In Conversation… Prof Argyris Stringaris

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Professor Argyris Stringaris discusses his research and the NIMH (National Insitute of Mental Health) with freelance Journalist Jo Carlowe.

Argyris’ exciting research includes the effects of experience on mood and machine learning and bio-statistics discussed in this JCPP editorial. He also talks about The CoRonavIruS Health Impact Survey (CRISIS) an international project he’s involved in to understand the coronavirus’ impact on mental health.

You can listen to this podcast directly on our website or on the following platforms; SoundCloudiTunesSpotifyCastBox, DeezerGoogle Podcasts and Radio.com (not available in the EU).

Prof Argyris Stringaris

Argyris Stringaris, MD, PhD, FRCPsych is a Senior Investigator at NIMH who researches and treats depression and related conditions in young people. He is a Professor of Clinical Psychiatry at Georgetown University. He trained in Child & Adolescent Psychiatry at the Maudsley Hospital in London and received his PhD from the Institute of Psychiatry, King’s College London. He served as an Attending Physician (Consultant Psychiatrist) at the National and Specialist Mood Disorder Clinic at the Maudsley and was a Senior Lecturer at the Institute of Psychiatry. He held an advanced Wellcome Trust fellowship and his research was funded by the National Institute of Health Research and the UK Biomedical Centre. His work on mood disorders has been awarded the 2014 Klingenstein Foundation Prize by the American Academy of Child and Adolescent Psychiatry, and the 2010 Research Prize from the European Psychiatric Association (EPA). His most recent book (co-authored with Eric Taylor) was published by Oxford University Press and awarded a High Commendation by the British Medical Association (2016). In 2018, Dr Stringaris was awarded the National Institute of Mental Health Outstanding Mentor Award. In 2018 Dr Stringaris was elected a Fellow of the Royal College of Psychiatrists as mark of distinction and recognition for his contributions to psychiatry. In 2019, Dr Stringaris received the 2019 Gerald L Klerman Young Investigator (under 45 years) Prize, the highest honor that the Depression and Bipolar Support Alliance gives to members of the scientific community. Also, Dr Stringaris was awarded the NIH Director’s Award for “for exemplary performance while demonstrating significant leadership, skill and ability in serving as a mentor.” Dr Stringaris is President Elect (2019-2021) for the International Society for Research in Child and Adolescent Psychopathology. (bio via NIMH)

Transcript

Intro: This podcast is brought to you by the Association for Child and Adolescent Mental Health, ACAMH, for short. You can find more podcasts and other resources on our website www.acamh.org and follow us on social media by searching ‘ACAMH’.

Jo Carlow: Hello, welcome to the In Conversation podcast series for the Association for Child and Adolescent Mental Health, or ACAMH, for short. I’m Jo Carlow, a freelance journalist with a specialism in psychology. Today, I’m interviewing Professor Argyris Stringaris, senior investigator at the National Institute of Mental Health, the NIMH, and Professor of Clinical Psychiatry at Georgetown University in Washington DC. The focus today will be on Argyris’s research and the role of the NIMH. Argyris, thank you for joining me. Can you say a little about yourself by way of an introduction?

Professor Professor Argyris Stringaris Yes. Firstly, thank you very much for inviting me. Yes, as you said, I’m a senior investigator at the NIMH and a Professor of Psychiatry at Georgetown University. I am, by training, a medical doctor and a child and adolescent psychiatrist. And I spend about… well, a good chunk of my time doing research, neuroscience research, primarily, trying to understand mood and what underlies mood changes in young people and how these changes are coded, if you like, in the brain. But also trying to understand how we and our brains interact with other human beings and our environment, particularly in young people. And I also spend a good part of my time doing clinical work. So looking after patients. Young people and their families. And I try to translate the research that my team and I are doing into clinical benefits and vice versa. So try to learn from our patients and families to inform our research.

Interviewer Right. Thank you. We’ll return to your research shortly. You have many titles, including president-elect for the International Society for Research in Child and Adolescent Psychopathology. Can you say something about your journey, in terms of how you came to be interested in the field of child and adolescent mental health?

Professor Argyris Stringaris Yes, sure. It may be an unusual journey. So in my early teens and even during childhood, I was very interested in research and trying to understand what was going on in the world. And I was pretty convinced that I would be either a physics-informed philosopher or a philosophically-informed physicist. Then through a series of, probably, decisions that were based on some teenage impulsivity, I thought that it would be very important for me to understand the brain. So that was in my mid-teens or so. And so I thought I’d become a neuroscientist. And then, in the end, said, well, I should do medicine for that. And part of this may have been an unconscious influence of people around me. I come from a family of medical doctors. So I ended up doing medicine with a very clear aim of doing something that related to human behaviour, the brain and neuroscience.

Professor Argyris Stringaris And then there were two main paths, that of neurology and then the other one of psychiatry. So I worked in neurology. I did part of my neurology training. And I decided to do a little bit of psychiatry to see how it is, just to make up my mind. And then, again, through a series of coincidences rather, I ended up working with some amazing people, particularly Professor Eric Taylor, at the time of the Maudsley and the Institute of Psychiatry at King’s. And I thought that, in order to understand what I always had wanted to understand, I should try to work developmentally, so start early on and understand what happens in childhood and adolescence.

So this is how I became a child psychiatrist. And after doing my basic training in general psychiatry, I did deep specialisation in child and adolescent psychiatry. And I became fascinated with the research questions, but also fascinated by the interaction with young people and their families. You get to see a young person over several years and follow them up, and this is absolutely incredible in terms of how much you can learn from that trajectory.

Interviewer You pretty much followed your childhood passion, really.

Professor Argyris Stringaris Yes. I must say, I consider myself a very lucky person in that regard. I don’t… I sometimes have the feeling that I’m not doing work, I’m just pursuing my long-term interests. I don’t think that all the time and I make it sound extremely smooth. There’s no reason to complain about anything, but, yes, it’s… I consider myself very lucky in that regard, yes.

Interviewer Okay. Well, let’s look at your work. You’re a senior investigator at the National Institute of Mental Health. Can you give some sense of what this role entails, but also say a little bit about what the NIMH does?

Professor Argyris Stringaris Of course, yes. So I guess I became a senior investigator only recently, and I want to emphasise that, so that I just want to make sure that people know that I’m not that senior in terms of age. But it basically means that I get the opportunity to lead a team of extremely talented researchers and clinicians, and that I work with them daily to care for patients, on the one hand, but on the other hand, as part of the, if you like, mission of the NIMH intramural programme… so the programme that the NIMH funds consistently… it also means that all the people we see are enrolled in research. So, we are trying to use the data we get, the clinical data we get, and link them to all the measurements that we take from the brain, their behaviour. So that’s my daily, my day-to-day.

Interviewer And you mentioned earlier about the importance of translating research into practice. Can you say something about how one goes about that?

Professor Argyris Stringaris Yes. Well, that is one of the biggest challenges at the moment. So there is… It is very difficult to translate knowledge from one area into another area. It’s just a general problem. This is not just about clinical medicine, and in particular, psychiatry and neuroscience, the linking between the two. It’s a more general problem. And so, for example, it has been a challenge to translate the amazing advances that we have had from animal research in neuroscience and brain research in animals, to our understanding of human disease, particularly of complex disorders like the ones we are dealing with in psychiatry, like depression, anxiety. So this has been difficult.

So there are several ways of doing this. I guess the one we are pursuing is we are trying to work with humans and we are trying to refine our measures, use the best possible ways of measuring either behaviour, understanding someone’s sadness, for example, or what happens in the brain. And measure them in such a way that we can link them, map them, onto each other. And then we use what we call computational modelling, and this refers to an approach that attempts to express in… take advantage of the formal language of mathematics, if you like, to express relationships that we either observe… So, we just say, okay, here are the data. Let’s see what they tell us about what is happening between brain and behaviour. Or we say, we have a very strong hypothesis. We think that this is what is happening. For example, when someone is sad, this is what is happening in their brain. Let’s express that mathematically and try to see whether that model, as we call it, really is reflected in the data, fits the data. So this is the approach we’re taking. It’s an approach that is being taken increasingly in the field in order to translate research.

Ultimately, though, the ultimate test is the models may fit very well and it may look good, but it needs to be tested against reality. And reality can be quite harsh often. So to see, basically, whether this leads to an improvement, a real change, in the lives of our patients. And here’s where the advantage of the… the uniqueness, I should say, probably, of the NIMH comes in. Is that we do all our research very close to the clinic. So it is quite unique that I have… I am the, as we say in the UK, the consultant psychiatrist of an in-patient unit. And that in-patient unit and the patients that we see, we are all committed to the research. So we can bring those concepts from research into the clinic in a safe way, and test them out, if that makes sense.

Interviewer It does. Absolutely. I want to look at your own research. So a lot of your research focuses on mood disorders. And you wrote a paper fairly recently called ‘Timing Matters’. This investigated the relationship between the timing of previous experience and mood. Can you tell me something more about this work, but also something about the main findings?

Professor Argyris Stringaris Sure. Thank you for asking. This is a work that we’re very excited about. It is very much in the spirit of what I was talking about before. Namely, a kind of computational approach to these questions. And what we’re looking to understand is how our mood changes according to what is happening in the environment. So we have a good intuition about this. We know that if bad things happen, we’re going to feel worse. If good things happen, we’re going to feel a bit better. But the question is, how much? What determines that? And what is necessary in the environment to create such experiences? And do people… and this is crucial… do people differ, do they vary, in how much they respond to their environment?

So for this, we did two things. We created what we call a mood machine interface, so, a computational device that is meant to change our mood by creating, if you like, an artificial environment. It’s a little bit like a gambling game. And it is set up in such a way that it can shift the experience that we have of the environment to be very positive or very negative by using the difference between what we expected from what we get.

So people have described this previously as an important influence on mood. They call it a prediction error. So, again, I’m saying this again, it is the difference between what we get from the environment and what we were expecting. It’s a good intuition. The particular novelty about our work is that we built this device, if you like, that can take mood and change it quite rapidly and strongly in people. And the second and maybe even more important innovation is that we fitted several different models and we said, look, there are some people who say that your most recent experiences in life are the most important ones. But there is a strong argument as well, a priori, that it may be your early experiences. So early on in the day, for example, or even early in life.

Now, it is hard to model, experimentally, the early life experiences, but we can model the early in the experiment versus late in the experiment experience. So we did that. We fitted mathematical models that distinguished between… give more weight to the more recent events or more weight to the previous events. And what we find is that early experiences have the strongest effect on our mood, and that recent experiences get dwarfed, if you like, by what’s happening early on. And this was very interesting for us. It meant that it could be quite crucial to… If we wanted to make changes in how someone feels, to do that early on rather than later. Now, I hasten to add, that this is all happening within an experiment at relatively short timescales. But it gives us an idea of what to expect. And now we’re now expanding that and we’re using this mathematical model to make predictions for other samples and other timescales which we’re hoping eventually to bring back into the clinic.

Interviewer Last year you wrote a fascinating editorial for the Journal of Child Psychology and Psychiatry, the JCPP, about the implications of machine learning and computational psychiatry. And in this paper you argued that medical trainees should engage more with computer science. What is your rationale for this and what impact did that paper have?

Professor Argyris Stringaris It was motivated by my own observation of what is happening in our field, that there is… Well, in medicine more generally, that there are rapid advances and they’re really rapid… they happened in the last, I would say, five or six years… in how machines can help us understand or help us at least predict what might be happening in the future. So in the editorial, I talk about instances in, say, dermatology or cardiology, so, heart medicine, skin medicine, where one can use a computer algorithm, and the computer algorithm can predict better what the person has, the disorder that a person has, than doctors, sometimes. So, particularly junior ones.

So this is extremely interesting and it is being used already in fields like, as I said, maybe dermatology, but certainly in radiology. Now, it doesn’t always work. It’s not going to replace doctors imminently in this role. But there is good evidence that, in some ways, computers, for certain tasks, particularly repetitive pattern recognition-type tasks, like recognising patterns in a photograph, in a picture, may be even better than humans. It may not need humans to train them. So the computers can, in a way, learn by themselves those structures. This is the other fascinating thing that people often don’t realise. It’s not that humans necessarily have to teach the computers. In fact, it may be superior if the computers are given the data and learn by themselves.

So this is happening in many fields. In some ways, machine learning has also entered our field of psychiatry, and it will help us in improved predictions, I think. And the problem is that these models are very hard to understand. Some people say that they’re even impossible to understand, which I think is a pessimistic view. But the medical training, the training that most medics has as the basis on which they operate, does not give any emphasis, place any emphasis, at the moment, on a curriculum of computer science and, or statistics. So bio-statistics is a very small course compared to other courses in medicine. And therefore, at the moment, I think doctors are not very well-equipped to understand those models. No-one is expecting, I’m not expecting, that the medical doctor should necessarily develop those algorithms or understand all their intricacies. But in order to be able to have a dialogue with computer science and be able to check and understand what is happening, I think the training does need to change.

There are also ethical problems that arise out of this, because computers, good as they may be in recognising patterns, they can easily get things wrong. And in order to regulate them, over-ride them, change them, fine-tune them, for all that, we will need an inter-disciplinary team, in which the human that looks after the patients and has the responsibility, the moral and legal responsibility, needs to understand what is happening with the models they apply. So I think it’s a very crucial thing. And in terms of the impact that this paper had, all I can say is that it led to numerous discussions with people from around the world who were writing to me. And each one of them with a very useful, helpful point of view for me. And I think, since then, there’ve been others who’ve written about it. And also, of course, before I wrote this editorial, this discussion has been ongoing in other areas of medicine.

Interviewer Argyris, what else are you currently researching that you’d like to mention?

Professor Argyris Stringaris I am fundamentally interested in human mood. So what is the thing that makes you get up in the morning and say, yes, I really want to go out and face life and all its vicissitudes? It seems to us so self-evident, that we don’t examine it, right? Yes, I do wake up every morning and I do go… Except when you don’t, right? When people don’t. Except when the system breaks down. When someone can’t get out of bed without being physically ill, as we would say. Except when someone doesn’t want to go about pleasurable activities. Why is this happening? This is one of the most fascinating questions, I think, in life, right? And so all my research, well, most of my research, centres around this question.

So we’re using techniques, like magnetoencephalography and functional magnetic resonance imaging, to map the process of wanting and liking things, and how we rate our mood onto the brain. We create different environments, as I was telling you before. We develop statistical techniques to help us understand how mood fluctuates. We look at it at the very, very granular level in a single individual, and how they change over the course of months. We look at it in a more population-based way, of looking how people’s ratings of mood and their brains change, in thousands of people, in samples and data sets we have access to. So all the research is geared towards this question, with the hope… And also, sorry, using treatments to see how that changes mood and what the mechanisms are that change mood.

And all this serves the purpose, the clinical purpose… Apart from the scientific fascination, it serves the clinical purpose of understanding why people don’t get up, for example, in the morning and what we can do to help them. Or when should we be able to say, look, this is normal variation. It’s okay. You may have days where you don’t get up in the morning. That’s absolutely fine. But knowing how to distinguish between that and the pernicious effects of severe depression, and know that in advance, is a very big task. So that’s what our research is devoted to.

Interviewer It’s fascinating, isn’t it? Why is evidence-based research of the type you’re describing so important when it comes to children and younger people’s mental health?

Professor Argyris Stringaris Yes. Well, there is… I would argue that evidence-based practice is, of course, important for everybody. We do want to base our thinking and our decisions on sound evidence. I think this is only common sense, right? But you’re asking a very important question, as it relates to young people. And there’s two things to say about this, I guess. One is that, when it comes to psychological ailments, as it were, to mental illness, particularly in young people, these are often stigmatised still. So people might not talk about them. But there’s another thing too, that everyone thinks they have a remedy, that can be derived from their own upbringing, their own cultural backgrounds. What seemed common sense in child-rearing 50 or 60 years ago, which included corporal punishment, we had to adduce evidence to say, well, look, actually, this may not be the best practice. So there are those things. So it’s important to say that, well, common sense is very important, of course, but it only gets you that far and you do want to see what the data tell you, what reality tells you. So that’s one thing.

The other thing is that, of course, mental health is tightly linked to youth. And this is because most psychiatric disorders that adults have really have their onset in childhood. It is very hard to believe this for most people, but that’s what the data tell us. Most mental illness that 25 year olds have really started, was evident, and would have been evident had we looked… and we know this from prospective studies, from epidemiological studies… in early adolescence, for example. So there is this trajectory which we want to use evidence base for, to help early on. And the crucial thing here is to do the right thing, the evidence-based thing, as opposed to do something that could be harmful or something that could be completely inefficient.

Put it this way, a drug that we would give to a young person that doesn’t have evidence of efficacy, of working, would, at the very least, would expose this young person to risks of side-effects unnecessarily. Similarly, psychological intervention, that does not have an evidence base, would expose this person, at the very least, to a waste of time, but maybe even unnecessary side-effects. Side-effects that they shouldn’t have because they shouldn’t be exposed to such a treatment. And such negative effects in a young person can be… during a sensitive period of development… can have long-lasting impact. So I think it is particularly important to be evidence-based in young people. But the problem is that, of course, creating the evidence base, coming up with the evidence, is hard, precisely because doing research ethically with adolescents can be a challenge.

Interviewer So it’s not just about getting in there early, it’s about getting it right.

Professor Argyris Stringaris Absolutely. And not getting it wrong. I’m sorry to emphasise this, but this is something that we often forget. That giving the wrong treatment is really bad and we should prevent this from happening.

Interviewer Do you think there’s enough research in that area?

Professor Argyris Stringaris Oh, no. It’s scandalous, actually, in some ways, because if you look at how much… Actually, I think the charity MQ have supported some studies that looked into this, if I recall correctly. There’s certainly papers that have come out recently, I think a couple of years ago in The Lancet was a particularly interesting one, where they looked at each pound or dollar spent on mental health versus what is spent, say, for cancer. And despite the fact that child mental health is far more important, just by the virtue of the fact that it’s much more likely to die, say, by suicide as a young person than from cancer as an adolescent. And the burden of illness in adolescence comes from mental illness. Despite all that there is a vastly disproportionate philanthropic investment in cancer. Same with government funding. This happens across the board.

The effect of that is, of course, that young people… There’s not enough evidence of this for young people in the mental health problem. So it’s extraordinary. Now, there have been some excellent initiatives, I think, by the MRC and the Wellcome Trust, amongst others, recently. And a huge focus by the NIMH in funding research for young people. And I think that it has been increasing as a field in the last decade or so.

Interviewer In an age where so much unregulated material can be accessed, what more can be done to promote evidence-based science?

Professor Argyris Stringaris I would say that it is communicating. So we talked about how to produce the evidence base. So what is necessary in order to produce the evidence base, and that includes investment. Now, again, we medical doctors and researchers are not fantastic often at communicating our results and at communicating the evidence base. So it will take training for most of us to be able to be better at that and for our organisations too to produce material that is accessible to young people, that young people and families will like looking at. Because this is a very important component. That contains information about the evidence that can be useful for them. We will need… I guess this is something where there should be inter-disciplinary work with journalists and people who know about how to communicate such information. I think this is crucial and, actually, under-appreciated.

Interviewer Argyris, what else is in the pipeline that you’d like to mention?

Professor Argyris Stringaris Well, we have started this international initiative called Crisis Coronavirus Impact Survey, where I think, by now, it’s probably fair to say that more than 50 senior researchers from around the world are taking part. And it’s an attempt at understanding the impact of coronavirus on people’s mental health. And also of… maybe a bit further down the line, of developing treatments for those who will need it the most in the aftermath of the pandemic. And use scalable interventions. But crucially, only for those who need them, as opposed to, as I said, providing treatments or interventions that are unnecessary. So building the evidence base around treatment. And thirdly, it is also an opportunity to use samples of participants, who are well-characterised, about whom we know a lot from our previous studies, and see how the coronavirus pandemic has impacted on their lives. And therefore see whether their genetic make-up or the way their brains are wired can explain why they reacted differently to the stress of the pandemic.

Interviewer And is that work focused on teenagers and young people?

Professor Argyris Stringaris The Crisis Network, as we call it, is both global, international, but also spans all ages. My own research is particularly focused on young people and their families, but we also do, and many other people do research in adults and old-age populations.

Interviewer And I know it’s early days, because we’re not that far into the coronavirus pandemic as we’re speaking, but what are your personal thoughts about the impact of the pandemic on the mental health of teenagers and young people and children?

Professor Argyris Stringaris Yes. Well, it is very encouraging to see that from the surveys we’ve done so far that many families say, oh, I had time to spend with my child, or it’s the first time in years that the father has been around for more than a few hours during the day. Or the first time that I, as a mother, haven’t been at work all day and I can spend time with my child. Or my child has had more time to play. So very important and lovely things that we read. So there’s certainly positive sides to it, and we mustn’t forget them. And people have been very creative during this time in what they do. And so this is really absolutely wonderful.

But there are two things that I would like to emphasise. One is that, for many people around the world, for many people in the countries we live, there is the fear of the social consequences, the economic consequences, of the pandemic. So we just completed a survey, for example, in Greece, where about 20 per cent of the sample of parents of five to 18 year olds told us that they and their children are worried about being able to provide food for them after the pandemic. So these are people whose businesses have been affected. People who have been made redundant. So there, having such an existential fear, is very likely to impact very adversely on many.

The other thing to say is that people with pre-existing mental illness are a particular risk. And they are particularly worried about contracting coronavirus and having Covid. They’re particularly worried about their relatives. And they find it very hard to have a structure today. They find it very hard to say, okay, well, I have a programme in my day. So what ends up happening is that the sleep gets messed up, the whole, if you like, biorhythm can get a bit unstable during this time, which in turn, has effects on people’s mental health and how they perform. So this is a vicious circle, if you like, which is quite painful to observe.

Interviewer Any advice if you’re worried about that?

Professor Argyris Stringaris Yes. Well, the first thing is, in terms of you talking about young people in particular, but I think it’s a more general message, is to be honest about what the problems are. To be honest about, for example, the pandemic and its effects and all that. Without dramatising, in a neutral tone, and in a positive and informative interaction with a child. Always adjusting this information to the developmental level.

Second, I think, very important thing is to retain a structure during the day. And this is very hard, even for adults to do. It’s even harder for young people to say, look, I try to wake up at a particular time during the day and then I have a few things that I want to do, accomplish during the day. And it could be, for young children, it could be, oh, let’s bake a cake tomorrow, if you can do that. Or let’s make sure that we fix that. Or let’s try to cook together. Whatever it might be that we could do with our children that could be helpful. Let’s do some homework together. It will be different for different families and there are some people, healthcare workers, for example, supermarket workers, who will not have this amazing opportunity that others have to spend time with their children. So we must remember that. But in general, having a structure to the day is extremely important.

Third thing I would say is to regulate exposure to the news and social media. As you said, there’s unfiltered, unregulated information. And that’s fine. No-one wants to impose some sort of censorship necessarily. But the issue is that that, for young people in particular, and for people who are prone to worry already, it can become overwhelming, absolutely overwhelming, to have this fear of the consequences. And it’s very often the case that there’s either misinformation or amplification of negative information in parts of the media. And this, we know, can have negative effects. And in fact, I heard some very tragic stories of people who were very stable… had a major mental illness, who were very stable, and became extraordinarily worried and they couldn’t stop checking the whatever, Twitter account or whatever it was, or watching television. Relapsed in a very bad way out of this stressor. Now, this is anecdotal information that I’m telling you now. And we are hoping to measure this properly. But I think it’s a big issue. So I think regulating that is very important.

Interviewer In terms of measuring it, when… For listeners who might be interested in the… Is it the Crisis Study, did you say? When will there be some sort of interim results?

Professor Argyris Stringaris Very soon. We’re actually writing the first paper. So after we hang up I’m going to get back to the analyses that we’re doing with my collaborators. So hoping very, very soon we’re going to be able to publish some of the first results, or at least submit them, yes.

Interviewer  Right. So, watch this space. Argyris, is there anything you’d like to add that I haven’t asked you?

Professor Argyris Stringaris Just to go back to that issue about computer science numeracy and statistics, with an example from the coronavirus pandemic. So there is this conversation, as you know, about the value of antibody testing, right? So one of the key aspects to this question pertains to the understanding of the properties of measurement, of what happens when you measure something, and how many, for example, false positives a test will give. And how this number of false positives, to be very concrete, how getting it wrong about whether someone has had coronavirus can have an impact on the general population. So if the antibody test give us lots of false positives, tell us that people have had the infection and they’re fine. And we say, oh, fine. You’re fine to return to work then. Is that… Can we really do this on the basis of the tests we have? Are we justified to do this?

Professor Argyris Stringaris There are some, if you like, questions that are virological, that have to do with the actual behaviour of the virus and of our immune system. But some of the very fundamentals are just understanding this very simple math behind it. That, even if you have a relatively small rate of false positives, if there are very few people in the population that actually have contracted coronavirus, you’re going to have, in the population, many, many people with false positives. And this means that it is a very risky business to tell individuals just on the basis of a single antibody test, oh, you’re fine to return to work. At least at the current levels of infection. The presumed current levels of infection in the general population.

Same thing with those models that have come out recently. Understanding those models and what an exponential model means can be hard for people. So it should be part of our training to understand these models and those considerations better so that we can inform the public and be informed ourselves and make decisions in that way. Those are general questions. This is just exemplified by the pandemic. But it’s the same question that you, as a person, might ask if you went to your doctor. Or a young person who would ask if they came to me and say, okay, your advice is to take this drug. But I’ve read up on the internet that ten per cent of people could develop symptom such-and-such, which is a side-effect. What does it mean for me? How likely am I to have this? And what are the consequences? So those are questions that are very hard, are notoriously hard, to answer for many in the medical profession. So I think this is why a rethink about the curriculum would be…

Interviewer Argyris, finally, what is your takeaway message for those listening to our conversation?

Professor Argyris Stringaris I can think of very few things that are more fascinating than humans and their behaviour and how this changes with development. How we become who we are in life. How we are shaped through genetics and experience and our environment is absolutely fascinating. So being able to develop this very fundamental science of that is absolutely wonderful. And I hope that young people will be equally fascinated and enter this field. But I also want to convey this to, maybe, patients or other non-neuroscientists who may be listening to us, and thank them for participating in research and invite them to just think about it alongside with us.

Interviewer Argyris, thank you ever so much. It was really fascinating. For more details on Professor Argyris Stringaris, please visit the ACAMH website, that’s www.acamh.org and Twitter @ACAMH. ACAMH is spelt A-C-A-M-H .

Finish: This podcast was brought to you by the Association for Child and Adolescent Mental Health, ACAMH, for short.

 

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