Orygen has received a $33 million grant from the United States’ National Institutes of Health (NIH) to develop models for predicting outcomes for young people who are at imminent and high risk of psychotic illness.
Orygen’s executive director, Professor Patrick McGorry, said the grant was, to the best of his knowledge, the largest competitive grant that had ever been awarded by the NIH to Australian-led medical research.
“It is hugely significant that this grant has been secured for mental health research, and is a significant acknowledgement of Orygen’s global leadership in early psychosis research,” Professor McGorry said. “The grant will enable Orygen to pave the way for novel and personalised treatment, and greatly improved outcomes, for a group of young people who have often been neglected by society.
“This grant is significant because psychosis, and especially schizophrenia, is often described as the ‘abandoned illness’ because it hasn’t been taken seriously by society. These illnesses typically cause severe and hidden suffering, a very high level of disability, lost potential and premature death.
“Preventing and reducing the impact of these illnesses is a number one public health priority, and this research grant will take us forward into a new future where we're able to do exactly that.”
Professor McGorry said the grant was recognition of Orygen’s 25 years of pioneering research in psychosis and would support a vast program of work aimed at developing robust models for predicting the trajectories of young people who are at risk of psychosis.
“One of the problems we have in early intervention in mental health is that we see young people coming into systems of care with a kaleidoscope of symptoms and, although we know they have a need for care, selecting the right type of care is a problem because we don't know exactly what their future will hold,” Professor McGorry said.
“Predicting that future – what kind of mental illness a young person is in the process of developing, or indeed if it's just a transient, self-limiting thing – is very important for treatment and care.”
The grant supports a project called Trajectories and predictors in the clinical high risk for psychosis population: Australian network of clinics and international partners (CHR-Aus).
CHR-Aus will involve Orygen researchers working with partners across Australia, Europe and Asia in order to collect extensive data on symptoms, biomarkers and clinical outcomes.
“We will also be collaborating closely with a parallel US consortium at Yale and Harvard to achieve breakthroughs in our understanding of how psychosis develops,” Professor McGorry said. “But perhaps the most exciting part of this new initiative is the link with novel therapies and drug discovery which will be yet another powerful dimension to this program of research.”
Professor Barnaby Nelson, the project lead and head of Orygen’s ultra-high risk for psychosis research program, said the research study would help deliver more reliable prediction models than ever before.
“We'll be recruiting a very large sample of young people who are at high risk of psychosis and undertaking a range of assessments – clinical interviews, neurocognitive and neurophysiological assessments, brain imaging and genetics,” Professor Nelson said.
“Once this large cohort is established, we'll be able to test out the prediction models that already exist in the field and – more importantly – develop new, more robust prediction models.
“Then, using another sample, we'll be able to see how externally valid these new prediction models are – in other words, how strongly they hold up across different clinical settings internationally and in different samples of young people.”
New technologies will be used to assess the wellbeing of young people and develop prediction models that are not only accurate, but adaptive too.
“We’ll be collecting what are called digital momentary assessments, which involves using a smartphone and other devices to record things like mental states, stress and context in real-time,” Professor Nelson said.
“This is a really novel approach for the field and will allow us to look at how somebody is tracking over time and detect early warning signs of imminent deterioration in mental state.”
Professor Nelson said better prediction models would ultimately improve clinical care, treatment and prevention.
“Ideally, we'll be able to introduce clinical tools that allow clinicians to input a whole range of measures in order to predict likely outcomes for individual patients,” Professor Nelson said.
“And because we'll be collecting dynamic data, repeating assessments over time, these risk calculators will be able to be updated as more data is collected.
“Having these more refined, robust, adaptive prediction models may allow us to achieve a holy grail in this area – more effective preventative treatments tailored to individual patients.”
Orygen secured the $33 million research grant in partnership with The University of Melbourne’s Centre for Youth Mental Health. The CHR-Aus project will be completed over five years.
Orygen began its work in first episode psychosis in 1984 and pioneered the now-national Early Psychosis Prevention and Intervention Centre (EPPIC) model in the early 1990s including the ultra-high risk strategy with Professor Alison Yung, who remains a key investigator on this project.
Other Australian and international collaborators on this project include Professor Matthew Broome, Dr Gerard Cagney, Professor Eric Chen, Dr Scott Clark, Professor Philippe Conus, Professor David Cotter, Professor Lieuwe De Haan, Professor Kim Do, Dr Louise Glenthoej, Professor Sung Wan Kim, Associate Professor Ashleigh Lin, Dr Dorien Nieman, Professor Merete Nordentoft, Professor Debra Rickwood, Professor James Scott, Dr Stefan Smesny, Professor Rachel Upthegrove, Dr Swapna Verma, Professor Thomas Whitford, Professor Marieke Wichers and Professor Naomi Wray.