Search

Background: The COVID-19 pandemic brought about profound social changes that affected students worldwide. These changes had both psychological and economic consequences, and also led to the adoption of new teaching methods. The present study examined the pandemic’s impact on French medical students’ perceptions of their profession. Methods: A questionnaire study based on the vignette methodology was conducted among third-year medical students. It included questions about their perceptions of the medical profession, their motivation, and their sense of belonging to the profession. Results: 352 students responded to the survey . The pandemic had both a positive and a negative impact on students’ perceptions of the medical profession. Cluster analysis using a k-means algorithm and principal component analysis revealed three clusters of students with different perceptions of the medical profession. The first cluster, which represented the majority of students, corresponded to a relatively positive perception of the profession that was reinforced during the pandemic. In the second cluster, students’ perceptions were reinforced still further, and particular importance was attached to field experience. Students in the third cluster had the most negative perceptions, having been shaken the most by the pandemic, and they attached little importance to field experience. Conclusions: The analysis highlighted the importance of students being able to adapt and draw on a range of resources during the COVID-19 pandemic. This underscores the need for work cultures that support adaptability and coping. Overall, the pandemic had a profound and far-reaching impact on medical students in France, but these effects were not uniform. Further research is needed to understand its long-term effects on students' perceptions of the medical profession and to identify interventions that could support students in the aftermath of this difficult period.

UNSTRUCTURED It has tremendous potential for both research and clinical applications, but challenges our conception of healthcare by opposing two distinct approaches to medicine: one centered around illness, with the aim of classifying and curing disease, the other centered around patients and their personal suffering and lived experience. In the context of mental health and psychiatry, while digital phenotyping holds out the promise of novel treatment avenues and the empowerment of patients to regulate their own health, it entails the sacrifice of the human approach to patients’ suffering that forms the very foundation of psychotherapy. In this article, we review the formidable advances rendered possible by digital phenotyping and highlight the risk that this technology may pose in partially or even wholly excluding healthcare professionals from the diagnosis and therapeutic process, thereby foregoing an essential dimension of care. We end by setting out concrete recommendations as to how to improve current digital phenotyping technology so that it can be harnessed to redefine mental health by empowering patients without alienating them.

Post-traumatic stress disorder (PTSD) is a common mental disorder following one or more traumatic events in which patients exhibit behavioural and emotional disturbances. Recent studies report alterations in social cognition with cerebral functioning modifications. While it is now established that brain function can be modified and severely altered following successive childhood traumas, less studies have focused on brain alterations in adults with normal social cognition development.We conducted a selective literature review by querying PubMed and Embase databases for titles of articles research on PTSD adults published from January 2000 to December 2021 focusing on adulthood traumatic events.Majority of studies reported frontolimbic rupture, with limbic structures like amygdala missing top-down control of frontal regulation. These cerebral dysfunctions could be observed even without overt behavioural defects on social cognition tests.These results can be analysed in light of intrinsic cerebral networks and we propose an attentional model of social threat information processing opening up perspective of social attentional rehabilitation in adjunction to usual care.

Background Non-invasive brain stimulation techniques are becoming a part of psychiatrists’ therapeutic arsenal. Proof of TMS effectiveness and its indications are becoming clearer. While international recommendations exist, and many countries have already recognized the use of these techniques, the French situation is peculiar since no recommendation has been published by the High Authority of Health. Consequently, those techniques are not reimbursed by the healthcare service, few practitioners are trained, some are criticized for using it, and practices remain very heterogeneous. It is therefore important to investigate what slows down the development of these techniques. The objective of this study was to determine the acceptability of TMS by psychiatrists and to analyze the factors influencing it. Method A sample of psychiatrists was recruited in order to complete an online quantitative acceptability study using a four variable domain model (utility, intention of use, facility, risk) allowing an acceptability score calculation. Result Four hundreds and seventy-six observations were included in the analysis. Regarding the main objective, the overall TMS acceptability score was high for 47.2% of psychiatrists, average for 40.6% and low for 12.1% of them. The main factors influencing it were theoretical orientation (psychoanalytic vs neurobiological) and training level (only one in three psychiatrists acknowledge having been trained in this technique). Discussion The majority of practitioners consider TMS to be a credible alternative to current therapies, especially for depressive disorders. Yet psychiatrists are uninformed and poorly trained in these techniques and report very clearly a desire for more training and information. Our study highlights a significant lack of training that negatively impacts the accessibility of these techniques.

BACKGROUND Mood disorder is commonly diagnosed and staged using clinical features that rely merely on subjective data. The concept of digital phenotyping is based on the idea that collecting real-time markers of human behavior allow one to determine the "digital signature of a pathology". This strategy assumes that behaviors are "quantifiable" from data extracted and analyzed through digital sensors, wearable devices or smartphones. That concept could bring a shift for the diagnosis of mood disorder, introducing for the first time paraclinical testing on psychiatric routine care. OBJECTIVE The main objective of this review was to propose a conceptual and critical review of the literature regarding the theoretical and technical principles of digital phenotypes applied to mood disorders. METHODS We conducted a selective review of the literature by updating a previous article and querying the PubMed database between February 2017 and November 2021 on titles with the relevant keywords regarding digital phenotyping, mood disorders and artificial intelligence. RESULTS 858 articles were included for evaluation, 43 articles were taken into account and classified by data source (multimodal, actigraphy, ECG, smartphone use, voice analysis, body temperature). For depressive episodes, the main finding is the decrease in terms of functional and biological parameters (decrease in activities and walking, decrease in the number of calls and SMS, decrease in temperature and HRV) while the manic phase produces the reverse phenomenon (increase in activities, number of calls and HRV). CONCLUSIONS The various studies presented support the potential interest in digital phenotyping to computerize the clinical characteristics of mood disorders

International audience; Introduction: Depression is highly prevalent and causes considerable suffering and disease burden despite the existence of wide-ranging treatment options. Momentary assessment is a promising tool in the management of psychiatric disorders, and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. Treating the motivational and hedonic aspects of depression is a key target reported in the literature, but it is time-consuming in terms of human resources. Digital Applications offer a major opportunity to indirectly regulate impaired motivational circuits through dopaminergic pathways. Objective: The main objective of this review was twofold: (1) propose a conceptual and critical review of the literature regarding the theoretical and technical principles of digital applications focused on motivation in depression, activating dopamine, and (2) suggest recommendations on the relevance of using these tools and their potential place in the treatment of depression. Material and Methods: A search for words related to “dopamine”, “depression”, “smartphone apps”, “digital phenotype” has been conducted on PubMed. Results: Ecological momentary interventions (EMIs) differ from traditional treatments by providing relevant, useful intervention strategies in the context of people’s daily lives. EMIs triggered by ecological momentary assessment (EMA) are called “Smart-EMI”. Smart-EMIs can mimic the “dopamine reward system” if the intervention is tailored for motivation or hedonic enhancement, and it has been shown that a simple reward (such as a digital badge) can increase motivation. Discussion: The various studies presented support the potential interest of digital health in effectively motivating depressed patients to adopt therapeutic activation behaviors. Finding effective ways to integrate EMIs with human-provided therapeutic support may ultimately yield the most efficient and effective intervention method. This approach could be a helpful tool to increase adherence and motivation. Conclusion: Smartphone apps can motivate depressed patients by enhancing dopamine, offering the opportunity to enhance motivation and behavioral changes, although longer term studies are still needed.

International audience; The purpose of this article is to describe complex psychiatric disorders, to recall “minimal classical” explorations in psychiatry, to describe the concept of “complex psychiatric disorders” and to propose a systematized method of exploration.Some organic diseases are well known for their links with psychiatric disorders (manic syndrome and hyperthyroidism, depressive syndrome and corticotropic insufficiency, anxiety disorder and heart disease, etc.).Many other neurological, autoimmune, metabolic, paraneoplastic or endocrine pathologies can have essentially psycho-behavioral manifestations before being neurological or systemic.A large number of factors (nutritional, toxic, immunological, etc.), often ignored, influence the links between organicity and psychiatric pathologies.It is necessary to optimize the medical management of these patients in whom the psychiatric diagnosis masks a curable organo-psychiatric cause.; Cet article a pour objectifs de décrire des troubles psychiatriques complexes, de rappeler les explorations « classiques minimales » en psychiatrie, de décrire le concept de « troubles psychiatriques complexes » et de proposer une méthode d’exploration systématisée.Certaines pathologies organiques sont bien connues pour leurs liens avec les troubles psychiatriques (syndrome maniaque et hyperthyroïdie, syndrome dépressif et insuffisance corticotrope, trouble anxieux et maladie cardiaque, etc.).De nombreuses autres pathologies neurologiques, auto-immunes, métaboliques, paranéoplasiques ou endocriniennes peuvent avoir des manifestations essentiellement psycho-comportementales avant d’être neurologiques ou systémiques.Un grand nombre de facteurs (nutritionnels, toxiques, immunologiques, etc.), souvent ignorés, exercent une influence sur les liens existants entre organicité et pathologies psychiatriques.Il est nécessaire d’optimiser la prise en charge médicale de ces patients chez qui le diagnostic psychiatrique masque une cause organo-psychiatrique curable.

International audience; The patient's decision-making abilities are often altered in psychiatric disorders. The legal framework of psychiatric advance directives (PADs) has been made to provide care to patients in these situations while respecting their free and informed consent. The implementation of artificial intelligence (AI) within Clinical Decision Support Systems (CDSS) may result in improvements for complex decisions that are often made in situations covered by PADs. Still, it raises theoretical and ethical issues this paper aims to address. First, it goes through every level of possible intervention of AI in the PAD drafting process, beginning with what data sources it could access and if its data processing competencies should be limited, then treating of the opportune moments it should be used and its place in the contractual relationship between each party (patient, caregivers, and trusted person). Second, it focuses on ethical principles and how these principles, whether they are medical principles (autonomy, beneficence, non-maleficence, justice) applied to AI or AI principles (loyalty and vigilance) applied to medicine, should be taken into account in the future of the PAD drafting process. Some general guidelines are proposed in conclusion: AI must remain a decision support system as a partner of each party of the PAD contract; patients should be able to choose a personalized type of AI intervention or no AI intervention at all; they should stay informed, i.e., understand the functioning and relevance of AI thanks to educational programs; finally, a committee should be created for ensuring the principle of vigilance by auditing these new tools in terms of successes, failures, security, and relevance.

International audience; High stake clinical choices in psychiatry can be impacted by external irrelevant factors. A strong understanding of the cognitive and behavioural mechanisms involved in clinical reasoning and decision-making is fundamental in improving healthcare quality. Indeed, the decision in clinical practice can be influenced by errors or approximations which can affect the diagnosis and, by extension, the prognosis: human factors are responsible for a significant proportion of medical errors, often of cognitive origin. Both patient's and clinician's cognitive biases can affect decision-making procedures at different time points. From the patient's point of view, the quality of explicit symptoms and data reported to the psychiatrist might be affected by cognitive biases affecting attention, perception or memory. From the clinician's point of view, a variety of reasoning and decision-making pitfalls might affect the interpretation of information provided by the patient. As personal technology becomes increasingly embedded in human lives, a new concept called digital phenotyping is based on the idea of collecting real-time markers of human behaviour in order to determine the 'digital signature of a pathology'. Indeed, this strategy relies on the assumption that behaviours are 'quantifiable' from data extracted and analysed through connected tools (smartphone, digital sensors and wearable devices) to deduce an 'e-semiology'. In this article, we postulate that implementing digital phenotyping could improve clinical reasoning and decision-making outcomes by mitigating the influence of patient's and practitioner's individual cognitive biases.

Background Technical innovations such as ecological momentary assessment (EMA), machine learning (ML), computerized adaptive testing (CAT), Digital Phenotyping, Clinical Decision Support Systems (CDSS), Algorithms, and Biomarkers have caused a paradigm shift in psychiatric care. The aim of the present study was to explore how student nurses view this paradigm shift, by assessing the acceptability of smartphone-based EMA, CAT, and biosensor-based Digital Phenotyping. We also investigated the factors affecting this acceptability. Method Student nurses recruited via nursing schools participated in a quantitative study involving the screenplay method, in which they were exposed to two scenarios about depression care, one featuring EMA and CAT, the other featuring a connected wristband (CW) for Digital Phenotyping. Four acceptability domains (usefulness, usability, reliability, risk) were investigated. Results We recorded 1216 observations for the first scenario and 1106 for the second. Regarding overall acceptability, the CW was viewed less positively than CAT and EMA. Regarding reliability, whereas respondents believed that the CW could correctly detect depressive relapse, they did not think that EMA and CAT were sufficiently reliable for the accurate diagnosis of depressive disorder. More than 70% of respondents stated that they would nevertheless be interested in offering EMA, CAT or CW to their patients, but more than 60% feared that these devices might hinder the therapeutic relationship. Conclusion This was the first study assessing student nurses' views of EMA, CAT and CW-based digital phenotyping. Respondents were interested in these new technologies and keen to offer them to their patients. However, our study highlighted several issues, as respondents doubted the reliability of these devices and feared that they would hinder the therapeutic relationship. Subgroup analysis revealed correspondences between acceptability profiles and demographic profiles. It is therefore essential for nurses and student nurses to receive training and become involved in the development of this new technologies.

International audience; Background: Substance Use Disorder (SUD) and behavioral addictions are common and require a multidisciplinary approach. New technologies like Virtual Reality could have the potential to improve assessment and treatment of these disorders.Objective: In the present paper, we therefore present an overview of Virtual Reality (Head Mounted Devices) in the field of addiction medicine for craving assessment and treatment. Method: We conducted a systematic review by querying PubMed database for the titles of articles published up to March 2019 with the terms [virtual] AND [addictive] OR [addiction] OR [substance] OR [alcohol] OR [cocaine] OR [cannabis] OR [opioid] OR [tobacco] OR [nicotine] OR [methamphetamine] OR [gaming] OR [gambling].Results: We screened 319 abstracts and analyzed 37 articles, dividing them into two categories, the first for assessment of cue reactivity (craving, psychophysiological response and attention to cue) and the second for intervention, each drug (nicotine, cocaine, alcohol, cannabis, gambling) being detailed within each category.Conclusions: This overview suggest that VR provide benefits in the assessment and treatment of substance use disorders and behavior addictions and achieve high levels of ecological validity. While, craving provocation in VR is effective across addiction disorders, treatments based exclusively on virtual exposure to drug related cues as shown heterogenous results.

Objectives Post-traumatic stress disorder (PTSD) is a common psychiatric condition. Patients with PTSD have marked symptoms that significantly impair their social and emotional abilities, and numerous studies have explored this issue. We hypothesized that impairment of social cognition takes part in functional disability of individuals with PTSD. Methods We conducted a systematic review by querying PubMed database for the titles of articles published up to February 2018 with the terms [PTSD] [Post traumatic disorder] AND [Emotion recognition] OR [Facial expression of emotion] OR [Facial expression perception] OR [Empathy] OR [Affective empathy] OR [Mentalizing] OR [Social cognition] OR [Theory of Mind] OR [Mental state attribution] OR [Cognitive empathy] OR [Emotional empathy] OR [Social behaviour deficits]. Results Our results suggest that affective and cognitive aspect of theory of mind is comprehensively disturbed in patients with PTSD, showing a significant impairment in their ability to predict what others feel, think, or believe. They could also be massively altered in their perception of basic emotional expressions whether it is an expression of threat or happiness. Their affective empathy appears to be systematically disturbed and correlated to verbal and/or physical aggressive behaviour. Conclusions Social cognition is disturbed in PTSD and should be regarded as an important symptom. Damages in social cognition seem to take part in the functional disability of people with PTSD. We highlight the interest of a systematic assessment of social cognition in the care of patients with PTSD and suggest which tests could be the most relevant for this evaluation. Practitioner points •PTSD is no longer regarded as a subtype of anxiety disorder, but as part of a new category in the DSM-5. In clinical practice, symptoms tied to alterations in arousal and reactivity - such as irritability and vigilance - and to the disturbance of cognition and mood, are particularly closely correlated with poorer quality of life. Impaired social cognition clearly impacts the functional disability of people with PTSD. There are potential benefits of individualized cognitive remediation based on empathy and the emotional component of ToM (cognitive remediation, cognitive-behavioural therapy, therapeutic education, etc.) in PTSD people.

International audience; Les données d’imagerie fonctionnelle ont permis de progresser dans la compréhension laphysiopathologie des troubles somatoformes. Les nouvelles hypothèses postulent l’implication de réseaux dysfonctionnels, que ce soit ceux en lien avec les étapes précoces du contrôle du mouvement volontaire , mais aussi avec ceux associées à la représentations de soi, au sentiment d'agentivité, à la régulation des émotions et de la douleur ou enfin de la mémoire . On peut désormais explorer des voies thérapeutiques en ciblant plus spécifiquement ces réseaux

International audience; The purpose of this article is to describe complex psychiatric disorders, to recall “minimal classical” explorations in psychiatry, to describe the concept of “complex psychiatric disorders” and to propose a systematized method of exploration.Some organic diseases are well known for their links with psychiatric disorders (manic syndrome and hyperthyroidism, depressive syndrome and corticotropic insufficiency, anxiety disorder and heart disease, etc.).Many other neurological, autoimmune, metabolic, paraneoplastic or endocrine pathologies can have essentially psycho-behavioral manifestations before being neurological or systemic.A large number of factors (nutritional, toxic, immunological, etc.), often ignored, influence the links between organicity and psychiatric pathologies.It is necessary to optimize the medical management of these patients in whom the psychiatric diagnosis masks a curable organo-psychiatric cause.; Cet article a pour objectifs de décrire des troubles psychiatriques complexes, de rappeler les explorations « classiques minimales » en psychiatrie, de décrire le concept de « troubles psychiatriques complexes » et de proposer une méthode d’exploration systématisée.Certaines pathologies organiques sont bien connues pour leurs liens avec les troubles psychiatriques (syndrome maniaque et hyperthyroïdie, syndrome dépressif et insuffisance corticotrope, trouble anxieux et maladie cardiaque, etc.).De nombreuses autres pathologies neurologiques, auto-immunes, métaboliques, paranéoplasiques ou endocriniennes peuvent avoir des manifestations essentiellement psycho-comportementales avant d’être neurologiques ou systémiques.Un grand nombre de facteurs (nutritionnels, toxiques, immunologiques, etc.), souvent ignorés, exercent une influence sur les liens existants entre organicité et pathologies psychiatriques.Il est nécessaire d’optimiser la prise en charge médicale de ces patients chez qui le diagnostic psychiatrique masque une cause organo-psychiatrique curable.

International audience; Background: New technologies may profoundly change our way of understanding psychiatric disorders including posttraumatic stress disorder (PTSD). Imaging and biomarkers, along with technological and medical informatics developments, might provide an answer regarding at-risk patient’s identification. Recent advances in the concept of ‘digital phenotype’, which refers to the capture of characteristics of a psychiatric disorder by computerized measurement tools, is one paradigmatic example.Objective: The impact of the new technologies on health professionals practice in PTSD care remains to be determined. The recent evolutions could disrupt the clinical practices and practitioners in their beliefs, ethics and representations, going as far as questioning their professional culture. In the present paper, we conducted an extensive search to highlight the articles which reflect the potential of these new technologies.Method: We conducted an overview by querying PubMed database with the terms [PTSD] [Posttraumatic stress disorder] AND [Computer] OR [Computerized] OR [Mobile] OR [Automatic] OR [Automated] OR [Machine learning] OR [Sensor] OR [Heart rate variability] OR [HRV] OR [actigraphy] OR [actimetry] OR [digital] OR [motion] OR [temperature] OR [virtual reality].Results: We summarized the synthesized literature in two categories: prediction and assessment (including diagnostic, screening and monitoring). Two independent reviewers screened, extracted data and quality appraised the sources. Results were synthesized narratively.Conclusions: This overview shows that many studies are underway allowing researchers to start building a PTSD digital phenotype using passive data obtained by biometric sensors. Active data obtained from Ecological Momentary Assessment (EMA) could allow clinicians to assess PTSD patients. The place of connected objects, Artificial Intelligence and remote monitoring of patients with psychiatric pathology remains to be defined. These tools must be explained and adapted to the different profiles of physicians and patients. The involvement of patients, caregivers and health professionals is essential to the design and evaluation of these new tools.; Contexto: Las nuevas tecnologías podrían cambiar de manera profunda nuestra forma de entender los trastornos psiquiátricos incluyendo el trastorno de estrés postraumático (TEPT). Técnicas de imagen y biomarcadores, junto con desarrollos en informáticas médicas y tecnológicas, pueden proveer una respuesta en relación con la identificación de pacientes en riesgo. Avances recientes en el concepto de ‘genotipo digital’, que se refiere a la ‘captura’ de las características de un trastorno psiquiátrico mediante instrumentos de medición computarizada, es un ejemplo paradigmático de todo ello.Objetivo: El impacto de las nuevas tecnologías en la practica de los profesionales de la salud en el ámbito del tratamiento del trastorno de estrés postraumático (TEPT), está aún por determinar. Las evoluciones recientes pueden trastornar o interrumpir tanto las prácticas clínicas como a los profesionales que las ejercen. También a sus conceptos éticos y a sus representaciones hasta el punto de poder poner en cuestión su cultura profesional. En este trabajo, hemos realizado una búsqueda intensa con el fin de poner de manifiesto los trabajos que mejor reflejan el potencial de estas nuevas tecnologías.Método: Hemos realizado una búsqueda panorámica en la base de datos PubMed basándonos en títulos hasta Junio de 2017 que contenían los términos ‘[PTSD] [Posttraumatic stress disorder] AND [Computer] OR [Computerized] OR [Mobile] OR [Automatic] OR [Automated] OR [Machine learning] OR [Sensor] OR [Heart rate variability] OR [HRV] OR [actigraphy] OR [actimetry] OR [digital] OR [motion] OR [temperature] OR [virtual reality]’.Resultados: hemos resumido la literatura sintetizada en dos categorías: predicción y evaluación (incluyendo dignóstico, discriminación y monitorización). Dos investigadores independientes realizaron el triaje, extrajeron los datos y determinaron la calidad de las fuentes. Los resultados se refieren y sintetizan narrativamente.Conclusiones: este estudio muestra que muchos estudios están en marcha permitiendo empezar a construir un fenotipo digital de TEPT, usando datos pasivos obtenidos por sensores biométricos. Datos activos obtenidos a través de una Evaluación Momentánea Ecológica (EME), puede permitir evaluar a pacientes con TEPT para hacernos una idea de su severidad. El lugar que deben ocupar objetos conectados, inteligencia artificial y monitorización remota debe ser aún definido. Para poder ser utilizados, estos instrumentos deben ser por tanto explicados y adaptados a los diferentes perfiles de médicos y pacientes. La participación de los pacientes, cuidadores y de otros profesionales de la salud es esencial cara a diseñar y evaluar estos nuevos instrumentos.; 背景: 新技术巨大地改变了我们对精神疾病的理解方式，包括对创伤后应激障碍（PTSD）。脑成像和生物标记，与技术和医学信息的发展一起，也许提供了一个识别有风险的病人的途径。最近关于‘数码表型’（指使用电脑化测量工具来‘捕捉’精神疾病特征）的进展，就是一个典型的例子。目标: 新技术对健康专家在治疗 PTSD 的实践上的影响还有待商榷。最新的进展可能干扰了临床实践，以及临床医生本身的信念、道德和表现，乃至对他们的职业文化提出了质疑。在本文中，我们进行了一个宽泛的检索，以便着重标记出那些能更好反映这些新技术的潜力的文章。方法: 我们在PubMed数据库里使用‘[PTSD] [Posttraumatic stress disorder] AND [Computer] OR [Computerized] OR [Mobile] OR [Automatic] OR [Automated] OR [Machine learning] OR [Sensor] OR [Heart rate variability] OR [HRV] OR [actigraphy] OR [actimetry] OR [digital] OR [motion] OR [temperature] OR [virtual reality] ’作为标题检索词，限制截止时间为2017年7月。结果: 我们把合成的文献总结成两类：预测和评估（包括诊断、筛选和调控）。两个独立的评审对来源进行筛选、数据抽取和质量评价。对结果进行了综合性叙述。结论: 这份总结显示出许多进行中的研究，使用生物感受器的被动数据来建立一个 PTSD数码表型。使用生态瞬时评估（EMA）的主动数据可能可以用来评估 PTSD 病人的严重程度。连接对象、人工智能和远程调控的定位仍需定义。这些工具因此需要根据医生和病人的不同情况进行解释和调整。重要的是，让病人、照顾者和其他健康专家参与其中来对这些工具进行设计和评估。

BACKGROUND New technologies are set to profoundly change the way we understand and manage psychiatric disorders, including obsessive-compulsive disorder (OCD). Developments in imaging and biomarkers, along with medical informatics, may well allow for better assessments and interventions in the future. Recent advances in the concept of digital phenotype, which involves using computerized measurement tools to capture the characteristics of a given psychiatric disorder, is one paradigmatic example. OBJECTIVE The impact of new technologies on health professionals’ practice in OCD care remains to be determined. Recent developments could disrupt not just their clinical practices, but also their beliefs, ethics, and representations, even going so far as to question their professional culture. This study aimed to conduct an extensive review of new technologies in OCD. METHODS We conducted the review by looking for titles in the PubMed database up to December 2017 that contained the following terms: [Obsessive] AND [Smartphone] OR [phone] OR [Internet] OR [Device] OR [Wearable] OR [Mobile] OR [Machine learning] OR [Artificial] OR [Biofeedback] OR [Neurofeedback] OR [Momentary] OR [Computerized] OR [Heart rate variability] OR [actigraphy] OR [actimetry] OR [digital] OR [virtual reality] OR [Tele] OR [video]. RESULTS We analyzed 364 articles, of which 62 were included. Our review was divided into 3 parts: prediction, assessment (including diagnosis, screening, and monitoring), and intervention. CONCLUSIONS The review showed that the place of connected objects, machine learning, and remote monitoring has yet to be defined in OCD. Smartphone assessment apps and the Web Screening Questionnaire demonstrated good sensitivity and adequate specificity for detecting OCD symptoms when compared with a full-length structured clinical interview. The ecological momentary assessment procedure may also represent a worthy addition to the current suite of assessment tools. In the field of intervention, CBT supported by smartphone, internet, or computer may not be more effective than that delivered by a qualified practitioner, but it is easy to use, well accepted by patients, reproducible, and cost-effective. Finally, new technologies are enabling the development of new therapies, including biofeedback and virtual reality, which focus on the learning of coping skills. For them to be used, these tools must be properly explained and tailored to individual physician and patient profiles.

International audience; ObjectivesThe 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.

BACKGROUND Recent discoveries in the fields of machine learning (ML), Ecological Momentary Assessment (EMA), computerized adaptive testing (CAT), digital phenotype, imaging, and biomarkers have brought about a new paradigm shift in medicine. OBJECTIVE The aim of this study was to explore psychiatrists’ perspectives on this paradigm through the prism of new clinical decision support systems (CDSSs). Our primary objective was to assess the acceptability of these new technologies. Our secondary objective was to characterize the factors affecting their acceptability. METHODS A sample of psychiatrists was recruited through a mailing list. Respondents completed a Web-based survey. A quantitative study with an original form of assessment involving the screenplay method was implemented involving 3 scenarios, each featuring 1 of the 3 support systems, namely, EMA and CAT, biosensors comprising a connected wristband-based digital phenotype, and an ML-based blood test or magnetic resonance imaging (MRI). We investigated 4 acceptability domains based on International Organization for Standardization and Nielsen models (usefulness, usability, reliability, and risk). RESULTS We recorded 515 observations. Regarding our primary objective, overall acceptability was moderate. MRI coupled with ML was considered to be the most useful system, and the connected wristband was considered the least. All the systems were described as risky (410/515, 79.6%). Regarding our secondary objective, acceptability was strongly influenced by socioepidemiological variables (professional culture), such as gender, age, and theoretical approach. CONCLUSIONS This is the first study to assess psychiatrists’ views on new CDSSs. Data revealed moderate acceptability, but our analysis shows that this is more the result of the lack of knowledge about these new technologies rather than a strong rejection. Furthermore, we found strong correspondences between acceptability profiles and professional culture profiles. Many medical, forensics, and ethical issues were raised, including therapeutic relationship, data security, data storage, and privacy risk. It is essential for psychiatrists to receive training and become involved in the development of new technologies.

International audience; Background: New technologies can profoundly change the way we understand psychiatric pathologies and addictive disorders. New concepts are emerging with the development of more accurate means of collecting live data, computerized questionnaires, and the use of passive data. Digital phenotyping, a paradigmatic example, refers to the use of computerized measurement tools to capture the characteristics of different psychiatric disorders. Similarly, machine learning–a form of artificial intelligence–can improve the classification of patients based on patterns that clinicians have not always considered in the past. Remote or automated interventions (web-based or smartphone-based apps), as well as virtual reality and neurofeedback, are already available or under development.Objective: These recent changes have the potential to disrupt practices, as well as practitioners’ beliefs, ethics and representations, and may even call into question their professional culture. However, the impact of new technologies on health professionals’ practice in addictive disorder care has yet to be determined. In the present paper, we therefore present an overview of new technology in the field of addiction medicine.Method: Using the keywords [e-health], [m-health], [computer], [mobile], [smartphone], [wearable], [digital], [machine learning], [ecological momentary assessment], [biofeedback] and [virtual reality], we searched the PubMed database for the most representative articles in the field of assessment and interventions in substance use disorders.Results: We screened 595 abstracts and analyzed 92 articles, dividing them into seven categories: e-health program and web-based interventions, machine learning, computerized adaptive testing, wearable devices and digital phenotyping, ecological momentary assessment, biofeedback, and virtual reality.Conclusion: This overview shows that new technologies can improve assessment and interventions in the field of addictive disorders. The precise role of connected devices, artificial intelligence and remote monitoring remains to be defined. If they are to be used effectively, these tools must be explained and adapted to the different profiles of physicians and patients. The involvement of patients, caregivers and other health professionals is essential to their design and assessment.

Background Recent discoveries in the fields of machine learning (ML), Ecological Momentary Assessment (EMA), computerized adaptive testing (CAT), digital phenotype, imaging, and biomarkers have brought about a new paradigm shift in medicine. Objective The aim of this study was to explore psychiatrists’ perspectives on this paradigm through the prism of new clinical decision support systems (CDSSs). Our primary objective was to assess the acceptability of these new technologies. Our secondary objective was to characterize the factors affecting their acceptability. Methods A sample of psychiatrists was recruited through a mailing list. Respondents completed a Web-based survey. A quantitative study with an original form of assessment involving the screenplay method was implemented involving 3 scenarios, each featuring 1 of the 3 support systems, namely, EMA and CAT, biosensors comprising a connected wristband-based digital phenotype, and an ML-based blood test or magnetic resonance imaging (MRI). We investigated 4 acceptability domains based on International Organization for Standardization and Nielsen models (usefulness, usability, reliability, and risk). Results We recorded 515 observations. Regarding our primary objective, overall acceptability was moderate. MRI coupled with ML was considered to be the most useful system, and the connected wristband was considered the least. All the systems were described as risky (410/515, 79.6%). Regarding our secondary objective, acceptability was strongly influenced by socioepidemiological variables (professional culture), such as gender, age, and theoretical approach. Conclusions This is the first study to assess psychiatrists’ views on new CDSSs. Data revealed moderate acceptability, but our analysis shows that this is more the result of the lack of knowledge about these new technologies rather than a strong rejection. Furthermore, we found strong correspondences between acceptability profiles and professional culture profiles. Many medical, forensics, and ethical issues were raised, including therapeutic relationship, data security, data storage, and privacy risk. It is essential for psychiatrists to receive training and become involved in the development of new technologies.