Thinking computationally in translational psychiatry. A commentary on Neville et al. (2024).

There is a growing focus on the computational aspects of psychiatric disorders in humans. This idea also is gaining traction in nonhuman animal studies. Commenting on a new comprehensive overview of the benefits of applying this approach in translational research by Neville et al. (Cognitive Affective & Behavioral Neuroscience 1-14, 2024), we discuss the implications for translational model validity within this framework. We argue that thinking computationally in translational psychiatry calls for a change in the way that we evaluate animal models of human psychiatric processes, with a shift in focus towards symptom-producing computations rather than the symptoms themselves. Further, in line with Neville et al.'s adoption of the reinforcement learning framework to model animal behaviour, we illustrate how this approach can be applied beyond simple decision-making paradigms to model more naturalistic behaviours.

Crisis y encrucijadas de una psiquiatría en busca de futuro / The crisis and crossroads experienced by a psychiatry in search of the future

Asumiendo la metáfora de la encrucijada, propuesta por Santiago Levín, en la que estaría situada la psiquiatría en la actualidad, el presente artículo pretende reflexionar sobre algunos aspectos de una crisis paradigmática de la medicina mental que ha hecho a algunos temer por su futuro. Se abordan algunas cuestiones epistemológicas de cierto calado, como el régimen de "verdad" en el que supuestamente deben manejarse los expertos, así como los dilemas planteados en los dos elementos clave del encuentro clínico: el diagnóstico y el tratamiento. Finalmente, se insiste en la importancia de lo ético, lo social, y lo político a la hora de replantear saberes y prácticas. (AU)

On the understanding we accept where psychiatry would today be located in the metaphor of the crossroads, as proposed by Santiago Levín, the purpose of this article is to explore certain aspects of a paradigmatic crisis in mental medicine that has raised some concerns as to its future. Certain deep epistemological questions are addressed, such as the schema of "truth", where experts should supposedly manage themselves, and the dilemmas raised from the two key elements of a clinical session: diagnosis and treatment. Finally, the study emphasises the importance of the ethical, social, and political aspects of rethinking knowledge and practices. (AU)

Invasive Computational Psychiatry.

Computational psychiatry, a relatively new yet prolific field that aims to understand psychiatric disorders with formal theories about the brain, has seen tremendous growth in the past decade. Despite initial excitement, actual progress made by computational psychiatry seems stagnant. Meanwhile, understanding of the human brain has benefited tremendously from recent progress in intracranial neuroscience. Specifically, invasive techniques such as stereotactic electroencephalography, electrocorticography, and deep brain stimulation have provided a unique opportunity to precisely measure and causally modulate neurophysiological activity in the living human brain. In this review, we summarize progress and drawbacks in both computational psychiatry and invasive electrophysiology and propose that their combination presents a highly promising new direction-invasive computational psychiatry. The value of this approach is at least twofold. First, it advances our mechanistic understanding of the neural computations of mental states by providing a spatiotemporally precise depiction of neural activity that is traditionally unattainable using noninvasive techniques with human subjects. Second, it offers a direct and immediate way to modulate brain states through stimulation of algorithmically defined neural regions and circuits (i.e., algorithmic targeting), thus providing both causal and therapeutic insights. We then present depression as a use case where the combination of computational and invasive approaches has already shown initial success. We conclude by outlining future directions as a road map for this exciting new field as well as presenting cautions about issues such as ethical concerns and generalizability of findings.

Umbrales del “no-ser”: figuraciones fanonianas sobre la sociogenia y el “doble narcisismo” del cuerpo epidermizado / Thresholds of “not-being”: fanonian figurations about sociogeny and the “double narcissism” of the epidermized body

Discutimos las complejidades críticas de lo que el psiquiatra martiniqués Frantz Fanon definió como la zona de no-ser en su estudio Piel negra, máscaras blancasde 1952. En un primer ins-tante, nos detenemos en los principales núcleos exegéticos de la zona de no-ser que se vincu-lan con la experiencia límite del cuerpo negro aludido por Fanon. Constatamos en un segundo momento cómo, lo que el autor define bajo el nombre de sociogenia, se entronca con un análi-sis histórico existencial del cuerpo racializado. El análisis del “doble narcisismo” y los procesos de epidermización explicitados por Fanon nos permiten concluir, en un tercer instante, que la zona de no-ser potencia la interrogación descolonial de un cuerpo epidermizado sobre el racis-mo y los repartos binarios de identidad. (AU)

We discuss the critical complexities of what the Martinican psychiatrist Frantz Fanon defined as the zone of non-being in his study Black Skin, White Masksfrom 1952. In a first moment, we stop at the main exegetical nuclei of the zone of non-being that are linked to the limit expe-rience of the black body alluded to by Fanon. We verify in a second moment how what the au-thor defines under the name of sociogeny is connected with an existential historical analysis of the racialized body. The analysis of the “double narcissism” and the epidermalization pro-cesses made explicit by Fanon allow us to conclude, in a third moment, that the zone of non-being enhances the decolonial interrogation of an epidermized body about racism and binary distributions of identity. (AU)

Psychiatry in the Digital Age: A Blessing or a Curse?

Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.

Using a Patient Safety/Quality Improvement Model to Assess Telehealth for Psychiatry and Behavioral Health Services Among Special Populations During COVID-19 and Beyond.

Telehealth has been rapidly deployed in the environment of the Coronavirus 2019 (COVID-19) pandemic to help meet critical mental health needs. As systems of care use telehealth during the pandemic and evaluate the future of telehealth services beyond the crisis, a quality and safety framework may be useful in weighing important considerations for using telehealth to provide psychiatric and behavioral health services within special populations. Examining access to care, privacy, diversity, inclusivity, and sustainability of telehealth to meet behavioral and psychiatric care needs in geriatric and disadvantaged youth populations can help highlight key considerations for health care organizations in an increasingly electronic health care landscape.

Ambulatory assessment for precision psychiatry: Foundations, current developments and future avenues.

Precision psychiatry stands to benefit from the latest digital technologies for assessment and analyses to tailor treatment towards individuals. Insights into dynamic psychological processes as they unfold in humans' everyday life can critically add value in understanding symptomatology and environmental stressors to provide individualized treatment where and when needed. Towards this goal, ambulatory assessment encompasses methodological approaches to investigate behavioral, physiological, and biological processes in humans' everyday life. It combines repeated assessments of symptomatology over time, e.g., via Ecological Momentary Assessment (e.g., smartphone-diaries), with monitoring of physical behavior, environmental characteristics (such as geolocations, social interactions) and physiological function via sensors, e.g., mobile accelerometers, global-positioning-systems, and electrocardiography. In this review, we expand on promises of ambulatory assessment in the investigation of mental states (e.g., real-life, dynamical and contextual perspective), on chances for precision psychiatry such as the prediction of courses of psychiatric disorders, detection of tipping points and critical windows of relapse, and treatment effects as exemplified by ongoing projects, and on future avenues of how ambulatory interventions can benefit personalized care for psychiatric patients (e.g., through real-time feedback in everyday life). Ambulatory assessment is a key contributor to precision psychiatry, opening up promising avenues in research, diagnoses, prevention and treatment.