Two countries, one shared ambition: advancing precision psychiatry

Prof. Leboyer, could you start by introducing us to the Experts Centers model in France? How do these centers for psychiatric disorders differ from traditional psychiatric care facilities, and how is the Fondation FondaMental embedded in the national care and research structure in France?

Created in 2010 and coordinated by the Fondation FondaMental, a non-profit foundation, the Expert Centers represent a third level of care within the French psychiatric system, inspired by the model of reference centers for rare diseases. 

Currently, we coordinate 55 centers, located throughout France, organized into four networks (bipolar disorder, schizophrenia, treatment-resistant depression, and autism without intellectual disability) and embedded within public psychiatry departments.

Patients are referred by their psychiatrist, general practitioner, or another specialist. They benefit during a two days day care hospital from a standardized, multidisciplinary assessment and receive a detailed feedback session where we make personalized therapeutic recommendations. Personalized recommendations—therapeutic, psychotherapeutic, and somatic—are transmitted to the referring physician to ensure continuity of care. 

Patients are systematically asked if they want to participate in research projects, which has enabled the creation of large multimodal cohorts, open for collaboration (Access to research data | La Recherche | Fondation FondaMental)

Finally, the FondaMental Foundation oversees national coordination, harmonization of practices, and the vital link between care and research. 

What are the primary clinical focuses of the Experts Centers – regarding both conditions and patients?

The Experts Centers focus on complex cases of schizophrenia, bipolar disorder, treatment-resistant depression, and autism without intellectual disability. Patients receive comprehensive and standardized assessments carried out by multidisciplinary teams composed of psychiatrists, neuropsychologists, and specialized nurses. The results lead to tailored therapeutic recommendations, which are transmitted to the referring physician. Since their creation, more than 10,000 patients have been evaluated, helping to reduce residual symptoms, number of rehospitalization, improve detection of comorbidities, and provide personalized treatment plans.

Together with the DZPG, you are working to harmonize the data and standards for transnational research. What are the opportunities here?

Collaboration with DZPG provides the opportunity to standardize clinical assessment and data collection between French and German Centers, enabling future comparisons across different contexts and populations. This harmonization facilitates the integration of data from diverse cohorts and advances translational research by accelerating the application of scientific discoveries to clinical practice. It also contributes to the development of more targeted and personalized treatments, tailored to the individual needs of patients. Furthermore, this approach strengthens cooperation among researchers, clinicians, and institutions by establishing a common framework to better understand complex mental health disorders and improve the quality of care globally.

In this context, we have recently launched a Franco-German consortium that brings together the French Expert Centers and the German Centers of Excellence within the DZPG network. This strategic alliance aims to jointly identify, discover, and validate a new generation of biomarkers — genetic, inflammatory, metabolic, cognitive, and digital — by comparing large, harmonized data cohorts from both countries and applying advanced AI-driven analytical methods. 

The first domain of interaction will be dedicated to applying AI to the search for biomarkers of mental disorders. This will be done by transforming data into synthetic data and organizing a hackathon on biomarkers discoveries in the following months. 

Beyond biomarker discovery, the consortium also seeks to build interoperable data infrastructures and predictive models that will support earlier diagnosis, stratify patient subgroups more accurately, and guide personalized therapeutic decisions. 

Ultimately, the goal is to accelerate the development of precision psychiatry tools and ensure that innovative diagnostics and treatments rapidly reach patients across Europe.

What are the greatest challenges to international harmonization - e.g. in relation to data protection or clinical routines?

One key challenge will be to align data protection regulations and clinical practices across countries. This involves ensuring patient confidentiality and informed consent. Another challenge lies in standardizing diagnostic tools and harmonizing methods to measure various biomarkers.  This approach requires careful coordination and sustained collaboration among institutions, clinicians, and researchers at both national and international levels, while considering legal, ethical, and cultural differences. Addressing these challenges is essential to foster genuine cooperation in psychiatric research and to accelerate clinical advances for the benefit of patients.

The term “precision psychiatry” comes up time and again. How do you define it and what do you think makes it so important for the future of psychiatry?

Precision psychiatry aims to enrich categorical diagnosis with stratification or prognosis biomarkers, including genetic, biological, environmental, and clinical factors. This approach seeks to identify more homogeneous subgroups within heterogeneous disorders to offer targeted therapeutic strategies. This allows for improved treatment effectiveness, reduced side effects, and better guidance for clinicians in making individualized decisions, paving the way for a more personalized and effective future in psychiatric care.

Can you give examples of where the work of the Experts Centers has already brought progress towards precision psychiatry?

In terms of research, in just 10 years, the Experts Centers networks, which include some of the largest cohorts worldwide, have produced over 200 international scientific publications, demonstrating the vitality and impact of their research.

These longitudinal datasets have enabled us to assess the impact of evaluation and recommendations in an Expert Center, including: improved treatment adherence, increased prescriptions of psychosocial therapies, reduced re-hospitalization rates, enhanced overall functioning, and more systematic identification of psychiatric and somatic comorbidities (such as metabolic syndrome). 

A central goal is the formation of large, well-characterized cohorts. What are the most important steps in building up such cohorts in France and making them usable for international research?

The establishment of large, high-quality cohorts requires rigorously standardized data collection, comprehensive clinical, biological, and psychosocial assessments, as well as the use of secure and interoperable databases. Regular longitudinal follow-up is essential to document the progression of disorders, evaluate the effectiveness of interventions, and identify distinct clinical trajectories.

Strict adherence to ethical and legal standards, particularly regarding data protection, must be ensured. Inter-rater reliability which is checked twice a year, harmonization of standards, both clinically and digitally, are also crucial to enable the integration and comparison of data at an international level. Finally, collaboration with foreign partners paves the way for global research projects while strengthening the support provided to patients locally.

One of the main issues of cohorts is ensuring that they stand the test of time. Thanks to the France 2030 program, we have been selected to build a French program in precision psychiatry, which will enable us to build a nationwide multimodal cohort across all severe psychiatric pathologies, also open for international collaborations. 

How important do you consider technologies such as machine learning and AI-supported prediction models in psychiatric research and care?

Technologies such as machine learning and artificial intelligence are becoming essential tools in psychiatric research. They enable the analysis of complex, multimodal datasets — including brain imaging, genetics, behavioral, and environmental data — to detect patterns, biomarkers, and predictors that are often invisible to traditional clinical observation. By aiming towards more accurate diagnoses and individualized treatments, these tools will help identify patient subgroups and potential therapeutic targets, ultimately enhancing clinicians’ ability to provide evidence-based, personalized care. 

Ethical considerations remain crucial: AI must be used transparently, ensuring patient consent and data confidentiality. Responsible deployment requires ongoing evaluation of biases, fairness, and accountability, to ensure that these technologies improve care equitably and effectively for all patients.

What political or societal changes are needed to turn the vision of transnational precision psychiatry into reality?

Building French German precision psychiatry requires the bilateral support of research organizations, strong political commitment, as well as dedicated private and public funding. Public awareness of the benefits of personalized psychiatric care is also essential. Together, these steps will ensure that advances in precision psychiatry are translated into tangible improvements in patient care.