Isaac R. Galatzer‐Levy

Zhe Sage Chen, Prathamesh, Kulkarni et al.

In light of the NIMH's Research Domain Criteria (RDoC), the advent of functional neuroimaging, novel technologies and methods provide new opportunities to develop precise and personalized prognosis and diagnosis of mental disorders. Machine learning (ML) and artificial intelligence (AI) technologies are playing an increasingly critical role in the new era of precision psychiatry. Combining ML/AI with neuromodulation technologies can potentially provide explainable solutions in clinical practice and effective therapeutic treatment. Advanced wearable and mobile technologies also call for the new role of ML/AI for digital phenotyping in mobile mental health. In this review, we provide a comprehensive review of the ML methodologies and applications by combining neuroimaging, neuromodulation, and advanced mobile technologies in psychiatry practice. Additionally, we review the role of ML in molecular phenotyping and cross-species biomarker identification in precision psychiatry. We further discuss explainable AI (XAI) and causality testing in a closed-human-in-the-loop manner, and highlight the ML potential in multimedia information extraction and multimodal data fusion. Finally, we discuss conceptual and practical challenges in precision psychiatry and highlight ML opportunities in future research.

Isaac R. Galatzer-Levy, Daniel McDuff, Vivek Natarajan et al.

The current work investigates the capability of Large language models (LLMs) that are explicitly trained on large corpuses of medical knowledge (Med-PaLM 2) to predict psychiatric functioning from patient interviews and clinical descriptions without being trained to do so. To assess this, n = 145 depression and n =115 PTSD assessments and n = 46 clinical case studies across high prevalence/high comorbidity disorders (Depressive, Anxiety, Psychotic, trauma and stress, Addictive disorders) were analyzed using prompts to extract estimated clinical scores and diagnoses. Results demonstrate that Med-PaLM 2 is capable of assessing psychiatric functioning across a range of psychiatric conditions with the strongest performance being the prediction of depression scores based on standardized assessments (Accuracy range= 0.80 - 0.84) which were statistically indistinguishable from human clinical raters t(1,144) = 1.20; p = 0.23. Results show the potential for general clinical language models to flexibly predict psychiatric risk based on free descriptions of functioning from both patients and clinicians.

Jiyeong Kim, Stephen P. Ma, Michael L. Chen et al.

Patients with diabetes are at increased risk of comorbid depression or anxiety, complicating their management. This study evaluated the performance of large language models (LLMs) in detecting these symptoms from secure patient messages. We applied multiple approaches, including engineered prompts, systemic persona, temperature adjustments, and zero-shot and few-shot learning, to identify the best-performing model and enhance performance. Three out of five LLMs demonstrated excellent performance (over 90% of F-1 and accuracy), with Llama 3.1 405B achieving 93% in both F-1 and accuracy using a zero-shot approach. While LLMs showed promise in binary classification and handling complex metrics like Patient Health Questionnaire-4, inconsistencies in challenging cases warrant further real-life assessment. The findings highlight the potential of LLMs to assist in timely screening and referrals, providing valuable empirical knowledge for real-world triage systems that could improve mental health care for patients with chronic diseases.

Isaac R. Galatzer-Levy, Jed McGiffin, David Munday et al.

Generative AI's rapid advancement sparks interest in its cognitive abilities, especially given its capacity for tasks like language understanding and code generation. This study explores how several recent GenAI models perform on the Clock Drawing Test (CDT), a neuropsychological assessment of visuospatial planning and organization. While models create clock-like drawings, they struggle with accurate time representation, showing deficits similar to mild-severe cognitive impairment (Wechsler, 2009). Errors include numerical sequencing issues, incorrect clock times, and irrelevant additions, despite accurate rendering of clock features. Only GPT 4 Turbo and Gemini Pro 1.5 produced the correct time, scoring like healthy individuals (4/4). A follow-up clock-reading test revealed only Sonnet 3.5 succeeded, suggesting drawing deficits stem from difficulty with numerical concepts. These findings may reflect weaknesses in visual-spatial understanding, working memory, or calculation, highlighting strengths in learned knowledge but weaknesses in reasoning. Comparing human and machine performance is crucial for understanding AI's cognitive capabilities and guiding development toward human-like cognitive functions.

Samy Abdel-Ghaffar, Isaac Galatzer-Levy, Conor Heneghan et al.

The autonomic nervous system (ANS) is activated during stress, which can have negative effects on cardiovascular health, sleep, the immune system, and mental health. While there are ways to quantify ANS activity in laboratories, there is a paucity of methods that have been validated in real-world contexts. We present the Fitbit Body Response Algorithm, an approach to continuous remote measurement of ANS activation through widely available remote wrist-based sensors. The design was validated via two experiments, a Trier Social Stress Test (n = 45) and ecological momentary assessments (EMA) of perceived stress (n=87), providing both controlled and ecologically valid test data. Model performance predicting perceived stress when using all available sensor modalities was consistent with expectations (accuracy=0.85) and outperformed models with access to only a subset of the signals. We discuss and address challenges to sensing that arise in real world settings that do not present in conventional lab environments.

Xin Liu, Daniel McDuff, Geza Kovacs et al.

Large language models (LLMs) can capture rich representations of concepts that are useful for real-world tasks. However, language alone is limited. While existing LLMs excel at text-based inferences, health applications require that models be grounded in numerical data (e.g., vital signs, laboratory values in clinical domains; steps, movement in the wellness domain) that is not easily or readily expressed as text in existing training corpus. We demonstrate that with only few-shot tuning, a large language model is capable of grounding various physiological and behavioral time-series data and making meaningful inferences on numerous health tasks for both clinical and wellness contexts. Using data from wearable and medical sensor recordings, we evaluate these capabilities on the tasks of cardiac signal analysis, physical activity recognition, metabolic calculation (e.g., calories burned), and estimation of stress reports and mental health screeners.

Li Zhang, Vijay Yadav, Vidya Koesmahargyo et al.

Tremor is a key diagnostic feature of Parkinson's Disease (PD), Essential Tremor (ET), and other central nervous system (CNS) disorders. Clinicians or trained raters assess tremor severity with TETRAS scores by observing patients. Lacking quantitative measures, inter- or intra- observer variabilities are almost inevitable as the distinction between adjacent tremor scores is subtle. Moreover, clinician assessments also require patient visits, which limits the frequency of disease progress evaluation. Therefore it is beneficial to develop an automated assessment that can be performed remotely and repeatably at patients' convenience for continuous monitoring. In this work, we proposed to train a deep neural network (DNN) with rank-consistent ordinal regression using 276 clinical videos from 36 essential tremor patients. The videos are coupled with clinician assessed TETRAS scores, which are used as ground truth labels to train the DNN. To tackle the challenge of limited training data, optical flows are used to eliminate irrelevant background and statistic objects from RGB frames. In addition to optical flows, transfer learning is also applied to leverage pre-trained network weights from a related task of tremor frequency estimate. The approach was evaluated by splitting the clinical videos into training (67%) and testing sets (0.33%). The mean absolute error on TETRAS score of the testing results is 0.45, indicating that most of the errors were from the mismatch of adjacent labels, which is expected and acceptable. The model predications also agree well with clinical ratings. This model is further applied to smart phone videos collected from a PD patient who has an implanted device to turn "On" or "Off" tremor. The model outputs were consistent with the patient tremor states. The results demonstrate that our trained model can be used as a means to assess and track tremor severity.

Jacob Ouyang, Isaac R Galatzer-Levy, Vidya Koesmahargyo et al.

In this paper, we present a model that can directly predict emotion intensity score from video inputs, instead of deriving from action units. Using a 3d DNN incorporated with dynamic emotion information, we train a model using videos of different people smiling that outputs an intensity score from 0-10. Each video is labeled framewise using a normalized action-unit based intensity score. Our model then employs an adaptive learning technique to improve performance when dealing with new subjects. Compared to other models, our model excels in generalization between different people as well as provides a new framework to directly classify emotional intensity.