FACTSHEET: SINGAPORE CLINICAL AND TRANSLATIONAL RESEARCH IN PSYCHOSIS (STRCP)

Background

Schizophrenia and related psychotic disorders are among the most disabling disorders to afflict mankind. It is one of the world’s greatest public health concerns with schizophrenia listed as among the 5 leading causes of disability worldwide. In Singapore, schizophrenia ranks ninth (together with breast cancer) among all the various diseases in terms of the burden of disease that it causes (the burden of disease uses a summary measure of population health that combines time (years of life lost) due to both premature mortality and disability arising from the disease.

Despite the low lifetime prevalence of psychosis, estimated to be about 3% world-wide, it generates an enormous burden in both economic cost and human suffering. There is currently no cure for schizophrenia and its cause is not fully understood. Although there is a strong genetic basis - making genetic risk factors key targets for research - its low prevalence presents a challenge for the identification of such risk factors and ultimately the identification of individuals who will develop the illness, prior to its onset. And it is vitally important to identify and treat those with psychosis as earlier as possible. The suppositions that disorders were almost inevitably chronic with bleak outlook were refuted by an emerging body of studies which demonstrated that special focus on the early phases of illness could result in a substantial reduction in morbidity (i.e. reduction in disabilities, hospitalization, disruption in family, suicides and costs), an improved quality of life for patients and their families, and improved functional outcomes. 

In addition, the current treatments are lacking. Current antipsychotic medications improve psychotic symptoms but are associated with a variety of side effects – some would cause some form or motor movements disorders while others cause weight gain, and a higher risk of developing diabetes. These drugs also do not reverse the disease process nor reduce the range of cognitive impairments that are core features of schizophrenia and which causes the great social and occupational disabilities.

Research on the causes of and treatments for schizophrenia has forged ahead recently in three promising directions, all of which have emphasized the importance of neurocognition in schizophrenia: the identification of genetic risk factors that may eventually lead to cures for the illness; the identification of young individuals are at greatest risk for the disorder so that preventative measures can be instituted, and the development of new treatments that may reduce disability in those who already have the illness.

Research Objectives

The overall objective of this TCR Neuroscience Flagship Programme is to identify key genetic, biological, cognitive, clincial and social risk factors for psychotic disorders, and to establish the efficacy and safety of a neurocognitive-enhancing agent for patients with schizophrenia. 

The payoff of this programme is not just the significant contributions to the basic understanding of the disease process that it will bring – enabling the translation of these findings to clinical care, but it will give us better means of identifying individuals who are at imminent danger of developing psychosis. These would enable very early intervention and the prevention of complications and disabilities. It would also pave the way for more effective treatments.  

We expect that the huge amount of information that will be generated will also address some of the real-world questions that mentally unwell persons, their families, providers, payers and policy makers face in selecting, delivering, and financing optimal care.  

This Programme will focus on the following three interlinked projects:  

1.       A Comprehensive Genetic Study of Schizophrenia and Neurocognitive Impairments
2.       Prospective Observational Study of Young Adults at Ultra High Risk for Psychotic Disorders; and
3.       Double-blind randomized controlled trial of cognitive enhancement. 

Comparative Advantage for Singapore 

Due to the structured nature of Singaporean society, its small geographical area, and highly organized health, education, and military systems, Singapore may be the best place in the world to implement a longitudinal study of individuals at ultra high risk for psychotic disorders.  

The Institute of Mental Health (IMH), unique in its expertise and capacity, is able to conduct large-scale assessments of patients for the genetics study and pregnenolone clinical trial. The patient population comprising 1500 inpatients with schizophrenia and over 20,000 outpatients will enable the collection of complete samples of high-quality data for the genetics study and neurocognition clinical trials efficiently and quickly.  

The Team

The team led by A/Prof Chong Siow Ann includes internationally recognized scientists from various institutions in Singapore as well as from Duke University and the University of Melbourne.   

They encompass a broad range of expertise, from basic science (in genomics, neuroimaging) to clinical acumen regarding high-risk psychosis studies and assessment and treatment of cognitive deficits in schizophrenia.  

An extensive network of collaboration will be set up with the Genome Institute of Singapore, Singapore Tissue Network, Clinical Trials and Epidemiology Unit, National University of Singapore, University of Melbourne, Duke University, and the various imaging facilities in Singapore for the study of psychosis encompassing various aspects of early detection, epidemiology, genetics and treatment.  It will also involve other centres in Hong Kong, New York and Shanghai.