIA portal to enable us to have a platform for clinical communication, patient management, data integrity, and easy and safe data digitalisation. Members at The University of Udine in Italy developed the PRONIA PEBL battery, a selection of neuropsychological assessments run via a tablet which automatically records participants’ results. At The LMU Munich, The University of Basel, Switzerland, and General Electric Global Research, members of PRONIA developed neuroimaging protocols, and at The LMU Munich, our colleagues developed protocols for collecting metabolomic and genomic data from participants.

Exactly one year ago in December we had our first training workshop on the many clinical measures which we are using in PRONIA. This was held at the Early Recognition and Intervention Centre for mental crisis (FETZ) at the Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Germany, and for many of us was the first chance to get to know each other, as well as exploring the amazing Christmas Markets of Cologne!  In April, the 2nd PRONIA Steering Committee Meeting was held in Florence, Italy at the Schizophrenia International Research Society Conference. More recently we held our 2nd PRONIA General Assembly Meeting in October at the Università degli Studi di Udine, University of Udine, Italy. Here we greeted our older members as well as welcoming many new members to our PRONIA team. Further training sessions and workshops were held, as well as reviewing past achievements and difficulties experienced by each site and looking forward to and anticipating the next year of PRONIA.

Recruitment

This year we have achieved ethical approval across all sites, with our last site Birmingham gaining both ethical approval and NHS support from the Clinical Research Network in July this year. This has enabled us to start our recruitment. Across our six sites in Europe, where we collect the data which will be used to develop PRONIA’s prognostic computerised tool, we have currently recruited 337 participants, including 73 individuals who are considered to be at risk of developing psychosis, 73 patients with a recent onset of psychosis, 55 patients with a recent onset of depression, and 136 healthy control participants.

Looking forward over the next few months we hope to continue to develop and optimise much of the work we have already started, including further improvements of the clinical evaluation procedure through immediate digitalisation of the acquired information by means of mobile PRONIA applications.  More specifically, At The University of Cologne, The LMU Munich and Dynamic Evolution in Germany, our members are working towards developing PRONIA@home; a patient interface where participants can complete questionnaire measures at home rather than having to visit us for each of their follow up assessments. Our colleagues in Udine are working towards the future commercial use of our neurocognitive assessment tool. Our colleagues at LMU Munich are proceeding with the implementation of NeuroMiner2 – an advanced machine learning platform that will be distributed to the consortium end of next year. This analysis tool will allow us to build machine learning predictors based on the PRONIA data in a highly standardised way, thus facilitating the integration of prediction models across the partners in the consortium. Across all sites we are enlarging our healthy control sample in order to develop norms from the general population for our neurocognitive battery and to generate neuroimaging-based reference models which will be used to calibrate our MRI data. We will also soon be running a travelling healthy control participants study between all of our European PRONIA sites, in order to check the inter-site reliability of our MRI scanning machines and further attenuate site-related differences in our MRI database.

PRONIA’s consortium consists of 11 partners, and combined, makes up to over 100 individuals. Within this group, we come from a great range of backgrounds, including: clinical psychology; neurology; radiology; bio-engineering and psychiatry. Along-side our work on PRONIA, consortium members are working on other prestigious research projects, and presenting at conferences both nationally and internationally. Listed below are a few of our consortium members’ most recent achievements.

University of Birmingham

Dr Katharine Chisholm (Research Fellow and site manager at Birmingham) spoke at the 9th International Conference on Early Psychosis in Tokyo, Japan, on promoting adolescent mental health, challenging stigma, and improving mental health literacy using intergroup contact. This reported on the results of some of Dr Chisholm’s PhD research; a randomised controlled trial run in schools in Birmingham, UK, which aimed to promote mental health, improve knowledge of mental health and illness, and to challenge stigma of mental illness in adolescents. Dr Chisholm also presented a poster at the same conference on the diagnostic and trait overlap between psychosis and autism in a first episode psychosis population.

LMU Munich

Nikolaos Koutsouleris (Coordinator of the project) published a paper together with Stefan Borgwardt (Principle Investigator in Basel) on the MRI-based prediction of psychosis across two independently recruited and examined at-risk populations (pre-PRONIA data). The results of this analysis were promising in that they showed that multi-site prediction and hence generalisation of imaging-based predictors may be achievable. These findings will pave the way toward the validation of such candidate marker based on the currently acquired PRONIA database.  Furthermore, Lana Kambeitz and Sebastian von Saldern, colleagues from the Munich team presented posters on the (1) promise of MRI data fusion techniques in improving diagnostic accuracy of machine learning classifiers, (2) the performance of imaging classifiers in aiding the differential diagnosis of schizophrenia vs borderline personality disorders.
PubMed

University of Cologne

Professor Stephan Ruhrmann (Principle investigator in Cologne) published a paper, alongside Professor Frauke Schultze-Lutter (Scientific Advisory Board for PRONIA), on the prediction and prevention of psychosis, its current progress and future tasks. This was published in 2014 in the European Archives of Psychiatry and Clinical Neuroscience.
PubMed

University of Udine

Dr Carolina Bonivento (Research Fellow at the University of Udine) recently published a paper in Neuroimage (2014) under the topic, “Neural correlates of transitive and intransitive action imitation: An investigation using voxel-based morphometry”
ScienceDirect

Dr Marco Garzitto (Director of the psychiatric clinic of the Academic Hospital of Udine) presented posters at the National Italian Association for Early Intervention in Psychosis, and the international conferences, Italian Association for Child Mental Health; International Society for Magnetic Resonance in Medicine; Organization for Human Brain Mapping; and the World Psychiatry Association.

Dr Adele Ferro (Clinical Psychologist for Udine) achieved a travel grant for the submission of an abstract, which lead to an oral poster presentation at the EPA Congress 2014. The topic of this was “Postcentral Gyrus in patients at first episode of schizophrenia: a longitudinal structural MRI study”.

University of Turku

This year, Professor Raimo K. R. Salokangas presented at three international conferences. The topic for each of these conferences focused on The European Prediction of Psychosis Study (EPOS). At the European Congress of Psychiatry in Munich, Professor Salokangas focused primarily on the "Premorbid adjustment predicts functional outcome in clinical high-risk patients”. Later, at the Schizophrenia International Research Society Conference in Florence and the World Congress of the International College of Neuropsychopharmacology in Vancouver, Professor Salokangas presented results on depression, and its predictive link for paranoia.

GABO:mi

On 26.02.2014 the PRONIA Website went online in a great team effort. The team at GABO:mi together with all PRONIA partners developed the design, implementation and the content of the PRONIA website, the result of which you can see on www.pronia.eu. To date the PRONIA website counts 6014 sessions in 94 countries; in 29 of those countries all over the world we have even had more than ten sessions per country on the PRONIA website. We update our website on a regular basis and look forward to attracting more visitors to our pages, which offer information for scientists and professionals as well as help-seekers and relatives. A section for investors is currently under preparation.

The University of Birmingham is a Russell Group university located in the city of Birmingham, and is the UK based site for PRONIA. The School of Psychology at the University of Birmingham is one of the largest and most active psychology departments in Britain, with an excellent reputation for teaching and research. Over 80% of the research published at University of Birmingham has been rated as internationally excellent, resulting in a greater understanding of the relationship between brain, mind and behaviour. PRONIA’s Birmingham research team includes the Chief Investigator Professor Stephen Wood, Research Fellow Dr Katherine Chisholm, Research Associate Mariam Iqbal and three honorary research assistants, Alice Phillips, Alex Stainton, and Katherine Kidd. 

Professor Stephen Wood recently ranked on Thomson Reuters' list of the World’s Most Influential Scientific Minds 2014, meaning that his research is amongst the most highly cited in his field of psychiatry. Stephen specialises in Adolescent Brain Development and Mental Health and works closely with the clinical teams in Birmingham & Solihull. His primary research interests surround understanding the onset phase of severe mental disorders, and how to predict clinical outcome.

Dr Katherine Chisholm is the Research Fellow for PRONIA. Katharine’s interests focus on adolescent mental health, particularly early detection and intervention of mental illness; risks and resilience; and primary and secondary prevention methods. This year, Katherine completed her PhD, which focused on the promotion of mental health in schools, and in particular, the creation of a programme designed to reduce stigma associated with mental health difficulties. Katharine also manages the Autism and Psychosis Project, which looks at the diagnostic and trait overlap between psychosis and autism.

Mariam Iqbal is a Research Associate on the PRONIA project. She joins the team with a mixture of clinical and research experience. Mariam worked previously as a Psychological Wellbeing Practitioner as part of the NHS Improving Access to Psychological Therapies (IAPT) service, providing CBT treatment for individuals with depression and anxiety.  Mariam has also previously investigated the experiences of pregnant women with epilepsy.

In addition to these PRONIA team members we are joined three excellent students; Alice Phillips who is currently on a placement year from the nearby Aston University, Alex Stainton who is currently studying Psychology MSci, and Katherine Kidd who currently studies on the Psychology MRes.