Taking the Pulse: What is Precision Psychiatry, with Dr. Simon Ducharme

Have you heard the term “precision psychiatry” but aren't too sure what it means and how it could benefit patients? Do you wonder what role artificial intelligence (AI) and machine learning play in precision psychiatry? What could a Centre for Precision Psychiatry do to advance research and improve patient lives?  

Dr. Simon Ducharme, Neuropsychiatrist (MUHC) and Director of the Centre for Precision Psychiatry – Quebec clarifies these and other questions in this episode of Taking the Pulse. In less than 10 minutes, you will better understand what this transformative initiative means for the future of psychiatry.   

00:00 Intro

00:36 What is precision psychiatry?

1:08 How long has precision psychiatry been around?

1:41 What are the benefits of precision psychiatry for patients and families?

3:30 What role does AI play in precision psychiatry?

4:09 What is the Centre for Precision Psychiatry – Quebec?

5:01 How does the SPARK biobank advance precision psychiatry?

6:23 Why is data sharing in this field both innovative and important?

7:16 What is the role of donors with the CPP-Q?

Chapters

• 0:00 Intro
• 1:04 What is precision psychiatry?
• 1:36 How long has precision psychiatry been around?
• 2:08 What are the benefits of precision psychiatry for patients and families?
• 3:57 What role does AI play in precision psychiatry?
• 4:37 What is the Centre for Precision Psychiatry – Quebec?
• 5:28 How does the SPARK biobank advance precision psychiatry?
• 6:51 Why is data sharing in this field both innovative and important?
• 7:43 What is the role of donors with the CPP-Q?

Transcript

[00:00:00] We're providing important care to patients, but there's a limit to what we can do. And patients still have a lot of suffering associated with their disease. Every psychiatrist would like to see that dramatically improve. So the concept that we could use the biological data, artificial intelligence, to develop new algorithms that could improve, that is very exciting.

[00:00:36] Precision psychiatry is inspired by precision medicine, which is the idea that we can use individualized biological information about a person to adjust the treatment. So it's the concept where in psychiatry, we could take more detailed biological information about someone, whether their genes, their hormones, their brain scans to be able to select a treatment that will have a better chance of working for that particular person, and ideally with less side effects.

[00:01:08] So precision medicine is a concept we've heard a lot about in, I would say, the last ten, 15 years. So the idea that we're starting to have tools with biology, with genetics and others to be able to really make better predictions of treatments for an individual. So we're starting to see some examples in medicine. For example, in some cancer where you have a hormone receptor or not, they will give you a different chemotherapy. We don't have this in psychiatry, but we want to be able to get there.

[00:01:41] There are two questions that patients and their family always have when they have their first episode. Let's say let's say a young person with a first episode of psychosis. They want to know what will happen to me in the future. Will this come back? Will I have chronic episodes? Will I be able to go back to my normal life. And the other part is, how do we treat this? Um, so we hope to be able to develop tools that will allow us to tell an individual at a young age what they can expect in terms of their future disease course. But the big piece is adjusting treatments. So people who come to psychiatry, when they have their first experiences, they're often surprised to see how much trial and error there is in treatment selection, medication, psychotherapy, brain stimulation. So what we do is that we have these guidelines of treatment. So we'll adjust the treatment based on big diagnostic categories bipolar disorder schizophrenia major depression. So that guides a little bit the treatment. But within that there's a huge amount of trial and error. So let's say antidepressants we probably have 30 medications that are antidepressant. I have no way to know if one individual will respond to this one versus that one, and that can be months and months of trial and errors up until finding the right dose, right combination. And so we're hoping that we can develop tools of precision psychiatry that we can then use to tell a specific patient, well, you should be taking that combination right from the start, hopefully to allow them to have better outcomes, get better, faster, less side effects, and be able to have go back to their life quicker.

[00:03:30] With AI, the the challenge is that has to be really well done to be able to replicate outside. So what we want to do is not just find patterns in our huge research data, put that in a scientific paper and then forget about it. What we want is to develop tools that can then be applied in all other hospitals. And our robust tool that would actually work in real life patient conditions. So the philosophy behind our center is really to make sure that researchers who work with it will actually try to implement their algorithms with real patients and really eventually go into the clinic.

[00:04:09] The center for Precision Psychiatry started as a vision to put the resources in place to eventually be able to do precision psychiatry. So the first step is research data. So that's why our flagship project is this huge biobank that we've started gathering with all adult patients followed at the Allen Memorial Institute. And now we're adding other sites at the Douglas Institute. So the research database is the core project that we're working on. But the center's mission is to eventually deliver precision psychiatry. So we will facilitate research using this data. But we'll also be promoting the idea of precision psychiatry. And the vision would be that in ten years, we years. We might also be a clinical service using this precision psychiatry.

[00:05:01] The Biobank project from the center for Precision Psychiatry is a large group effort. So when we started this a few years ago, we were seeing at McGill that a lot of capacities were being developed at various institutions. So we had the biobank at the Rim, UHC imaging facilities at the MGH, Neuroinformatics capacities at the Montreal Neurological Institute. We had the Mila with artificial intelligence. So all of these groups were putting together resources, but no one was actually using them to bring data on psychiatry. And so we saw that there was an opportunity to create a synergy, because what we had in our department at the UHC, in particular at the Allan Memorial with collaborators like Doctor Howard Margolis, we had all these amazing outpatient clinics with a ton of expertise who were willing to contribute to the research effort. So we put all of these people together with this research protocol, and everyone has a key role. So the clinicians, they provide us information on diagnosis, on treatment trials, treatment response. So they really have a key role in this because without that information we wouldn't be able to eventually try to do prediction about treatment response.

[00:06:23] Our project is really inspired by the open science movement. So the idea is that all the data that we're going to be collecting in research, we're going to use with our own research teams, but we'll also make it right from the start, entirely publicly available to any researcher who has any sort of reasonable project with an ethics approval, they will be able to access the data. So open science has been a movement of the last few years, but there is still not a lot of these big databases Says. In psychiatry in particular, there are some research groups that have tons of imaging, but they don't have the genetics, the clinical information. We really have everything on those patients, and we're covering all the psychiatric diagnoses. So all of these aspects will be innovative for open science and psychiatry.

[00:07:16] These are very costly projects. And at the beginning when we have these big visions, these are not projects that can be easily funded by public granting agency because it's too long, it's too big. So that's where there's a crucial role for philanthropy. So we are thrilled of the support from the MGH Foundation. They've been our partners from the start, and they've allowed us to grow. And hopefully we're going to keep growing this project a lot more.