Solving the Psychological Diagnosed Problem Using Case Based Reasoning
Kyar Nyo Aye, Dr. Naychi Lai Lai Thein
University of Computer Studies, Mawlamyine
kyarnyoaye@gmail.com
Abstract
Artificial Intelligence has been applied in
numerous applications in the health science domain.
Case Based Reasoning (CBR) is appeared as an
interesting alternative for building medical AI
applications, CBR is a very effective tool for decision
making and problem solving process. A concept is a
stable mental representation of objects, classes,
properties, and relations. In CBR, a problem is
solved by searching a library of previously
encountered cases, retrieving similar cases,
comparing the retrieved cases with threshold value,
producing the optimal solution to the user.
For retrieving similar cases, concept
mapping is necessary. Concept mapping is a
technique for visualizing the relationships among
different concepts. The success of any case based
approach depends on the existence of previous cases.
This paper presents the problem solving system by
using Case Based Reasoning in psychological
diagnosis process. In this system, the concepts
represent possible psychological disorder symptoms.
Psychological disorders are stored in memory using
ontologies. The system accepts the symptoms that are
suffering by the patient as the input and uses
mapping techniques for matching these symptoms
with the symptoms that are stored in memory to
decide the disorder. Reasoning is provided reusing
past cases to solve psychological problems for
patients. By this way, the system gives the solution
(i.e. what disorder is suffering) and explanations (i.e.
why this solution is given). But if the symptoms are
not exactly equal, the system gives the possible
disorder using the threshold value.
When new case is found, the system states
that it cannot describe the case and it is
automatically recorded in the system as a new
unsolved case. In the future, machine learning
approach can handle such type of cases.
Keywords: Case Based Reasoning, concept mapping,
ontologies.
1. Introduction
Most approaches to problem solving in AI
treat each problem as a unique case. One deficiency
of such problem solvers is that they cannot rely on
previous experience. The same problem presented
two different times requires the same (possibly long
and complex) set of reasoning steps. Nor can such
system learn from the mistakes they have made.
Suppose, however, that our systems could augment
their problem solving capabilities by making
analogies to previous similar cases.
Reference to a previous case focuses
reasoning on those parts of a current problem which
were important in analysis of the previous case,
potentially reducing the number of features that need
to be considered. When the process of reaching a
solution to a problem involves many steps, analogy
to a previous case can often reduce the number of
steps required to reach a solution. Furthermore, if the
set of cases used in problem solving include those
where errors had been detected and later fixed, then
analogy to a previous case can not only help in
recovering from similar errors, but also in avoiding
similar failures in the future. So, case based
reasoning methods are used to provide correct
decision.
CBR is an approach for solving problems
based on solutions of similar past cases. A case
consists at least of a problem description (e.g.
symptoms) and a solution (e.g. a diagnosis). Cases
are stored in a database of cases called a case base.
To solve an actual problem a notion of similarity
between problems is used to retrieve similar cases
from the case base. The solutions of these found
similar cases are used as starting points for solving
the actual problem at hand. CBR has been used to
create numerous applications in a wide range of
domains including financial analysis, risk
assessment, technical maintenance, process control,
quality control, medical diagnosis, software support
systems, forecasting, planning, design, and
classification of objects, photo-interpretation,
electronic commerce, customer support, knowledge
management and software engineering.
2. Related Work and Problem Issues
The research in medical CBR is
concentrated to Europe and US, as with CBR in
general. The medical domain of CBR is generally
focused on producing systems for specific tasks, such
as diagnosing a specific symptom. These systems are
rarely in every-day-use and they are seldom
commercially exploited [1]. Limitations of CBR in
medical systems are addressed by Schmidt and Gierl
[2, 3] where they approach the difficult task of case
adaptation. Jaulent et al [4] is diagnosing
histopathology in the breast cancer domain. Their
system uses cases that are derived from written
medical reports. A case has an internal tree structure,
and represents a collection of macroscopic area.
Cases are compared for structural (structure of the
histological tree), surface (semantic resemblance of
microscopic areas) and feature similarity. A
translation transposes the subjective features into
numerical values. FM-Ultranet [5] is a medical CBR
project implemented with CBR –works; FM-Ultranet
detects malformations and abnormalities of foetus
through ultrasonographical examinations. The
detection, or diagnosis, uses attributes derived from
scans of the mother’s uterus, and identifies abnormal
organs and extremities. Cases are arranged in a
hierarchical and object oriented structure. Every
concept has one or more attributes. The attributes
consists of anatomical features, medical history and
general domain knowledge. Similarity between
attributes in the concepts (objects) are
mathematically calculated or compared through a
look up table, depending on the attribute type. A
report of the system’s findings is generated when the
detection (CBR) process is completed.
Nilsson et al [6] addresses the domain of
psychophysiological dysfunctions, a form of stress.
The system is classifying physiological
measurements from sensors. Features are extracted
from the first and second set, and patient specific
data, are used as a case. The cases are classified with
a k-nearest neighbor match. Some CBR issues are
especially interesting for the medical domain. Fault
tolerance is one of the most important issues.
Bichindaritz et al.[7,8] has developed a medical CBR
system based on a safety-insurance plan to insure that
no local faults are spread beyond its scope. The rest
of the paper is organized as follows: In Section 3, we
present the CBR process, how similarity is used and
system design. In Section 4, we introduce the
similarity algorithm for case retrieval. And then
conclusions are described in Section 5.
3. Case Based Reasoning Process
The case based reasoning process works as
follows;
1. Retrieve the most similar case or cases
2. Reuse the information and knowledge in that case
solve the problem
3. Revise the proposed solution
4. Retain the parts of this experience likely to be
useful for future problem solving
A new problem is solved by retrieving one
or more previously experienced cases, reusing the
case in one way or another, revising the solution
based on reusing a previous case, and retaining the
new experience by incorporating it into the existing
knowledge-base (case base). The four processes each
involve a number of more specific steps. An initial
description of a problem defines a new case. This
new case is used to retrieve a case from the collection
of previous cases. The retrieval case is combined
with the new case-through reuse-into a solved case,
i.e. a proposed solution to the initial problem.
Through the revised process this solution is tested for
success, and repaired if failed. During retaining,
useful experience is retained for future reuse, and the
case base is updated by a new learned case, or by
modification of some existing cases.
In medical domains, a case contains a
description of the observed symptoms during
examination of a patient as well as the diagnosis or
the treatment that was identified by a physician. In
the psychological domain, the symptoms are
recorded in a case. Each symptom appears as an
attribute in the case representation, each of which has
a particular type assigned, defining the value range of
the attribute.
The CBR be process than proceeds by
searching for the most similar known case from the
case base. For this purpose, the similarity between
two cases (the problem case and the case in the case
base) must be defined through the similarity of the
attributes used in the case representation. Case
retrieval is a process that a retrieval algorithm
retrieves the most similar cases to the current
problem. Case retrieval requires a combination of
search and matching.
3.1 Similarity Assessment
Similarity can consist of two other
terminologies. These are similarity measure and
similarity value. The similarity measure describes the
algorithm used to calculate the similarity between
two entities. Similarity value is the numeric result of
the similarity measure. In ontologies, similarity can
be found in different areas: Similarity by topology,
graph, sets and probability. To find similarities
between concepts, graph similarity will be used. In
Figure 1.we present the steps of Case Based
Reasoning (CBR) process.
Step 1: User types the symptoms (concepts) by using
user interface.
Step 2: System maps the concepts with the historical
cases by using similarity assessment.
Step 3: System computes the similarities and selects
the optimal case by using threshold.
Step 4: System recommends the optimum solution.
First, user chooses the symptoms
(concepts) by using graphical user interface. The
system represents these symptoms by an ontological
graph, the root node represents the unknown concept
(i.e. suffered disorder) and its child nodes represent
the symptoms that entered by the user. The system
stores many disorders in the case base. A case refers
to one mental disorder. A case is represented by an
ontological graph. The system maps the concepts Table 1. Notation Table
with historical cases by using graph similarity
algorithm. This algorithm assesses the similarity
degree between the two concepts with similarity No attributes symbols
function F. The similarity degree is between 0 and 1. 1 Persistent feelings of sadness PFS
If the two concepts are exactly similar, the similarity
2 No sound sleep NSS
degree between them is 1 and if quite different, it is
3 A lack of pleasure in most LPA
0. If the cases in the case base are not exactly equal
activities
with the user’s entered case, the algorithm uses the
4 Thoughts of suicide TS
threshold value to select the optimal case. And then
the system recommends the optimum solution 5 Feelings of worthlessness of FWG
guilt
(disorder) to the user.
6 Fluctuations from extreme FHS
User maps the symptoms (concepts) happiness to extreme sadness
by using interface 7 Hallucinations H
8 Delusions D
9 Loss of Control LC
Similarities Concepts
Map the concept with Assessment 10 Themes of violence TV
historical cases of
historical 11 Doubts about ones character DCB
cases and behavior
12 Breaking laws BL
Compute the similarities 13 Pervasive distrust and PDS
and select the optimal suspiciousness of others
case (using threshold)

Table 2. Patient’s symptoms

Recommend the optimum solution
Disorder P N L T F F H D L T D B P
Figure 1. Case Based Reasoning Process F S P S W H C V C L D
S S A G S B S

In this paper, we introduced the similarity Depression Y Y Y Y Y N N N N N N N N

Mood Y N Y Y Y Y Y N N N N N N
algorithm. For knowledge representation, RDF is disorder
used. Each RDF triple is made up of subject, Schizophren N N N N N N Y Y N N N N N
predicate and object. Each RDF statement can be ia
represented either as a document statement or as a
graph. We represent a set of RDF statements as a In depression case, user enters the
triple {s, p, o} as a directed labeled graph: each depression symptoms by using graphical user
subject and object is shown as a vertex and the interface. These symptoms are represented by an
predicate is shown as an arc directed from subject (s), ontological graph as shown in Figure 3. User’s
to object (o), labeled by predicate (p). There are mental case represents the root node (X) and its
many psychological disorders and symptoms but we symptoms represent the child nodes.
present only depression case in this paper. For the
statement: depression has symptoms such as
persistent feelings of sadness, no sound sleep, a lack
of pleasure in most activities, thoughts of suicide and X
feelings of worthlessness or guilt, the graphical
representation is shown in Figure 2.
Persistent feelings of
sadness
TS
PFS FWG
No sound Depression Thoughts of
sleep suicide LPA
NSS

Lack of pleasure in most Feelings of worthlessness

activities or guilt = has symptom

= has symptom Figure 3. Ontological graph for user suffered

symptoms
Figure 2. Graphical RDF statement for depression
depression
 By using the user’s symptoms, the system
extracts the subgraph as shown in Figure 4.
Depression
function F. The function F is defined in terms of the
function f. The function f can be formally expressed
as f: E1rs  {0, 1}.
The function f is used to determine the
existence of a given relationship, associated to
concept c, in the set of relationships of the concept s,
where the two concepts c and s are directly related to
primitive concepts.

LPA
f((rc,j),rs)= 1 if k N| (rs,k)Ei  (j)=(k)
TS NSS (rc,j) = (rs,k),j N (1)

PFS
FWG f((rc,j),rs)= F(j,k) if  kN| (rs,k)Ei (j)=(k)
(rc,j) = (rs,k),jN (2)
= has symptom f((rc,j),rs)= 0 if otherwise (3)
Figure 4. Ontological graph for depression Similarity function F: {rc}{rs}→ [0, 1], is defined as
symptoms

First, the two concepts (unknown concept

and depression) are compared. The two relationships  f((rc,j),rs)
“has symptom” are equal. So, PFS is compared to j: (rc,j)E
every symptom in the depression case. If PFS is F(rc,rs) = (4)

found, f is assigned to 1. Unless f is assigned to 0. In
second time, the symptom NSS is compared to every (rs)+(rc)- f((rc,j),rs)
symptom in depression case and so on. Finally, the j: (rc,j)E
similarity function F is calculated. In this example, F
is 5/ (5+5)-5) =1. So user suffered disorder is Where  = the node cardinality of the set of outgoing
depression. If the similarity function F is 0, the arcs of a given node.
system fails. If the symptoms are not exactly equal
and similarity function F is ranged between 0 and 1, 4.2 Similarity Algorithm
the solution is judged by threshold value.
When new case is found, the system states Given a concept c C1:
that it cannot describe the case and it is automatically # Algorithm FindSimilar(UnknownConcept:c)
recorded in the system as a new unsolved case. In returns KnownConcept
the future, machine learning approach can handle {rc = Node corresponding to the concept c }
such type of cases. begin
for each not elementary concept s C2 do
{ rs = Node corresponding to the concept s }
4. Approach to Determine Ontology
begin
Mapping extractSubGraph(rs);
Compare graphs S1c and S2s: compute F(rc,rs);
An ontology can be represented by an end
max = max F(rc,rs);
ontological graph G = (N,A,,) where
G = a labeled directed graph {s such that F(rc,rs) = max is the concept similar to
N = the set of nodes that represents concepts c}
A= the set of arcs that represents relationships return s such that F(rc,rs ) = max;
between concepts such that ANNR end
 = the association of a node to a concept such that
:N  C
 Algorithm extractSubGraph(Node:rc) returns
 = the association of an arc to a relationship such
Subgraph
that :A  R begin
Skc = Subgraph corresponding to concept c;
4.1 Similarity Function add the node rc to Skc ;
for each arc (rc,j) outgoing from rc do
In the two subgraphs S1c = (M1, E1, rc) and begin
s
S2 = (Mi, Ei , rs), the similarity degree between two add the arc (rc,j) to Skc ;
concepts c and s will be assessed by the similarity add the node j to Skc ;
 if j not elementary then recall. According to each threshold value, the
extractSubGraph(j); performance evaluation of proposed system is
end presented in Table 3.
return Skc ;
end
Table 3. Performance Evaluation of the System
 Algorithm F(Nodes : rc,rs) returns value in [0, 1]
begin
Threshold Recall Precision F-Measure
for each arc (rc,j) outgoing from rc do
value (k)
sum = sum + f((rc , j ) ,rs);
k ≥0.6 0.9 0.8 0.847
F=sum/(size(outgoingArcs(rc))
+size(outgoingArcs(rs))- sum) k ≥0.7 0.8 0.9 0.847
return F;
end k ≥0.8 0.7 1 0.824

 Algorithm f(Arc : a = (rc,j),Node :rs) returns value Figure 5 shows the performance of the
in [0, 1] system graphically. According to this chart, we can
begin evaluate the performance clearly.
for each arc h = (rs,k) outgoing from rs do
if (δ(a) = δ(h))) then Performance Evaluation Chart
if ((λ(j) = λ(k)) then
if j,k elementary then
f = 1;
else if j,k not elementary then
f =F(j,k);
else
f = 0;
return f;
end

Figure.5. Performance evaluation chart of

5. Experimental Results the system

The experimental cases are obtained from 6. Conclusions

Mental Health Hospital, Yangon.
The performance of proposed system using
real-world bibliographic is evaluated according to The Case Based Reasoning (CBR)
three metrics: paradigm has been successfully used in various
(1) Recall medical fields. CBR methods identify the current
(2) Precision problem situations, find a past case similar to the new
(3) F-Measure one, use that case to suggest a solution to the current
These metrics focus on how well the problem, evaluate the proposed solution, and update
system performs on identifying the relevant the system by learning from this experience. We have
information. proposed an algorithm for the solution to the
psychological problems using similarity
5.1 Metrics measurement. That means for achieving more
accurate and effective medical diagnosis for
#correct-found-mappings psychological patients. Further work on developing
Recall r = the algorithm is in progress. In present, CBR is an
#possible-existing-mappings ongoing process. But CBR systems are focused on
reference to underlying diagnostic factors. Thus, the
#correct-found-mappings systems cannot work properly unless a suitable case
Precision p= exists in the case base. So nowadays, problem solvers
#all-found-mappings combine CBR with Neural Network and fuzzy logic
to improve the performance of the diagnostic
F-Measure combines the two mentioned measures
systems.
(b2+1) pr
F =
b2p+r
with b=1 being a factor to weight precision and
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