Redefining Psychiatric Disorders with Big Data
Mental health disorders are binned into specific categories, such as depression or bipolar disorder or schizophrenia. Lately, there has been a shift in viewing these disorders as more loosely defined spectrums. Are the psychotic episodes observed in a schizophrenic patient similar to those experienced by a bipolar patient? Does the high occurrence of anxiety and depression imply that they share similar underlying mechanistic pathways? Childhood trauma can increase one’s risk for schizophrenia and depression. What is it about the environment and our genetics that can explain this finding? Instead of focusing on a particular disease, researchers are focusing on a particular aspect of a disorder and seeing how this can be narrowed or expanded to include other patients who display similar behavioral symptoms.
This shift is, in part, driven by the National Institute of Mental Health research domain criteria (RDoC) initiative. The goal of this initiative is to rethink psychopathology and build a framework upon which neurobiology can explain outward symptoms. Researchers are responding by looking at how genetic risk, brain activity, physiology (such as inflammation), behavioral processing (how people process information) and life experiences spanning social, cultural and environmental factors can impact the spectrum of mental health disorders. The goal is to deconstruct a mental health disorder, such as depression, into these different sub-categories to determine whether there are specific sub-clusters of depression. For example, are there certain patients who have a specific genetic variant plus a life experience and a certain behavioral phenotype that distinguishes them from other depressed patients? Once those sub-clusters are defined, the question would be two-fold:
1) Do these specific sub-cluster groups respond better or worse to a specific therapy regiment? If so, then this would pave the way for use of precision medicine in the mental health space.
2) What characteristics of a specific sub-cluster in one disorder are shared with another? This second question could explain why certain drugs can be used to treat different disorders.
It may be premature to easily shift our understanding of mental health disorders to a specific neural circuit disorder precisely fitted for an individual need. However, everyone agrees that we need to incorporate more than observable behavior in our diagnostics for mental health.
To study these trans-diagnostic measures effectively, we need to collaborate and share data. The genetics community has responded by forming consortia such as the Psychiatric Genomics Consortia (PGC), where over 800 investigators from 38 countries are committed to sharing their collected genomic data in an open-source format, allowing for meta- and mega-analysis of genomic data for various psychiatric disorders to be conducted. At this 2016 meeting, the Genetics and Neuroscience Special Interest group announced that they want to continue the spirit of the PGC in sharing and collaborating. Specifically, the leaders of the group asked the crowd to step up and share what data they have collected with the group to facilitate new projects spanning post-traumatic stress disorder to anxiety. The imaging community has also responded by establishing the Consortium of Reliability and Reproducibility (CoRR), an open-source resource to create standards for how data should be collected for optimal data sharing.
Another area that is rapidly growing is mobile health technologies to help the clinicians better understand the nuances of their patient’s disorder as it pertains to their daily lives and habits. New wearable technologies can assess sleep patterns, speech behaviors and physical activity, which can inform clinicians about the patient’s well-being in real-world settings versus snapshot observations during clinic visits. The capabilities of these wearables to interface with the genetics and brain imaging consortia create a vast array of measures that can be assessed to better understand behavior in the context of mental health. However, these initiatives do not have adequate long-term support to make their collaborative efforts financially sustainable.
At the Center for Strategic Philanthropy, we work with philanthropists who are interested in strategically deploying philanthropic capital to amplify medical solutions that can drive a field forward and change the lives of patients. Philanthropists who can support this much needed infrastructure of data sharing, especially as the data sets continue to grow, would be a much needed boost for the mental health space.