Through our long-standing affiliation with the Melbourne Neuropsychiatry Centre, we have become internationally recognised for conducting leading and collaborative research into the diagnosis and treatment of neuropsychiatric, neurocognitive, neurodegenerative, and neurological disorders.
Together, we can find new and better ways to prevent, detect and treat conditions of the brain and mind.
As a clinical and research team, we strive to find ways to improving health outcomes and the quality of life for patients and their loved ones – at the present day and for future generations.
Our areas of research interest include:
Differentiating severe mental illness from ‘organic disorders’
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research-areas
Current Studies
The MiND Study: a simple blood test to diagnose dementia quickly and accurately?
People with psychiatric, cognitive and/or neurological symptoms, and their clinicians such as psychiatrists, neuropsychologists, neurologists, and other specialists, often face the diagnostic dilemma of, “is this a primary psychiatric disorder, or is there something neurological or neurodegenerative going on”?
Despite gold-standard assessments, this question is not easily resolved. Timely and accurate diagnosis of dementia, especially young-onset dementia, is challenging.
Did you know that patients with young-onset dementia frequently endure a “diagnostic odyssey” of over 3-5 years, associated with multiple assessments (seeing an average of three to five specialists) and repeated and costly investigations, misdiagnosis, inappropriate treatment, uncertainty and negative outcomes, and diagnostic delay (if a diagnosis is reached at all)?
The Markers in Neuropsychiatric Disorders (MiND) Study is a new five-year longitudinal study that hopes to solve some of these problems.
MiND is led by Professor Dennis Velakoulis (Director of Neuropsychiatry Royal Melbourne Hospital, and Clinical Director of Melbourne Neuropsychiatry Centre), Dr Dhamidhu Eratne (Neuropsychiatrist and PhD student), and the team at Neuropsychiatry, Royal Melbourne Hospital, Victoria, Australia.
MiND is exploring the blood biomarker of neuronal injury, neurofilament light (NfL), in the assessment of cognitive, neurological and psychiatric symptoms, in a wide range of people from broad settings. Our pilot study (Eratne et al. ANZJP 2020) showed great promise for NfL as a diagnostic screening test for psychiatrists, neurologists and GPs. The ultimate aim of MiND is clinical translation, and the availability of a simple, routinely available blood test (think of it as a ‘CRP or ‘PSA’ for the brain), to improve timely and accurate diagnosis, and subsequently enhance the quality-of-life and outcomes for patients, their families, their treating clinicians, and the healthcare system at large.
The Study, funded by MACH, MRFF and NHMRC grants, has a target of 500 patients, with recruitment planned across Neuropsychiatry, general practice, memory clinics, as well as public and private health services and specialists (e.g., psychiatrists, neurologists, geriatricians) across Victoria, and nationally.
The MiND Study has partnered with national and international leaders, leading to an impressive MiND Study Group. Collaborations, just to name a few, include working closely with the Department of General Practice at the University of Melbourne, the Walter and Eliza Hall Institute of Medical Research, The Florey Institute of Neuroscience & Mental Health, and The University of Gothenburg and Lund University in Sweden.
If you would like to collaborate, or if you have a patient to refer to the Study, please visit: https://themindstudy.org
The Ramsay Hospital Research Foundation
The Royal Melbourne Hospital’s (RMH) Neuropsychiatry team has been awarded $750,000 by the The Ramsay Hospital Research Foundation (RHRF).
The project led by RMH clinical director of Neuropsychiatry Professor Dennis Velakoulis, is aimed at developing a blood test to help distinguish neurological and neurodegenerative illnesses from psychiatric illnesses.
This novel work will be in collaboration with Ramsay Health psychiatrists Professor Malcolm Hopwood (Albert Road Clinic Melbourne) and Professor Philip Mitchell (Northside Clinic Sydney).
The MiND program of research (The Markers in Neuropsychiatric Disorders, NHMRC 2020-2024) aims to identify whether a blood marker called neurofilament light (NfL) can help address this important question.
Crucially, the levels of neurofilament light is not elevated in patients with mental illness, meaning this test could differentiate between those people with mental health disorders and those with neurological disorders such as dementia.
“The main aim of this work is to reduce the time taken to diagnosis dementia. People who have dementia in middle age will often have seen their doctors with depression, anxiety or other mental health disorders years before the diagnosis of dementia is made. A test such neurofilament light may help in the earlier detection of dementia, could reduce the need for unnecessary expensive and time-consuming investigations, and improve outcomes for patients and their families,” Prof Velakoulis said.
The Ramsay Health Research Foundation grant will allow the Neuropsychiatry team’s work to extend the mood and anxiety disorders programs at Albert Road Clinic and Northside Clinic.
Previous Research - Music and Psychology and Social Connections (MAPS)
Young-onset dementia (YOD) is characterised by symptom onset prior to age 65. YOD is associated with unique challenges and significant psychosocial impacts for both the individual and their family. As many post-diagnostic services are targeted towards older adults with dementia, those with YOD and their caregivers often feel isolated, less supported and are at higher risk of poor mental health. Therefore, there is a great need for targeted interventions to support people with YOD and their caregivers.
The MAPS program has been designed by our team, led by Associate Professor Samantha Loi, in collaboration with Professor Felicity Baker and a team of music therapists from the Faculty of Fine Arts and Music at the University of Melbourne. It is an 8-week online group therapy intervention for people with a diagnosis of YOD and their caregivers. The program is co-facilitated by a psychologist and a music therapist, and combines cognitive behavioural therapy-informed discussions and music therapy in the form of therapeutic song writing. The main aims of the program are to improve mental health and coping skills, and increase feelings of social connection for couples affected by YOD.
What some of our participants say:
"The program helped us learn how to deal with it and not let it suffocate us"
"Hearing other people's stories and experiences made me feel like we are not alone"
"It was amazing what we were able to put together [the song]. It holds a lot of truth and value".
To learn more:
The program featured on a recent episode of the Psych Matters podcast, hosted by the Royal Australian and New Zealand College of Psychiatrists.
Huntington’s disease (HD) is a progressive neurodegenerative condition that manifests with motor, cognitive and psychiatric symptoms. It is a genetic disease which is autosomal dominant, meaning that there is a 50% risk of passing the gene from an affected person to the next generation. There are currently no cures for HD but symptomatic treatments. We are interested the progression of the disease and how it affects a person’s mood, quality of life and other behaviours as well as the family member who lives and supports them (https://enroll-hd.org/) . Currently our team, led by Professor Walterfang, we are investigating the phenotypical variation in HD by looking at whole genome sequencing, funded by the Bethlehem Griffith Research Foundation, in concert with Calvary Care Bethlehem. We investigate neuroimaging, animal models and lab neurosciences in HD, with Monash University (Professors Julie Stout and Nellie Georgiou-Karistianis), the Florey Institute of Neurosciences and Mental Health (Professor Tony Hannan) and Bio21 (Professor Danny Hatters), respectively.
Music and Psychology and Social Connections (MAPS)
If you are interested in participating in the MAPS program and would like to learn more, or if you would like to refer a couple affected by YOD, please contact us at maps-program@unimelb.edu.au
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currently-recruiting
Previous Research - Telehealth and young onset dementia
Better Care Victoria BRIGHT-YOD Project
The Bridging Gaps in Health using Telehealth for people with Young Onset Dementia (BRIGHT-YOD) Project was an innovation project supported by the Better Care Victoria Innovation Fund.
Young onset dementia (YOD) – dementia that occurs in people under 65 years of age – affects more than 25,000 Australians, making up almost 10 per cent of all dementia diagnoses.
It is a life-limiting illness that can cause those affected to lose up to 20 years of their life. They can also experience multiple, complex symptoms that require specific expertise for diagnosis and care.
People experiencing YOD, as well as their families and carers, experience several barriers to receiving the care they need. These can include significant diagnostic delays, navigating multiple different medical specialties, using support services designed for the elderly, and living with unmet practical, psychological ,and financial support needs.
The Melbourne Young Onset Dementia (MYOD) service in Neuropsychiatry at the Royal Melbourne Hospital is one of the few services nationally that can provide tailored, flexible, and expert services to those affected by this condition.
The Neuropsychiatry Service at the Royal Melbourne Hospital harnessed telehealth technology to give more patients access to its MYOD service and reduce the personal and economic costs for those requiring care in rural and regional Victoria.
In December 2020, the Royal Melbourne Hospital secured recurrent state government funding to continue the Melbourne Young Onset Dementia telehealth service. The BRIGHT-YOD project also received a high commendation in December 2019 in the Chief Executive Healthcare Innovation Award category of The Royal Melbourne Hospital’s Celebrating Excellence Awards.
For more information about the Project, including methodology, outcomes, learnings, please visit the Better Care Victoria website here
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bright-yod-project
Movement disorders
Huntington’s Disease
Huntington’s disease (HD) is a progressive neurodegenerative condition that manifests with motor, cognitive and psychiatric symptoms. It is a genetic disease which is autosomal dominant, meaning that there is a 50% risk of passing the gene from an affected person to the next generation. There are currently no cures for HD but symptomatic treatments. We are interested the progression of the disease and how it affects a person’s mood, quality of life and other behaviours as well as the family member who lives and supports them (https://enroll-hd.org/) . Currently our team, led by Professor Walterfang, we are investigating the phenotypical variation in HD by looking at whole genome sequencing, funded by the Bethlehem Griffith Research Foundation, in concert with Calvary Care Bethlehem. We investigate neuroimaging, animal models and lab neurosciences in HD, with Monash University (Professors Julie Stout and Nellie Georgiou-Karistianis), the Florey Institute of Neurosciences and Mental Health (Professor Tony Hannan) and Bio21 (Professor Danny Hatters), respectively.
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movement-disorders
Metabolic Disorders
Niemann-pick Type C Disease
Brain changes in Niemann-pick Type C Disease
Professor Walterfang has been involved in more than two decades of work and research in the adult-onset neurometabolic and neurodegenerative disorder, Niemann Pick type C disease (NPC), a recessive genetic illness that often presents with psychiatric illness such as schizophrenia prior to the onset of ataxia, dystonia and cognitive decline. We have published not only the standard reference reviews on neuropsychiatric and cognitive aspects of NPC (https://pubmed.ncbi.nlm.nih.gov/16720792, https://pubmed.ncbi.nlm.nih.gov/30632019), but undertook the first group structural neuroimaging studies utilizing magnetic resonance imaging (MRI) in the disorder, showing that brain changes in vivo largely matched those seen in animal models and human neuropathological studies (https://pubmed.ncbi.nlm.nih.gov/20484681, https://pubmed.ncbi.nlm.nih.gov/23237858). More recently, we have undertaken a suite of positron emission tomography (PET) imaging studies in the disorder, showing a characteristic signal of metabolic, inflammatory and tauopathic changes in the disease (https://pubmed.ncbi.nlm.nih.gov/32209649, https://pubmed.ncbi.nlm.nih.gov/30690666, https://pubmed.ncbi.nlm.nih.gov/33830335). We are further examining more sophisticated imaging techniques involving the cerebellum and other brain regions, and novel neuroimaging techniques examining the role of iron changes in the NPC brain, and have active research ongoing in cognitive and other motor changes seen in NPC patients.
More recently, Neuropsychiatry was a key site in the international phase 2B/3 trial of intrathecal cyclodextrin in NPC (https://clinicaltrials.gov/ct2/show/NCT02534844), and is involved in examining a range of other therapies in the disorder, including novel molecules and therapies with our colleagues Professor Bush and Dr Hung at the Florey.
Ongoing pre-clinical work includes an examination of the role of “killer” immune cells in NPC with A/Prof Voskoboinik at the Peter Mac, and the role of genetic modifiers in adult and pediatric patients with NPC with Dr Andrew Muncaksi in Wellington, NZ.
Neuropsychiatry Of Phenylketonuria
Professor Walterfang sees a number of patients with phenylketonuria (PKU), a genetic disorder of amino acid metabolism that results in a toxic buildup of the amino acid phenylalanine in the brain and, although now treated with dietary modification, often presents with neuropsychiatric and cognitivie symptoms across the lifespan. After publishing the definitive review of psychiatric and cognitive issues in PKU (https://pubmed.ncbi.nlm.nih.gov/31551819), we have also shown that untreated adults who return to diet show significant reductions in depression and anxiety in addition to cognitive symptoms (https://pubmed.ncbi.nlm.nih.gov/33461585). We are finalizing a number of neuroimaging studies in PKU and also looking at further studies on brain function in PKU adults, in addition to participation in upcoming therapeutic trials including gene therapy in the disorder.
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metabolic-disorders
Technology
The utility of technology can play a multiple roles in neuropsychiatric disorders, in inpatient settings, in the community and in residential care. These can range from very simple techniques such as utilising touchscreen technology (iPads etc) as a tool for engagement and learning (PubMed Article), a strategy to address neuropsychiatric symptoms associated with dementia (PubMed Article), to more complex technology such as socially-assistive robots (more here and here), which we collaborated with Latrobe University. In addition, the monitoring of neuropsychiatric symptoms is essential in order to design appropriate non-pharmacological and pharmacological interventions and a real-time method, the Symptom Assessment Manager (www.cerescape.com/sam) was successfully trialled at Neuropsychiatry (Reseach Paper).
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technology
Research leads
Albeit a small team, we have published over 600 articles in reputable national and international journals. We have received over 10 million dollars’ worth of research funding from State and Federal Governments, and many generous private benefactors. For a complete list of our publications, please visit PubMed via this link.
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our-publications
Our research collaborations
We are fortunate to work with leading organisations around the globe.
Are you a patient/carer, student, researcher, or organisation, who would like to learn more about our research work, please contact us via email at: neuropsychiatry@mh.org.au
