Développement d’un réseau nosographique collaboratif

Abstract

ObjectivesThe use of massive amounts of digital data in mental health offers interesting perspectives that could influence the evolution of psychiatric nosography. The characteristics of this data could become key elements to understand the future organization of knowledge — and debates — in psychiatry. Such an evolution could take different shapes, including the development of a collaborative and networked psychiatric classification. Materials and methodsSeveral issues related to the use of large amounts of data in psychiatry were identified and developed in this context: (1) the growth of new health related data producers and storers, which could influence the development of some research topics or diagnostics to the detriment of others, depending on the availability or profitability of this data; (2) the fact that mental health data is often available in an unstructured form: textual data, like reports of complementary examinations, reports of hospitalization or expertises, but also imageries or videos, from institutional or alternative sources; (3) the need of scalability and flexibility of this data, to make it possible to integrate recent discoveries as well as to take into account the phenomenon of pathomorphosis or cultural factors in psychiatry. A collaborative framework is proposed to answer each of these issues, including the possibility of integration of different data forms, associated with a complete traceability of sources and a nominal registration. The need to structure data is also specified, with the use of tags to modelize diagnostic consensus that include professionals, patients and families. This collaborative tool would make it possible to consider data resulting from perceptions of patients or their families, enabling patients to benefit from a higher level of confidence and engagement, and limiting the deleterious effects of stigmatization. ResultsThe possibilities of a collaborative web tool integrated into the French Shared Medical File (Dossier Medical Partagé) are described, and two examples of practical situations are presented: A mental health professional reporting his influences on the diagnosis of schizophrenia: he integrates the symptoms described by the German psychiatrist Karl Leonhard (Leonhard classification), cultural references (cinematographic reference like A beautiful mind directed by Ron Howard), and links to articles on medical and psychiatric comorbidities among adults with schizophrenia. In the other example, a psychiatrist uses this tool to develop a collaborative diagnosis that integrated an active participation of the patient around the diagnostic. In France, the latest version of the digital Shared Medical File was launched in November 2018. The integration of a collaborative nosographic tool into this file would be an interesting answer to the difficulties that might happen for its use with patients suffering from mental disorders. It could thus limit the stigmatization of a shared diagnosis and enable a better understanding of practices among mental health professionals. ConclusionThe psychiatrists use specific knowledge resulting from multiple influences and theoretical orientations. The risk of incomprehension of practices in psychiatry by patients and their families being major, nosographic research trying to include the coexistence of these orientations appears necessary. Moreover, in the context of the development of large-scale data processing, it is essential that a collaborative human-scale interpretation of this knowledge exists. This would make the psychiatric nosography an ethical tool, allowing an active participation and dialogue between patients, families and health professionals, that could become key features of future psychiatric nosography.