An important research focus of the CIMH is to investigate the development and causes of mental illness and health. The aim is to better understand and recognize mental illnesses and to develop new therapies. In order to identify correlations between symptoms and biological patterns, as much clinical data as possible from people with mental illnesses is required. This is why the clinical-scientific characterization of all patients is a key focus of the Institute's translational strategy. The newly established organizational structure for the admission of patients now combines the requirements of the clinic and research: data-supported treatment and patient-oriented research.
Interface between patient care and research
The Diagnosis and Admission Center (DAZ) is an upstream first point of contact within the structures of the central outpatient clinic, through which all outpatients and (partially) inpatients pass. Initially, patients from the Clinic for Psychiatry and Psychotherapy, the Clinic for Addictive Behavior and Addiction Medicine and the Clinic for Psychosomatics and Psychotherapeutic Medicine will be diagnosed. In future, all patients at the CIMH will follow this path.
Since the beginning of June 2024, patients at the DAZ have also been comprehensively informed about what data is collected during their treatment and how they can voluntarily support medical research with their data. In addition, broad, standardized diagnostics are carried out in which data is collected as a basis for further treatment. The DAZ thus forms an important interface between patient care and research and integrates the needs of both areas.
The standardized data set used at the CIMH has a modular structure and is based on the common core data set of the Medical Informatics Initiative (MII). The additional data collected at the CIMH is coordinated with the partners in the German Center for Mental Health (DZPG) in order to be able to use harmonized data sources together in the future. Among other things, data on the person and living environment, laboratory findings, diagnoses and treatments as well as mental health will be collected. In addition, biomaterials such as blood and tissue samples can be submitted and stored in the CIMH biobank. If patients agree to the modules of this Broad Consent in whole or in part, they support the work of researchers at the CIMH and within the DZPG, as well as nationwide via the MII. “Experience to date has shown that patients are very willing to make all or part of their data available for research. Especially when they see that the data collected can help them specifically in their treatment as well as other patients, many of them are happy to give their full consent, says Dr. Urs Braun, Head of the DAZ.
Tailor-made treatment planning
Regardless of which consent is given after the informed consent process, all patients are characterized across all diagnoses. This is done through standardized psychological and psychiatric diagnostics, including laboratory and electrocardiological examinations. Based on this detailed information, the practitioners can make a data-driven decision as to which further diagnostics and treatment options are most suitable. Patients can also be recommended to take part in relevant studies that contain treatment elements. “Overall, we are experiencing a high level of acceptance of the new structure. Patients find the comprehensive diagnostics useful for their treatment, and those treating them benefit from the comprehensive collection of information and targeted referral when planning individual treatment,” says Dr. Oliver Hennig, Head of the Central Outpatient Clinic.
Processing and exchanging highly sensitive data securely
To enable scientists to conduct research with the collected data, an IT infrastructure is being set up at the CIMH to store and evaluate the broad consent data in compliance with data protection regulations. The independent trust office pseudonymizes the medical data and thus guarantees data protection during the entire data processing procedure. In addition, the trust office manages the declarations of consent in the Broad Consent and the revocations of patients.
In the future Data Integration Center (DIZ), the pseudonymized data will be transferred, processed and stored in an analyzable form. Researchers at the CIM can request suitable data for their study based on defined criteria. In the future, the data infrastructure will also make it possible to contact potential subjects from the data pool for new studies, provided that the subjects have agreed to be contacted in advance. In all cases of data retrieval, the Use & Access Committee decides whether data will be released for studies at the CIMH following a vote by the local ethics committee. In future, the data will be exchanged with partners in the DZPG and in the nationwide MII across all sites and used for medical research.
Basis for the application of artificial intelligence in research
Through the work of the DAZ, health data is continuously collected. This is gradually creating a unique database of clinical data and biosamples across the lifespan and along the entire diagnostic and therapeutic process. These large and high-quality data sets are the prerequisite for applying artificial intelligence for research and clinical purposes.
At the CIMH, for example, the Hector Institute for Artificial Intelligence in Psychiatry (HITKIP) combines scientific data with information from clinical care. By analyzing this data, new correlations can be identified, for example between symptoms of illness and biological patterns. The researchers use this data to develop models to adapt treatment to personal risk and protective factors. In this way, the scientific findings are transferred to patient care and new ways can be found to treat mental illness even more effectively or even prevent it.