Digital mental health: challenges and next steps

Digital innovations in mental health offer great potential, but present unique challenges. Using a consensus development panel approach, an expert, international, cross-disciplinary panel met to provide a framework to conceptualise digital mental health innovations, research into mechanisms and effectiveness and approaches for clinical implementation. Key questions and outputs from the group were agreed by consensus, and are presented and discussed in the text and supported by case examples in an accompanying appendix. A number of key themes emerged. (1) Digital approaches may work best across traditional diagnostic systems: we do not have effective ontologies of mental illness and transdiagnostic/symptom-based approaches may be more fruitful. (2) Approaches in clinical implementation of digital tools/interventions need to be creative and require organisational change: not only do clinicians and patients need training and education to be more confident and skilled in using digital technologies to support shared care decision-making, but traditional roles need to be extended, with clinicians working alongside digital navigators and non-clinicians who are delivering protocolised treatments. (3) Designing appropriate studies to measure the effectiveness of implementation is also key: including digital data raises unique ethical issues, and measurement of potential harms is only just beginning. (4) Accessibility and codesign are needed to ensure innovations are long lasting. (5) Standardised guidelines for reporting would ensure effective synthesis of the evidence to inform clinical implementation. COVID-19 and the transition to virtual consultations have shown us the potential for digital innovations to improve access and quality of care in mental health: now is the ideal time to act

Évaluation des troubles thymiques par l’étude des données passives : le concept de phénotype digital à l’épreuve de la culture de métier de psychiatre

International audienceObjectivesThe search for objective clinical signs is a constant practitioners’ and researchers’ concern in psychiatry. New technologies (embedded sensors, artificial intelligence) give an easier access to untapped information such as passive data (i.e. that do not require patient intervention). The concept of “digital phenotype” is emerging in psychiatry: a psychomotor alteration translated by accelerometer's modifications contrasting with the usual functioning of the subject, or the graphorrhea of patients presenting a manic episode which is replaced by an increase of SMS sent. Our main objective is to highlight the digital phenotype of mood disorders by means of a selective review of the literature.MethodWe conducted a selective review of the literature by querying the PubMed database until February 2017 with the terms [Computer] [Computerized] [Machine] [Automatic] [Automated] [Heart rate variability] [HRV] [actigraphy] [actimetry] [digital] [motion] [temperature] [Mood] [Bipolar] [Depression] [Depressive]. Eight hundred and forty-nine articles were submitted for evaluation, 37 articles were included.ResultsFor unipolar disorders, smartphones can diagnose depression with excellent accuracy by combining GPS and call log data. Actigraphic measurements showing daytime alteration in basal function while ECG sensors assessing variation in heart rate variability (HRV) and body temperature appear to be useful tools to diagnose a depressive episode. For bipolar disorders, systems which combine several sensors are described: MONARCA, PRIORI, SIMBA and PSYCHE. All these systems combine passive and active data on smartphones. From a synthesis of these data, a digital phenotype of the disorders is proposed based on the accelerometer and the GPS, the ECG, the body temperature, the use of the smartphone and the voice. This digital phenotype thus brings into question certain clinical paradigms in which psychiatrists evolve.ConclusionAll these systems can be used to computerize the clinical characteristics of the various mental states studied, sometimes with greater precision than a clinician could do. Most authors recommend the use of passive data rather than active data in the context of bipolar disorders because automatically generated data reduce biases and limit the feeling of intrusion that self-questionnaires may cause. The impact of these technologies questions the psychiatrist's professional culture, defined as a specific language and a set of common values. We address issues related to these changes. Impact on psychiatrists could be important because their unity seems to be questioned due to technologies that profoundly modify the collect and process of clinical data.ObjectifsLa recherche de signes cliniques objectifs est une préoccupation constante des praticiens et des chercheurs en psychiatrie. Le développement récent de certaines technologies (miniaturisation des capteurs, intelligence artificielle) permet d’avoir accès à certaines données dites passives (c’est-à-dire qui ne nécessitent pas d’intervention du patient) jusqu’alors non exploitables et de nouveaux modèles basés sur une sémiologie qui serait médiée par ces nouvelles technologies commencent à se développer avec le concept de phénotype digital : le ralentissement psychomoteur se traduisant par des modifications de l’accéléromètre, la graphorrhée par une augmentation du nombre d’appels et de SMS envoyé, etc. Notre objectif principal est de mettre en évidence le phénotype digital des troubles de l’humeur à l’aide d’une revue sélective de la littérature.MéthodeNous avons conduit une revue sélective de la littérature en interrogeant la base PubMed jusqu’à février 2017 avec les termes [Computer] [Computerised] [Mobile] [Automatic] [Automated] [Machine learning] [Sensor] [Heart rate variability] [HRV] [actigraphy] [actimetry] [digital] [motion] [temperature] [Mood] [Bipolar] [Depression] [Depressive]. Huit cent quarante-neuf articles répertoriés ont été soumis à l’évaluation, 37 articles ont été inclus.RésultatsPour les troubles unipolaires, les smartphones permettent de diagnostiquer la dépression avec une excellente précision en combinant les données du GPS et du journal des appels. Les mesures actigraphiques mettant en évidence une altération diurne dans le fonctionnement basal tandis que les capteurs ECG évaluant la variation de la variabilité du rythme cardiaque (HRV) et la température corporelle semblent être des outils utiles pour diagnostiquer un épisode dépressif. En ce qui concerne les troubles bipolaires, des systèmes qui combinent plusieurs capteurs sont décrits : MONARCA, PRIORI, SIMBA et PSYCHE. Tous ces systèmes associent des données passives et des données actives sur smartphone. À partir d’une synthèse de ces données, un phénotype digital des troubles est proposé en se basant sur l’accéléromètre et le GPS, l’ECG, la température corporelle, l’utilisation du smartphone et l’étude de la voix. Ce phénotype digital vient ainsi remettre en question certains paradigmes cliniques au sein desquels les psychiatres évoluent. L’impact de ces technologies interrogeant profondément la culture de métier du psychiatre.DiscussionCes systèmes peuvent être utilisés pour informatiser les caractéristiques cliniques des différents états mentaux étudiés, parfois avec une plus grande précision qu’un clinicien ne pourrait le faire. Par ailleurs, la plupart des auteurs recommandent l’utilisation de données passives préférentiellement aux données actives notamment en cas de troubles bipolaires car les données générées automatiquement réduisent les biais et limitent le sentiment d’intrusion que les autoquestionnaires peuvent causer. L’impact de ces technologies interroge la culture de métier du psychiatre, définie comme une langue spécifique et un ensemble de valeurs communes. Nous abordons les problèmes liés à ces changements en soulignant que l’impact de ce changement de paradigme sur les psychiatres pourrait être important, leur unité semblant remise en cause par des technologies qui modifient profondément la collecte et le traitement des données cliniques

Acceptability, attitudes and knowledge towards Transcranial Magnetic Stimulation (TMS) among psychiatrists in France

International audienc

Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015–16 terrorist attacks

International audienceBACKGROUND:The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to clinicians in this context.METHODS:This study protocol is a two-arm non-randomized, multicenter controlled trial, comparing RT to treatment as usual for the treatment of trauma-related disorders. RT consists of actively recalling one's traumatic event under the influence of the ß-blocker propranolol, once a week, for 10-25 min with a therapist, over 6 consecutive weeks. This protocol evaluates the feasibility, effectiveness, and cost-utility of implementing RT as part of a large multi-center (N = 400) pragmatic trial with a one-year follow-up.DISCUSSION:Paris MEM is the largest trial to date assessing the efficiency of RT in the aftermath of a large-scale man-made disaster. RT could possibly reinforce the therapeutic arsenal for the treatment of patients suffering from trauma-related disorders, not only for communities in western countries but also worldwide for terror- or disaster-stricken communities