Panel Discussion Including All Speakers
Summary
TLDRIn this insightful panel discussion, experts explore the application of transcranial magnetic stimulation (TMS) for treating PTSD, highlighting the effectiveness of targeting the ventromedial prefrontal cortex and amygdala. They delve into the nuances of treatment efficacy, the role of motor dominance, and the integration of behavioral measurements. The conversation also touches on the importance of accessibility in mental health care, the potential of digital therapeutics, and the challenges of scaling precision medicine globally. The panel emphasizes the need for further research and the development of efficient, personalized treatment approaches.
Takeaways
- π§ TMS Treatment for PTSD: The script discusses the use of Transcranial Magnetic Stimulation (TMS) for treating Post-Traumatic Stress Disorder (PTSD), specifically targeting the ventromedial prefrontal cortex and amygdala.
- π‘ Motor Dominance and TMS: The effectiveness of TMS does not seem to be linked to motor dominance, with most symptomatology manifesting in the left frontal lobe, which is dominant in most people.
- π Behavioral Measurements: The incorporation of behavioral measurements using ecological momentary assessments and other methods to capture behavior is discussed as a potential next step in mental health research.
- π Natural Language Processing: Advances in natural language processing models have made it easier to analyze personal experiences and behaviors through speech and text, which could be applied to mental health assessments.
- π Cognitive Tests: A large database of cognitive tests and behavioral data has been collected over many years, providing a standardized cognitive battery used across studies for assessing various cognitive domains.
- π Accessibility in Mental Health: There is a significant discussion on the accessibility of mental health treatment, with long waiting times for treatment being a major concern, even in privileged areas.
- π Digital Therapeutics: The potential of digital therapeutics to increase accessibility and provide scalable solutions in mental health care is highlighted, including the use of wearables and passive sensing.
- π Integration of Physiological Systems: The importance of integrating physiological measures, such as cortisol and glucose monitoring, into mental health assessments is emphasized for a more comprehensive understanding.
- π‘οΈ Privacy Concerns: The discussion touches on the importance of dealing with privacy issues when using wearables and capturing personal data for mental health assessments.
- π Resource Allocation: The challenge of resource allocation in mental health care is addressed, with a focus on ensuring that basic mental health services are available to everyone while also advancing precision medicine approaches.
- π¬ Research to Clinical Practice: The script highlights the need for translating research findings into clinical practice effectively, including the use of genetic markers to inform treatment decisions and avoid adverse effects.
Q & A
What is the main topic of the discussion in the provided script?
-The main topic of the discussion is the application of transcranial magnetic stimulation (TMS) for treating PTSD, the use of behavioral measurements in mental health studies, and the integration of digital therapeutics and precision medicine in mental health treatment.
What is TMS and how is it being used in the context of the script?
-TMS stands for transcranial magnetic stimulation, a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. In the script, it is being discussed as a treatment for PTSD, targeting the ventromedial prefrontal cortex and amygdala.
What was Dr. Phillip's response to the question about the effectiveness of TMS treatment for PTSD?
-Dr. Phillip indicated that the TMS treatment for PTSD seems to work quite well, even though the treatment shown in the slides was standard for the dorsolateral prefrontal cortex, not the ventromedial prefrontal cortex and amygdala as initially assumed.
What does the term 'dorsolateral prefrontal cortex' refer to in the context of the script?
-The dorsolateral prefrontal cortex is a region of the brain that is involved in various cognitive processes. In the script, it is mentioned as the area where the TMS treatment was applied, which is different from the ventromedial prefrontal cortex discussed in the context of PTSD treatment.
What is the significance of the ventromedial prefrontal cortex and its connections in treating PTSD with TMS?
-The ventromedial prefrontal cortex and its connections are significant in treating PTSD with TMS because they are involved in the regulation of emotions and behaviors, which are often dysregulated in individuals with PTSD.
What was the question about the impact of stimulating the dominant versus the non-dominant hemisphere on psychiatric symptom change?
-The question asked whether there was a difference in the effectiveness of TMS treatment for psychiatric symptoms when stimulating the dominant hemisphere (usually the left side for most people) versus the non-dominant hemisphere.
What is the role of ecological momentary assessments in capturing behavior related to mental health?
-Ecological momentary assessments are used to capture real-time data on an individual's behavior and experiences in their natural environment. They can provide insights into mood, reward processing, and other aspects of mental health that may not be apparent through traditional clinical assessments.
What is the significance of natural language processing models in understanding mental health?
-Natural language processing models can analyze the content and manner of speech to provide insights into an individual's mental state. This can be particularly useful in understanding mood and behavior patterns without the need for constant self-reporting.
What challenges are associated with the accessibility of mental health treatment, as discussed in the script?
-The script discusses the long waiting times for mental health treatment, even in privileged areas, and the need for greater integration of digital therapeutics to improve accessibility. There is also a concern about leaving some individuals behind if the focus is too heavily on scalable solutions.
What is the potential of wearables and passive sensing in mental health treatment?
-Wearables and passive sensing have the potential to provide continuous, real-time data on an individual's physiological and behavioral state without the need for frequent self-reporting. This can lead to more personalized and timely interventions in mental health treatment.
What is the importance of integrating physiological measures with mental health assessments?
-Integrating physiological measures, such as cortisol levels or glucose metabolism, with mental health assessments can provide a more comprehensive understanding of an individual's mental state and the potential interactions between physical health and mental well-being.
Outlines
π€ TMS Treatment for PTSD and Brain Stimulation Inquiry
The panel discussion begins with an informal introduction by Reed Kaplan, who explains the Q&A process. Dr. Phillip discusses the use of transcranial magnetic stimulation (TMS) for treating PTSD, focusing on the ventromedial prefrontal cortex and its connections. He clarifies that while TMS is typically applied to the dorsolateral prefrontal cortex, treating the ventral region has shown positive results for PTSD. The conversation delves into the impact of stimulating the dominant versus non-dominant hemisphere, with Dr. Andy Kol's work suggesting motor dominance does not strongly correlate with psychiatric symptom changes. It is noted that most effective symptomatology appears in the left frontal lobe, which is dominant in most individuals. The discussion also touches on the broader implications of TMS treatment and the need for further exploration of different stimulation spots.
π Behavioral Measurements and Ecological Assessments
The discussion shifts to the incorporation of behavioral measurements in mental health studies, with a focus on the U engage study's use of Mindstrong's approach. Helen addresses the complexity of capturing behavior through ecological momentary assessments and the challenges of using wearables for data collection. She highlights the potential of natural language processing models to analyze speech patterns and behavior, emphasizing the importance of personal experience in mental health research. The conversation also touches on the annoyance of constant self-reporting and the need for more accurate and less intrusive measurement methods.
π Accessibility and Precision Mental Health
The conversation explores the issue of accessibility in mental health treatment, particularly in privileged areas like the Bay Area, where long wait times for treatment are common. Dr. Caroline discusses the importance of advocacy, outreach, and digital therapeutics to increase accessibility. She also mentions the use of videos for education and the potential of wearables and passive sensing for assessment. Concerns are raised about the potential for digital therapeutics to widen the gap between those with access to such technologies and those without, highlighting the need for balanced approaches to treatment.
π‘ Integration of Physiological Measures in Mental Health
The panelists discuss the integration of physiological measures into mental health assessments, comparing it to the routine use of such measures in conditions like diabetes. The potential for high-reach measures, like wearables and imaging facilities, to be linked with mental health conditions is explored. The conversation also touches on the cost and access issues related to these technologies, with a focus on how to make them more widely available and efficient. The importance of understanding the necessary and sufficient data for effective treatment is emphasized, along with the challenges of resource allocation.
π The Importance of Timing and Education in Mental Health Treatment
The discussion delves into the importance of timing in mental health treatment, drawing parallels with the evolution of stroke treatment. The need for public education on recognizing mental health issues is highlighted, as well as the challenges of distinguishing between similar symptoms. The conversation also addresses the historical shifts in treatment approaches, such as the pendulum swing between drug therapy and psychotherapy, and the importance of personalized treatment. The potential of physiological systems, like glucose monitoring, to inform treatment is also discussed.
π Scaling Precision Medicine in Mental Health
The panelists consider models for scaling precision medicine in mental health, using pharmacogenetics as an example. They discuss the potential for tools developed for mental health to benefit other fields and vice versa. The conversation highlights the importance of identifying the most effective treatments and the challenges of resource allocation to ensure that everyone has access to the basics. The need for awareness and education for both clinicians and patients is emphasized, along with the potential for technology to facilitate this process.
π¬ Application of Healthy Participant Research to Psychiatric Disorders
The final paragraph addresses the application of research findings from healthy participants to those with psychiatric disorders. Dr. CH explains that despite the study involving healthy individuals, some participants exhibited symptoms of psychiatric disorders and had experienced early life stress. This suggests that the findings could be relevant to clinical populations. Dr. CH also mentions plans to include subjects with more clinical symptoms in future research phases, indicating a commitment to expanding the applicability of the research.
Mindmap
Keywords
π‘PTSD
π‘TMS
π‘Ventromedial Prefrontal Cortex
π‘Amygdala
π‘Dominant Hemisphere
π‘Ecological Momentary Assessments
π‘Natural Language Processing
π‘Wearables
π‘Precision Medicine
π‘Accessibility
π‘Digital Therapeutics
Highlights
The discussion explores the use of TMS (Transcranial Magnetic Stimulation) for treating PTSD, focusing on the ventromedial prefrontal cortex and amygdala.
TMS is shown to be effective for PTSD treatment, even though the standard approach targets the dorsolateral prefrontal cortex.
The effectiveness of TMS on the dominant versus non-dominant hemisphere for psychiatric symptom change was examined, with motor dominance not correlating well with symptom change.
Behavioral measurements using Mindstrong's approach and ecological momentary assessments are considered for future research.
The challenge of incorporating more behavioral measurements due to their complexity and potential intrusiveness is discussed.
Natural language processing models are highlighted as a promising tool for capturing personal experiences and behaviors.
The importance of timing and synchronization between brain state and behavior in mental health treatment is questioned.
The potential of wearables and passive sensing in mental health monitoring and treatment is emphasized.
Concerns about accessibility and the digital divide in mental health treatment are raised, especially in privileged areas.
The integration of physiological systems with mental health assessments is advocated for a more comprehensive approach.
The role of education in improving the speed of diagnosis and treatment for mental health conditions is highlighted.
The potential of pharmacogenetics in tailoring treatments for individuals based on genetic markers is discussed.
The need for resource allocation to ensure that basic mental health services are available to all is emphasized.
The importance of creating awareness about the importance of timely and correct treatment in mental health is stressed.
The challenge of scaling effective treatments to reach a wider population while maintaining quality is addressed.
The potential of using healthy participants' data for understanding and treating psychiatric disorders is explored.
Plans to extend the study to include subjects with more clinical symptoms are mentioned for future research.
Transcripts
how this is going to work is it fairly
um informal so if you have a question we
have roving mics please just put up your
hand or stand up let us know um who on
the panel you'd like to ask it to and if
there are multiple people please let
us start
yeah the very
backk you uh Reed Kaplan here again uh
this is a question for Dr Phillip uh
correct me if I'm wrong but I think
earlier in your
presentation you intimated that the
treatment that you were trying for PTSD
with TMS was to the ventor medial
prefrontal cortex and the amydala and I
assume its connection bya the unson at
facular regions is that
correct so uh
um there we go so so the the TMS that I
was showing everybody in all of those
slides the transcranial magnetic
simulation actually was standard boring
dors lateral prefrontal cortex so the
biology right always involves the the
the the ventromedial prefrontal cortex
and its various connections um but uh it
is remarkable that uh you know treating
the dpsc seem to work quite well for
postra stress as well okay and follow up
to that regardless of the actual
connectivity did you examine whether it
made a difference if you stimulated the
dominant versus the non-dominant
hemisphere I I so I love the question um
and uh so I can't take credit for for
answering that but I'll I'll I'll direct
to some work that's been done by my
colleague uh Andy kol um who's actually
done a lot of work stimulating uh uh
ipsilateral and sort of bilateral sides
um and um I think that the simple answer
is that the motor dominance doesn't link
well with the um uh psychiatric symptom
change um but I think there's probably a
lot more in there dep depending on how
uh how folks may be wired even so most
effective symptomatology seems to
manifest predominantly in the left
frontal lobe which would be dominant in
most people correct uh so yeah and I
think and and we also have to remember
and and sort of the broader comment here
is that folks have largely stimulated
left doors latal proof hunel cortex
because that's where the field started
and they found a signal in so folks have
have done what they know works and I
think there's there there is uh not
nearly as much looking at um different
spots thank you um thanks
yeah oh oh Walter go
ahead what I
have lean I remember you had
incorporated into the U engage study
some behavioral measurements uh using
mindr Strong's uh approach and others um
I haven't seen that talked about very
much in today's presentations how we can
using ecological momentary assessments
and other ways of capturing behavior and
I'm just wondering is that something
that is uh uh the next layer on top of
this to be done soon or is it uh an
aspect of we don't have very accurate
measurements in that Arena so we're
dialing back just curious about the
thoughts of the panel for incorporating
more behavioral measurements it's a
great question I'm I might ask um Helen
to jump in on this one
yeah I think the um the concept is right
I think the level of complexity needed
is being worked on so I think you know
it goes way back to even CP thinking
about movement in bipolar and how
regularly irregular movement can emerge
and that those properties aren't linear
and how you can pick them up so I think
embedded in movement on a watch with
actigraphy or foraging and even novelty
um there have been some interesting
papers that I'm going to miscite that
have tried to look at reward processing
and foraging as as an indicator that you
can do a readout on Mood by the amount
that you move when you walk around in
your environment in a novel way so I
think that that but it's not a
straightforward metric as people have
shown even in cardiovascular disease the
other hand this thing of asking people
how they're doing all the time is really
annoying and I don't know if anybody has
actually done that and tried to do it
before you have someone else do it you
basically throw the device at a wall
after a couple of days and I think it is
sort of remarkable that people will do
those things but you I think as soon as
you ask someone the question you don't
get the answer you really want so the
notion though of what people's personal
experience is and how you capture it is
actually really important so I think the
emerging natural language processing
models that just even in the last year
have just blown up that going from it
cost you a fortune to transcribe an
interview to you can throw it into
whisper and get a perfect transcription
in any language pretty fast allows you
to build models on the nature of what
people say and how they say it which is
the fundamentals of behavior and I think
that naturalistic data capture in dense
ways is going to evolve but I think it's
the thing that that lean said so
brilliantly and that was really
inspiring to hear about your place by
the way but this idea that if the brain
leads how do
you simplify and how do these things tie
together but what's the right data and
the right density of collection to build
the model that you want that goes with
the brain State because they're not
collected when you do you know cranial
recordings you get slammed all the time
about time syncing and how can a Time
sync for a behavior match the brain
State I don't actually believe you
actually need that because these signals
are actually kind of slow and so I think
that the
wearables in all of its forms by how you
talk in your texts and how we deal with
the Privacy is another issue but the
signal is there and we just haven't
modeled quite
[Music]
right this is a sous question but how
about a psychiatric evaluation is a
requirement for prerequisite for running
for political office perhaps that would
save the world a
lot as employee of the US federal
government I am definitely not going to
touch that
question so maybe I could um ask a
question that is not on my list but I
was very intrigued Dr toy with the uh a
slide that Dr William show that Tau
about 5,200 cognitive tests and I wonder
could you expand on exactly what kinds
of test those were and where they were
sourced from that was kind of
impressive yes so
[Music]
sorry yeah sorry mine is oh no now it
works sorry just took a second sorry yes
so uh this is really uh one huge
Advantage at the center so for for many
many years uh Dr Williams and others
have been collecting a very large amount
of Behavioral data and the huge
Advantage like in the studies we we
showed before and also what Dr Williams
was saying is that uh the same
standardized the cognitive battery has
been used across all studies so not only
we have this data from a very large
amount of people and this involves for
example measures of memory you know
reaction times uh emotion
processing uh Cog executive function
various forms of cognitive uh measures
but also healthy Norms to which we can
then Norm this data and so Express
really at the level of the individual
how affect each cognitive domain is so
that's the the huge advantage of you
know being consistent and consistent in
data acquisition and then that enables
us to pull uh you know this state across
a very large number of people and we
think going forward that's going to be a
big asset uh as we uh focus more and
more also on the cognitive aspects of uh
the disorders we investigate for example
depression uh and that's going to be a
gold mine for that you know well that's
very uh helpful to hear and uh very
exciting there is not a standardized
approach to assessing cognition in
younger adults with a range of
psychiatric disorders we have a very uh
uh strong body of empirical data in
depression for example as people get
older but these uh ways more digital
ways of assessing cognition in real time
I think could be instrumental so it's
very exciting work that you're
[Music]
doing
yeah
Dr hello it's good to see Ruth and
and good to see you lean um I'm
wondering about um you know in the Bay
Area even beyond the Bay Area it takes a
very very very very very long time for
somebody to get into treatment to begin
with metol treatment so I'm wondering
how you kind of balance accessibility
you know we have slides filled with all
these measures and all this stuff we're
going to do and then we're going to find
it and then we're going to do this but
in reality you know I heard of statistic
that it could take up to a year up at
UCSF or somebody with depression to get
into the clinic down here it's not much
better so maybe just a little bit about
like Precision medicine Precision mental
health and accessibility and especially
like in a privileged place like this and
you know there's the rest of the
world I guess I I could start do you
want to jump in
Caroline
yes testing okay um Dr thank you so
much for this uh wonderful question and
um you know I think you know you for me
personally I think um that my you know
my research is just but one domain of
what's important and necessary for
mental health um and at least in OCD it
takes 14 to 17 years for somebody to be
identified so part part of um you know I
I feel like a mission is um advocacy and
and Outreach and help and and Stanford
has a wonderful resource of videos um
that that are for the community for
Education um that are free videos
available on YouTube and they're doing
them in English and different disorders
and also in Spanish translation to
increase um accessibility and access and
I'd love to take your question back to
you which is you're doing really
brilliant um work in digital
Therapeutics um both at the VA and
Beyond and just have done such an
amazing training for students and I
really feel like that that that is the
future in terms of um increasing
accessibility so I hope you don't mind I
would love to hear a little bit more
about you know what what you've heard
and what what you think could be ways to
to open this as well sure well well of
course I would uh uh advocate for more
digital Therapeutics I think the
assessment side of it and what we can do
with wearables and um passive sensing
it's really the the the New Frontier
where we can just get these data without
having to burden people with bothering
them six times a day with a prompt and
yeah throwing with our veterans
especially you know throwing things at
the wall would probably be that mourning
of the first time they get binged but I
do think that um having these scalable
um I I don't know if we want to call
them low intensity maybe High Reach I
think Keith humph calls them High Reach
interventions but um also just kind of
balancing that with we're going to be
putting these out there and are we going
to feel like okay well we've covered the
low and middle- inome countries with
these things and over here we still have
all this great stuff that's going on and
therefore we don't have to worry too
much about that that's my burden is that
we're gonna I mean my concern is that
we're going to leave a lot of folks
behind because we're going to feel like
we're we're doing the right thing um for
them when maybe they're not getting
exactly or the the type of treatment
that they would need you know to that
point Eric and I mean you've really
we're way ahead of the field in trying
to get some of these applications both
for tracking symptoms as well as for
treating um you know in in 2013 I had I
was 2009 to 2013 I served on the dsm5
and we were asked in the first uh sort
of sessions as they routine us up for
our work groups on uh what would you
wish for the DSM 5 to do that hasn't
been done and I raised my hand and said
I think greater integration with
physiological systems Leanne talked
about cortisol we also have glucose
monitoring which H I think is going to
revolutionize our understanding of the
relationship between blood sugar levels
and psychiatric symptoms obviously not
the case in all cases but really there's
an unprecedented opportunity here to
integrate at that time when I said
better assessment of physiological
systems beyond the mental health systems
I was told that was a pipe dream and
pipe down and now I have to say that
this is a vision that also can be
operationalized there's so many systems
for sleep for uh uh glucose metabolism
for um stress that we can measure in
real time with the kinds of applications
you've developed to actually get and see
if there are uh interactions there that
are may be very potent uh type 1
diabetes is one of the highest rates of
suicidality for example and yet who's
tracking that in real time particularly
in Rural and more distal populations
that may not have access to the care you
raise so I think it's a wonderful
opportunity at this point in
time maybe to
mention pausing to mention picking up on
that theme of
integration and I can Circle back to the
elephant onto the cpit about cost as
well which um I'm always asked about
understandably to me the what what Ruth
was just highlighting about
physiological measures being routine for
diabetes or other conditions that's an
opportunity to to harness what has been
done for mental health because obviously
it would be a huge shift to have Mental
Health Integrated as part of Health
fully but if it was we'd be able to make
use of all of the workflows and systems
that are already available for all other
conditions including the Imaging
facilities the
EGS and we' have the evidence base for
linking those to the wearables and
the what did you call it again the not
high touch but the high reach high reach
measures which I again go back to
Framingham that I think did a great job
of that because they've linked the
understanding of the organ of interest
to those High Reach
measures and I've been very heartened by
um conversations and collaborations with
other disciplines so I'm including
Radiology neuro Radiology I'm including
um all the the disciplines that use
EG and then those who are at the front
lines
clinically neur neur radiology's been
fascinating I've spoken at their
meetings and I learned to my surprise
that they're thinking that Psychiatry is
um already has the solutions and that
we're we're waiting on them so from NE
Radiology point of view at least from my
experience they're saying we're ready
like we're used to introducing new
assessments for what is the next and
complex condition we've done that for
all of the
conditions so yes scale is an issue but
that's that's what they do um and then
that idea of how do you link to the high
reach of course there's the cost and
access issue and I've really looked a
lot at that because the costs are very
different as to whether you're talking
about research or clinical use and which
country you're in um research-wise we
think of Imaging as expensive because it
is upfront expensive in terms of the
actual allocated cost in the clinic is
not that much different excluding
facilities fees between Imaging and EG
used in sleep and other areas act the
actual cost of the
assessment it's about then onethird of
the price in many other countries and
it's routine if you need to have a
evaluation for myig green you would be
referred for a a scan so I think if we
had the opportunity to have these tests
available the the cost and the would
come down and the workflows would be
there to make it efficient and of course
not everyone will get them but that's
been addressed in areas like mamography
where it's like if you don't have access
to the scanning facility how can we get
to you and how can we get to you with
maybe a a an an Outreach measure that
gives us a good proxy even if it may be
taking in in a
fotograph so I know that was a free
association but I'm sure Ellen wants to
show yes so um not to be buzzkill but
there is I think the issue of how
resource allocation will happen given
that we have the most you can do but
then to actually scale it to the people
who have the least and to how to get all
the data we need to know what part is
necessary and sufficient and then to
have resource allocation that can move
through the pipeline so that everybody
has access to the basics but that Basics
assumes that there is a basic which
implies that the biology has an
evolution over time that it isn't just
equally potential match people to the
treatment that they need because
everybody has a treatment and you just
kind of move through the system until
you get matched up but in fact how do we
create awareness if it's true that
actually getting the wrong treat
treatment isn't just wasting time but is
actually hurting you and I think that
you know in the evolution of stroke I
mean I remember when I was a resident
somebody would show up Hemi you know
hemic and couldn't speech and the family
would be there and you go how long has
this been and it'd be like three days
and when was it going to occur to you
that not being able to move the entire
side of your body or speak was like
actually bad and it became the education
of what is a stroke and then as the
treatment became there's window to treat
then things mobilize to do things in the
same way how did we teach people that
chest pain needed to be dealt with but
how do you parse the difference between
a heart attack and a bad burrito and
that they might feel the same but um not
but I think that the thing that we
didn't really talk about today was the
idea
about you know again England went
through a period remember we I mean it
was about 20 years ago that no drugs are
you know everybody got drugs as a first
line and then nobody got therapy and
then they did 180 and said everybody
should get therapy we should teach
everybody how to do CBT then nobody got
drug and we're back to the thing as
though it's one is better than the other
rather than you need to be getting what
you need and then it gets into are there
stages of these illnesses where actually
the timing matters because if timing
matters maybe if you identified some
with mood symptoms that the stress was
creating a pro-inflammatory or pro-
insulin sensitivity state that actually
the glucose would tell you that you had
the problem or vice versa and how do we
build these platforms so that we catch
the kind of the
diaspora faster with the least
expenditure because I me I mean what I
did at 1:00 was I had to be on a call
for the National Academy of Science on
DBS and why hasn't
DBS um not for what I do but even in
Parkinson's you talk to people you have
readouts you have these devices built
nobody has time and nobody's learned how
to do it and the education is bad so you
build the device you build the stuff you
have experts that know how to do imaging
or physiology you have no way to
translate it so that regular docs can do
it so I I think the thing is how do we
take what you do which I certainly want
to know more about and actually how do
we triangulate so that things that are
done in many things meet the things that
are done in a few because you'll never
get neur Radiology to be able to do what
we heard today about these analytics
because they just won't be Personnel
when you're reading 500 scans a day to
invest that time unless you can build
the algorithm so how do we bypass it so
that the most people get Basics and then
you you move up the pyramid so that very
few people need what I do or that I kind
of reverse engineer to find the people
earlier on not use resources and and get
them back to functionality yeah so it
definitely sounds like that that
efficiency that could potentially come
out of this would open up resources for
a whole um you know group of other
people that wouldn't have those
resources available so thank you and
sometimes times and to Helen's point
that um is that point of the scaling is
not actually where you might think it
would reside so a very good example we
have an investigator Terry kleene who
resides in our department of
bioinformatics and data sciences and she
got a center several years ago to
actually uh collate and curate all the
data and you can imagine how much it is
on a pharmaco genetics and uh treatment
response and eventually you know out of
all the thousands and hundred thousands
of data points we're now at a point
where there are several fairly standard
medications that have profound negative
adverse effects in certain individuals
and they actually created really a list
of that and so the question became
exactly as you ask how do we get this
out to the community to the clinician
what is the clinician going to do order
genetic test or a boutique test what
they actually did and it started they
went to some of the hospitals and not to
the clinicians but to the pharmacists so
the hospitals and one of them in
Cincinnati has actually taken that
information just a very small set of
genetic markers that have profound
adverse effects with certain medication
interactions that save thousands in
terms of the time in hospital the
mortality rates and of course what's
happening now in this educational piece
is that they're telling others how to do
this because the cost savings for the
hospital is so dramatic and I think what
we have to do to the 's point is look at
some of these other models and see where
we could take a model like that are
there some aspects of what we bring to
the table in our tools that could
benefit pharmaco uh genetics being one
of them uh and help with an increased
Precision medicine approach applying to
mental health but there are examples of
other scaling just not yet in our
domain you like this discussion continue
maybe we could continue it over the
poster session you are very generous and
keeping on time everyone today and i' I
am not on time right now so I don't want
to hold you back from the poster Session
One Last Question of Dr that's exactly
what I was going to suggest so we're
going to wrap up with one question and
then we'll head to the poster session so
this is one for you Dr
CH given your results are from healthy
people how would you like for them to be
used for people with psychiatric
disorders that's a great question um so
I want to answer it in two ways but keep
it short because I know people are
excited about the poster session despite
our findings from a healthy participants
group actually they show certain level
of PDs D symptoms and some of them even
reach the level of moderate pdsd
symptoms and they also suffer from early
life stress um so from that point of
view we believe our finance could be
translated into the clinical population
uh the second point is we're actually in
the plan of trying to collect subjects
with more clinical symptoms in the phase
two um data collection of our sample so
please keep uh stay tuned we will have
more results maybe next year for the
next
Symposium thank you to all of our
speakers I'm I'm absolutely honored that
you all joined us today and presented it
was a brilliant program I'm sure you'll
all
agree
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Expert panel talks mental health
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