2020-11-15: Sapien Labs Virtual Symposium on Mental Health Trip Report

The Sapien Labs Virtual Symposium on The Future of Mental Health: Measurement, Treatment and Therapies was held virtually via Adobe Connect on 2-3 November 2020.   The symposium consisted of 2 sessions on each day.  Each session would begin with multiple presentations.  The presenters in each session would also join in a moderated panel discussion in the second half of that session.  Founder and CEO of Sapien Labs, Dr. Tara Thiagarajan, hosted the virtual symposium, introduced many of the speakers, and led multiple panel discussions.

Symposium Day 1

Session 1:

Dr. Eiko Fried from Leiden University started the first session's presentations with his talk on "Measure Matters: Challenges to Assessing Mental Health Problems Pose a Substantial Barrier to Clinical Progress."  Dr. Fried stated that while proper measurement is critical, it is difficult especially when attempting to measure individuals' internal states to include personality, cognition, and mental health problems.  He identified the lack of transparency, lack of funding, and questionable measurement practices as some of the issues contributing to the challenges in these measurements.  Dr. Fried further explored the issues with measurements through an examination of the measurements used to determine depression severity.

Dr. Yukiko Uchida, a Professor of Social and Cultural Psychology at Kyoto Universityfollowed the first presenter with a discussion on "Culture, Health and Well-being:  A Perspective from Cultural Psychology."  Dr. Uchida spoke of the need to rethink psychological universalism and consider culture and context in behavior assessments.  She discussed the cultural meaning systems and emphasized the need to consider thiose meaning system in psychology.  

Dr. Jennifer Newson of Sapien Labs ended the first session's talks with a presentation on "The Heterogeneity of Mental Health Assessment."  She described the landscape of mental health assessments, which typically rely on self-reporting tools (surveys) or reports from clinicians or parents rather than biological tests.  Her group's analysis of the distribution of symptoms measured with assessment tools for various mental disorders revealed inconsistencies in those tools.  Some tools may also be more emotion focused and other more behavior focused, all of which makes it difficult to compare between mental illness research studies that use different assessment tools.  As a result of their assessment of 10,154 questions across 126 surveys, Dr. Newson's group proposed a new, standardized assessment tool called the Mental Health Quotient (MHQ).  Through this survey, they have found that many respondents have symptoms profiles that map to multiple disorders while others may experience severe symptoms while having symptom profiles that do not map to any of the 10 disorders that the MHQ is used to identify. 
The presenters Dr. Fried, Dr. Uchida and Dr. Newson joined moderator Dr. Uma Vaidyanathan of the RDOC Unit NIH/NIMH for a panel discussion on "Measurement and Assessment in Mental Health."  The panel discussion built on the panelists' presentations with dialogue centered around the challenges in symptom measurements.  Challenges discussed included the validity of measurement tools, the timing of the questionnaires modulating the analysis, and multiple manifestations of emotions and/or disorders.  Panelist expressed the difficulties in trying to infer unobservable internal states from behavior in people that differ dramatically from each other.  However, the group also acknowledged that the state of measurements in psychology is not what it should be.

Session 2:

Dr. Oren Shriki, a Principal Investigator from Ben-Gurion University, gave a talk titled "Living on the Edge:  On critical brain dynamics as a Framework for Assessing and Regulating Brain Function."  He discussed the framework of critical brain dynamics as well as neuromarkers for schizophrenia, epilepsy, and other conditions.  Dr. Shriki further described how electroencephalogram (EEG) data showed signatures of neuronal avalanches and how EEG-based neural gain metrics could be used to discriminate between different levels of consciousness and disorders.

Dr. Amit Etkin, CEO of Alto Neuroscience and a Professor of Psychiatry and Behavioral Science at Stanford University, was the second briefer in Session 2 with his topic on "Grounding Psychiatry in Scalable Brain-Based Biomarkers."  He discussed where biomarkers and EEG data come into play in psychiatry.  Dr. Etkin went over machine learning techniques and how they can be used in the prediction of treatment outcomes.  He discussed a method for determining EEG connectivity at rest and how his team used it to analyze connectivity between brain regions of interest in Post-Traumatic Stress Disorder (PTSD) patients, finding that control subjects had greater connectivity than those with PTSD.  Dr. Etkin also explained how brain signatures can be used to predict how patients will respond to psychotherapy and select the most appropriate treatment.

The last talk of session 2 was given by Dr. Vladimir Miskovic, a Senior Scientist at X, on "Technology Enabled Multimodal Assessment for Mental Health."  He described how mental health disorders are dynamic and change over time.  He also spoke on how scores from surveys like the Patient Health Questionnaire (PHQ)-9 tell a clinician little to nothing about how their depression or anxiety is manifesting and that two individuals with the same survey scores may not share any symptoms.  As a result, his team proposed a system that uses multiple input streams to obtain subjective self reporting data via a smart phone application, continuous objective physiology and behavior data through wearables, and objective episodic neural activity from EEG measurements.  To collect and process the EEG measurements, his team developed hardware and software for a portable EEG system.  The Team at X will be donating 50 of these custom EEG systems to Sapien Labs as a part of the Human Brain Diversity Project. 
These three speakers joined Dr. Tara Thiagarajan in the Session 2 panel discussion, which centered around "Brain Physiology to Behavior."  The group spoke about technology and education meeting a practical goal and the disconnect between the clinical and research world.  They also discussed conditions, their associations with certain symptoms, and the challenge in being able to map the way people express their symptoms to an objective measure.  Panelist discussed how symptoms can be expressed differently due to cultural differences, age, and other factors, which make mapping them to disorders difficult.  Rather than looking for specific symptoms, the group considered the potential use of broader categorizations of emotional distressed and cognitive distress for various conditions.

Symposium Day 2

Session 3:

The first presenter during the third session of the symposium was Dr. Neil Leibowitz, a Chief Medical Officer with the Talkspace online therapy company.  He gave his talk on "2020:  The Year of Adoption for Digital Mental Health - Lessons learned for 2021 and Beyond."  He discussed how COVID-19 accelerated the use of telehealth for mental health care.  He went over electronic solutions like smart phone applications and electronic journals, which provide people with more choices and a feeling of having more control over their mental health treatment.  Dr. Leibowitz also discussed the use of big data and machine learning in predictive models for the diagnosis of mental health conditions, treatment plan development, patient engagement, and risk assessments in support of improved care.

Dr. Leibowitz was followed by Theresa Nguyen, the Chief Program Officer and Vice President of Research and Innovation at  Mental Health America, who discussed "Equity & COVID Insights from Online Screening."  Dr. Nguyen revealed how depression, anxiety, and psychosis dramatically increased in 2020, with 64.89% of individuals screened for anxiety in September attributing their mental health issue to loneliness or isolation.  She spoke specifically about the differences in concerns amongst individuals of different races.  Dr. Nguyen also detailed the need to develop digital tools that are inclusive for a diverse group of consumers and things that must be considered for that to happen.
Dr. Hellen Christensen, Director & Chief Scientist with the Black Dog Institute, gave her talk on "Using Smartphone Technologies to Detect and Deliver Mental Health Interventions:  Where We Are and Where We Need to Go."  In Australia where she resides, mental health is underfunded but investments in health related technology is increasing.  Dr. Christensen discussed how her organization has been developing digital mental health preventative solutions and treatment interventions, from stand-alone applications to multi-platform services.  Such applications include those for youth suicide prevention, teaching strategies to improve sleep, tools for screening students for mental health issues, and mental health care for front-line workers.

Dr. Stephen Schueller from the School of Social Ecology, UC Irvine, served as the moderator for the Session 3 panel discussion on "Digital Tools for Mental Health."  The panel began the discussion with concerns regarding digital healthcare, which included privacy, data ownership and usage, establishing the right level of standards, cost control, and how to ensure the best solution is adopted rather than the best funded solution.  They provided their thoughts on digital system adoption and whether technology can help increase the number of individuals that seek help for mental disorders.  They also discussed the youth mental health crisis and the need for creating products that are responsive to that group.  Certain panelist spoke against a purely self-service approach to mental health treatment, emphasizing the need for level of human interaction, even if significantly reduced, along side the use of technology.

Session 4:

There were two presenters for the final session of the symposium.  Dr. Mitual Mehta, a professor at the King's College London, presented his brief on "Academic Collaboration with the Pharmaceutical Industry to Validate Critical Theories in the Drug Development Pathway:  Advantages and Pitfalls."  Dr. Mehta talked about how the FDA has approved few to no drugs in the past few years for psychiatry, which he attributed to a lack of successes in clinical trials and/or a decrease in corporate investments in psychiatry research and development. As a result, he emphasized the need for more academic collaboration to make up for that loss and describes how universities could become more involved in the development of treatments for conditions such as depression and schizophrenia.

The final presenter of the symposium was Dr. Ekaterina Malievskaya, Chief Innovation Officer and Co-Founder of Compass Pathways, who gave her talk on "The Promise of Psychedelic Therapy" as an alternative to conventional psychiatric medication for the treatment of conditions like depression and obsessive-compulsive disorder (OCD).  She discussed how there was little evidence for conventional mental health treatment effectiveness and the lack of guidance on how to proceed with patients who become treatment resistant.  Although she referred to her company as drug agnostic, it did support clinical trials in the use of psilocybin, a substance found in magic mushrooms, to treat mental health conditions.

The fourth panel discussion centered around "The Future of Psychiatric Drugs."  The panel included the two Session 4 presenters with Dr. Tara Thiagarajan once again serving as the moderator.  The panelist discussed how clinical trials in the use of psychedelic therapy impacted their view of the human mind.  They responded to questions about the possibility of tying psychedelic experiences to a single serotonin receptor in the brain. The panelist also talked about the ability of therapists to interpret subjective experiences, the impact of regulators in the success of clinical trials, and models used for treatment responses before taking questions from the audience.
Despite minor technical challenges with the virtual platform along the way, the virtual symposium was very informative.  It definitely gave me several things to consider as I proceed with my research in the use of EEG and other data sources for automated PTSD symptom assessments in support of PTSD diagnosis.  I look forward to hearing of other events hosted by Sapien Labs. 

-- Bathsheba Farrow