It’s a problem which has faced the psychiatric profession for years – how can we reduce the number of suicides committed by seriously mentally ill people each year?
The key, a team of Aberdeen researchers believe, is simple: Just look into our eyes
A tray of food, a baby’s face, a bundle of cash – a series of everyday scenes appeared on the computer screen in front of me. My task was simple: rest my chin on the brace before me, face forward and allow my eyes to freely roam around the pictures.
Then the screen went black, save for a single red dot. I was instructed to follow it closely as it glided smoothly from side to side, then in undulating arcs, then blinking in and out of existence.
As I progressed from one test to the next, it all seemed pretty straightforward. But for many people, it was explained to me, the tests could prove problematic, even indicating an underlying psychiatric disorder.
The tell tale signs are all in the eye. Their gaze may lag behind an object and then catch up by making rapid skips called saccades.
“Saccades are very prevalent in schizophrenics,” explained Dr Philip Benson, sitting at a desk behind me. He was monitoring the path of my eye movements which were being captured on a high-speed eye tracking camera.
“There may also be something fundamentally wrong with particular parts of the visual areas around the brain that have developed from infancy that results in this abnormality in following something that moves on the screen.
To follow something accurately, whether a ball that’s falling, or a car that you want to want to avoid, that timing is very important.”
While the eye movement test may have seemed simple, years of work have gone into developing and fine tuning it.
Vitally, the Aberdeen scientists who have been developing it over the past 10 years may well be on the cusp of revolutionising the way we diagnose mental disorders – a game-changing discovery which could drastically alter the psychiatric profession, and the lives of millions suffering from a variety of mental disorders.
A REVOLUTIONARY TOOL
It’s been 10 years since Dr Benson – a lecturer in psychology at the University of Aberdeen – and his colleague Professor David St Clair, chair of mental health, began their study into the link between eye movements and psychiatric disorders.
The difficulties some people have with smoothly tracking objects has been known for over 100 years. But this study sought to explore this more deeply, aiming to see how powerful saccades are as bio-markers – a term used to describe measurable indicators of biological states or conditions.
The academics began their study looking at the difference between schizophrenics’ eye movements, comparing them with healthy groups.
The results revealed eye movements as a strong indicator of schizophrenia, and so naturally the researchers were compelled to see if the test could indicate other major disorders.
Next up was bipolar disorder. The results were similarly pronounced.
“We discovered that there seemed to be these two serious illnesses that produce their own unique types of abnormal eye movements. So that was a big step for us,” said Dr Philip Benson.
“Discovering bipolar disorder had unique abnormalities was very exciting,” added Professor David St Clair. “So then we scratched our heads and thought, ‘what other illnesses may also have abnormal movements?’”
Flash forward to today, the scientists’ saccade eye test has proven to be able to recognise schizophrenia, bipolar disorder and major depression with better than 95% accuracy, and within 30 minutes.
This is already been heralded as a revolutionary tool by many members of the research and medical communities.
But the praise doesn’t stop there. Individuals with a range of psychiatric disorders, and their parents, have also been following the researchers’ progress eagerly – some even professing their willingness to fly to Aberdeen to be put through the test.
A SINGLE TEST
The main reason for this widespread excitement is that, quite simply, there is no other diagnostic tool in the psychiatrist’s portfolio which is as robust in finding bio-markers of the conditions.
“It can take several months or even years to observe all the symptoms to qualify a particular diagnosis,” explained Dr Benson.
“For example, David, as a psychiatrist, will conduct a series of interviews in order to isolate what type of illness a patient might have.
There you are observing the patient’s behaviour, listening to them explain their symptoms, and also taking their medical history – all of which will hopefully lead to a diagnosis.”
Prof St Clair jumped in: “But the problem is, unlike almost any other branch of medicine, there is no objective test to help with diagnosing or directing towards what the best form of treatment might be.
In medicine, there are blood tests, scans, echocardiograms and so on, but in psychiatry there is none of that at the moment.
“The gap of having these bio-markers, as we call them, is one of the great weaknesses of psychiatry, and it’s preventing it from moving beyond being purely based on observing symptoms and behaviours.”
The saccade test, Dr Benson added, has a “great deal of accuracy compared with other tests.”
He said: “For instance, is there a blood test for these disorders? A brain scan? What about genetic analysis? All of these methods have failed to produce a single test for a single psychiatric disorder. What we are talking about here is a single test.”
The implications of this new tool being approved for use by psychiatric professionals are many – from earlier and more accurate diagnosis, better choice and monitoring of treatment, and in turn, cost effective improvements and savings.
“Also, it’s key to make patients compliant with medicine,” said Prof St Clair.
“Many people don’t take their treatment because they aren’t even sure they have bipolar disorder, for example. If there is a test like this that they would have to take, they would be more likely to take the treatment. It doesn’t sound like a big deal, but in busy clinical settings, that in itself is a huge improvement.”
MASSIVE REDUCTIONS IN MORBIDITY
The aim of this study isn’t to pick holes in current diagnostic methods. Crucially, Dr Benson explained, it is to enhance what is already in place.
“It’s a supplement, an objective test, but not something to replace psychiatry,” he said. “It’s there to provide the psychiatrist or clinician and the patient with some hard evidence.”
It’s feasible, the researchers explained, for their saccade test to be approved for use in the medical profession within three to five years. First though, they are conducting further clinical trials, and passing through the multi-staged approval process.
They have gathered robust evidence on a handful of major mental health disorders, but they want to see what other conditions the saccade test can reveal.
In their current phase, they are exploring a less easily defined condition – mild to moderate depression, or “low mood” as it is often termed.
What they hope to discover is that it’s possible to identify specific bio-markers for each of the six or so sub-conditions which are currently placed under the umbrella term of “low mood”.
“If we can divide them into meaningful subdivisions, that will make an enormous difference,” said Prof St Clair.
“That’s because we are dealing with such a big branch of psychiatric disorders that, even an improvement of a few percent will result in massive reductions in morbidity, time off work, and suicides even, plus enormous savings in terms of healthcare budgets.”
The Saccade Diagnostics team is now seeking about 200 volunteers for their study. Volunteers should be between the ages of 18 and 60, male or female, have experienced low mood/depression and have been prescribed antidepressants in the past 12 to 24 months.
Anyone willing to be involved in the study should contact Eva Nouzova for further information on 07864 921272 or by emailing eva.nouzova@abdn.ac.uk.
As this is an academic study, participants will not be given the results after the test. However, they will be offered the chance to retake the test once the team have been approved for its use in clinical practice.
Case study –
Living with schizophrenia: “What the saccade test could mean for me”
Thirty years ago, at the age of 21, Graham Morgan began to be assailed by dark thoughts, leading him to suffer long periods of depression, find it hard to communicate with others, and even contemplate suicide.
By 28, this took a new turn, with sleep proving increasingly difficult, and his self destructive thoughts becoming stronger.
“Before getting help, I began to think I had evil spirits in my blood, and that things like the sea, sparkles on the sea or lights in rooms were spirits altering my thoughts.
It became intense very quickly, and my reaction was to think that I was so evil that I had to kill myself,” Graham explained.
At the time, he was diagnosed as being “floridly psychotic” – an acute phase of mental illness where full-blown hallucinations and delusions are experienced.
However, it would be a further two years until the term schizophrenia was properly brought into the equation, and the associated medical treatment for the condition was properly put in place.
Graham’s diagnosis in full is of paranoid schizophrenia, depression and anxiety. Since his diagnosis, he has been sectioned on four separate hospital admissions, and he is currently detained under the Mental Health Act on a compulsory treatment order, involving fortnightly injections of Risperdal Consta – a long-acting medication for people living with schizophrenia.
His most recent sectioning was four years ago.
In the main, he leads a positive life in Inverness, both in his personal life and as the manager for HUG Spirit Advocacy – a collective advocacy group, which represents the interests of users of mental health services across the Highlands.
While his condition is under control at present, Graham has always had difficulty in accepting his diagnosis as a schizophrenic, and his dubiety endures to this day.
“I would love to believe I have schizophrenia,” he said, going on to explain that he has often sought further hard proof of his diagnosis.
Most recently, Graham and his Community Psychiatric Nurse – who he has sessions with regularly as part of his compulsory treatment plan – went through his 30-year case history to reiterate the evidence.
It demonstrated how his periods on medication have always resulted in an improvement in his condition, from lightened moods, to keeping suicidal thoughts and hallucinations at bay.
That evidence is fine for his rational side, he explained, but his condition goes beyond rationality.
“Emotionally, I cannot connect with this feeling that I’m ill.
“My belief that I’m someone who damages people is much more real than the medical definition. Even when I look at this with the more rational part of my mind, I can’t deny it – I’m an atheist who believes I’m possessed by the Devil,” he said.
Something like the Aberdeen University team’s saccade test, Graham said, could be the key he and others like him need to fully unlock themselves from their psychoses.
“It would be such a relief that this experience is explainable, and that it’s not what I think. If I could admit to myself that I had schizophrenia, then I could stop believing some of the awful things I believe about myself.”
While his own opinion is that this diagnostic tool would be a blessing, Graham added that there may be some downsides. Some may say it could encourage an over-medicalisation of people’s experiences.
To define everything as a “malfunction” or “impairment” may have a negative impact on self-confidence or other areas of an individual’s life, he said.
Even with today’s proliferation of legislation aiming to further protect the rights of the mentally ill, and myriad campaigns setting out to increase society’s acceptance, it could be some time before the stigma attached to mental disorders are abolished, Graham said.
“What if you are diagnosed with schizophrenia at the age of 14, what could happen to your job prospects and insurance policies? Will you be seen as somebody who is impaired? Will you be considered different before you even become different?”
Already, Graham is imagining how he would treat such evidence if he were to receive it. Would he find ways to refute it as he has done with his current diagnosis?
Irrespective of this nagging thought, Graham remains firmly of the opinion that any positives of such a new diagnostic tool would far outweigh the negatives.
“If there was something that proved my condition to be schizophrenia, it would be such a burden off my mind. It would be wonderful. I’ve lived with this diagnosis for 20 years and I still just cannot accept what they say. They tell me it over and over again, but I just can’t incorporate it into my viewpoint.”
To find out more about Graham Morgan’s experiences, and the work of his team at HUG Spirit Advocacy, visit www.hug.uk.net