Mindscape — A New Framework for Psychiatry2022-09-05

What gets measured gets managed.

—Peter Drucker

The majority of psychiatric patients end up with multiple diagnostic labels. In some cases, it can be that some of the labels are historic, and the knowledge of the patient or disease course has progressed. In other cases, it can be a disagreement between different clinicians, due to various levels of experience, and the lack of use of standardized and quantitative tools. However, the most common cause is that patients have multiple things going on at the same time, i.e., some anxiety, some mood, and some cognitive abnormalities. Which is primary and which are secondary are important to know. But even more important are to account for all of them in a consistent and unitary fashion, and to treat them all appropriately.

That is why we have developed a tri-dimensional framework called Mindscape (mental landscape), with the three dimensions being anxiety, mood, and cognition. (Stress can be added as a fourth dimension that affects all of the other three). Each person is a point in this Mindscape at a particular moment in time, defined by (x, y, z) coordinates. Over time, each person is the totality of these points, having their own unique Mindscape cloud. That representation is a better description of who the patient is than having a hodge-podge of labels.

The scores on each dimension can be measured, leading to those quantitative x, y, z coordinates. The measurements can be at a behavioral (phenomic) level, using quantitative questionnaires and scales, or at a biomarker (genomic) level, using blood tests. We have developed and made available both. Our Life x Mind app contains simple questionnaires that quantitatively measure your anxiety, mood, and cognition (the pathological flip side of that being psychosis), as well as stress. It also generates your Mindscape. With 2 weeks of daily use, you can see your Mindscape cloud, and what Mindscape Type you are. You can email a report of that to your clinician. Those types can be translated to current DSM labels to aid clinical documentation. Such simple advances can empower preventive, powerful, precise, and personalized 21st Century Psychiatry.

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