How Technological Advances Could Transform Psychiatry

Digital Tools Already Enhancing Patient Care and Increasing Access

Physician, entrepreneur, and innovator Arshya Vahabzadeh, MD, understands the power neurotechnology can have in the lives of patients. Dr. Vahabzadeh serves as chief medical officer of the neurotechnology company Brain Power, and he has seen the difference smart glasses equipped with artificial intelligence and augmented reality can make in enhancing the social skills of children and adults with autism and attention-deficit/ hyperactivity disorder (ADHD).

In addition, Dr. Vahabzadeh is director of addiction services at Cynergi Health, a part-time correctional psychiatrist and telepsychiatrist, and innovation officer at Massachusetts General Hospital Academy. He is trained in family medicine, general psychiatry, and child and adolescent psychiatry. Based in Boston, Massachusetts, and San Francisco, California, Dr. Vahabzadeh has received more than 20 national and international awards in health care, innovation, and business. The technology expert recently shared some thoughts on the future of psychiatry, which he will expand upon during his upcoming featured session at Psych Congress.

Q: You predict a convergence of technology and science will transform patient care in the coming years. What do you anticipate mental health practice to look like 10 years from now?

A: Human mental health professionals and researchers will continue to be a central part of health care, but they will be augmented by a range of technologies that will help them better understand patients and more thoroughly collect and analyze data.

We are already seeing the heightened expectations of consumers regarding how quickly and easily they can obtain a medical or health care service. This change has been partly fueled by the dramatic rise in affordable, on-demand services, helping us obtain transport, same-day deliveries, and personalized cuisine at the touch of a button. I hope we will be able to address many of the data privacy concerns that have arisen over the last couple of years. However, we will likely continue playing catch-up to rapidly advancing technologies and companies when it comes to data protection and privacy laws.

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One area of substantial change will be our home and work environments. They will be increasingly enhanced with a wider array of connected devices that will continuously monitor aspects of our lives, including emotions, social interactions, movements, and speech/language. The captured information will then be analyzed using a variety of secure, cloud-based processes. Through a range of visual, audio, and other perceptual inputs, we will be given individualized recommendations that will help us reduce stress, recognize mental health issues, or even suggest an intervention, such as meditation.

Therapy will still be an important part of mental health delivery, and access will be considerably improved using a combination of digital therapists and augmented human clinicians. Triage chatbots will have matured in their use to assess for risk and determine urgency/severity of presentations, while therapeutic chatbots will be able to provide ongoing treatment and assessment in a range of modalities, such as digital cognitive behavioral therapy.

We will also see growth in molecular interventions, partly fueled by improved drug discovery using artificial intelligence and through increased recognition of the value of specific foods, supplements, hallucinogens like psilocybin, and medications that work through the endocannabinoid system. Medication will be supplemented with prescriptive digital software that will improve adherence, monitor for symptom change, and, in some cases, work synergistically with the medication to improve patient symptoms. These pieces of software may run on a variety of wearable (handheld/optic/bodyworn) or remote technologies.Treatment and medication selection algorithms will use pharmacogenomics, sensor data, functional/structural neuroimaging markers, and neurophysiologic findings, such as electroencephalogram (EEG) potentials. In individuals who have serious mental illness, gene editing may even allow us to target specific neurons/ receptors through the use of chemogenetics. Neuromodulation will continue to advance, providing for both personal products and clinic-based therapy.

Addictive disorders will continue to be a challenge, and we will be much more aware of the potential of new technologies to cause addiction-like conditions. I suspect we will have a range of digital addiction disorders. Interventions to address these will also be digital in nature, and the concept of a digital detox will have been proven ineffective. We will also see a major transformation in how we experience social media, with continuing concern about its impact on our attention and real-world interactions. Social media may very well move off of the smartphone and become part of our perceptual experience of the world through advanced versions of augmented reality (mixed reality and beyond). The closer the proximity of social media to our cognitive and perceptual organs, the greater the potential positive and negative impact on our daily lives.

All these advances may even change the diagnoses we use today. Some of them may be found to have a range of subtypes, for example schizophrenia, while others may have their symptoms changed or weighted differently. Quantitative and objective ways of assessing patient symptoms may produce research findings that lead to certain diagnoses being withdrawn or substantially redefined.

Q: What near-term technologies will start to make an impact over the next 2 to 3 years?

A: One of the most obvious is telepsychiatry. Its ability to improve access and decrease costs will benefit patients. We will also see the approval of several prescriptive digital therapeutics—software running on smart devices shown to be efficacious in treating mental health disorders. It is likely the earliest areas of success will be in ADHD and substance use disorders.

Smartphones are being researched as a tool that could help with digital phenotyping—a way of helping quantify behavior and cognition through analyzing how a person uses the different features of a smartphone (monitoring the duration, timing, and frequency of phone calls or text messages, for example). Information such as movement monitoring via GPS or voice/speech analysis are being explored. These technologies could assess large amounts of free text data in patient records or evaluate what patients say (language, such as syntax or pragmatics) and how they say it (acoustic qualities of speech) as a means of monitoring symptom severity or treatment response.

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Another area of near-term impact is the use of big data gathered from health records or national registries. Machine learning will allow for previously unknown insights into mental health conditions. This may include finding previously unknown risk factors that would heighten suicide risk or the identification of demographic factors or specific symptoms/ signs that help predict a patient’s response to a particular treatment.

Q: What about technology to help advance research?

A: A huge range of changes are coming to research and clinical trials. One could be tempted to think the enormous amount of data from all of the monitoring technologies around us and the rapid increase in affordable computing power and storage would lead to rapid research discoveries. Unfortunately, the huge amount of data has led to a huge amount of questions. How do we ensure these data are reliable or accurate? Are our traditional statistical approaches appropriate? How do we choose an area of data to focus on and not become overwhelmed?

The pharmaceutical industry has already embraced the use of artificial intelligence, such as machine learning and neural networks, to help it discover candidate drugs, find new insights in clinical research, and help improve the chance of taking drugs to approval. Certain disease areas have had greater focus in this area, such as metabolic, immunological, and oncological conditions. Brain conditions may be a tougher nut to crack but could very well follow.

Some of the technological advances may mean that neuroimaging becomes more promising as imaging modalities and data analysis improve. We are already witnessing artificial intelligence programs becoming more accurate at interpreting imaging tests in other fields, such as chest x-rays and mammograms. The hope is that advancements in neuroimaging will allow us to find a variety of markers based on functional or structural findings that will help us understand disease severity, predict response to a particular treatment, and even predict risk of associated conditions.The field of genomics has also seen an explosion of research interest and potentially helpful tools, although many ethical concerns have also been raised about our ability to potentially “edit” the genome of humans. One area of special interest to mental health is the growth in interest in pharmacogenomics, an emerging field that studies a person’s genome to determine their likely response to a specific medication. The ability to tailor treatment in this personalized way is certainly appealing, especially if we consider a condition such as depression.

Q: How might technology change outpatient mental health visits?

A: Historically, we have relied on discrete, in-person mental health appointments to diagnosis, treat, and monitor mental health. The majority of people with mental health conditions do not become patients, and they do not or cannot seek care. In someone with a mental health condition, the vast majority of their life is not observed or seen by a mental health professional. Technology is able to continuously gather quantitative behavioral, social, and emotional information about an individual. Privacy arguments aside, this is powerful data that could impact diagnosis and treatment decisions during mental health appointments. Even more interesting, this information can be gathered in real-time, opening the possibility that a significant change to data being gathered could trigger communication to a clinician (“Your patient has not slept in 3 days. Consider an urgent appointment.”) or provide a digital intervention (“Are you having a hard time sleeping? Would you like to try a breathing exercise?).

However, a major challenge is being able to make sense of the enormous amounts of raw data we can collect about a patient through smart devices. Analyzing these data in a manner that would accurately predict a change in mental health status remains very difficult. It is also likely analytic algorithms would need to be personalized based on a person’s demographics and clinical history.

Q: Can you talk about the role virtual and augmented reality may have in mental health care?

A: This is one of my areas of research and development expertise. My particular interest is in the use of augmented reality and artificial intelligence for enhancement of social-emotional learning and social communication. At Brain Power, we have been running a series of federally funded research studies that have helped validate a commercial technology called Empowered Brain. Empowered Brain uses emerging technology to augment the special education programs of students with autism and ADHD.

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While virtual and augmented reality have been around for decades, only in the last few years has high-quality and affordable technology become available for the mainstream. A substantial body of evidence has shown carefully designed virtual and augmented reality technologies can improve mental health concerns such as anxiety disorders, delusions, depression, and post-traumatic stress disorder. I think that there is a need to develop more refined and usable hardware platforms to improve public adoption of these technologies, and it may be a number of years before these technologies are used as more mainstream therapies. Poorly designed or purposefully harmful virtual or augmented reality technology could easily result in a negative emotional or behavioral reaction in users. Therefore, it is important to carefully design and test any potential intervention.

Q: Will it be possible, in your opinion, for resistant clinicians to avoid incorporating technology into their practice? Or is this simply the way the tide is turning, and there really is no going back?

A: Humans are creatures of habit. Once certain behaviors are established, they become harder to change. I think “resistant” clinicians are ones who have found a way to practice that suits them and provides value for their patients. They must believe that there is a substantial benefit to be gained for their practice to change.

The health care field has been burnt many times by technologies, companies, or policies that really did not live up to the hype. We have also seen major issues around privacy for technology and social media companies. It is now vital for technology companies to place safeguards on personal information and be more transparent about their actions in regard to user data. With these issues in mind, the apprehension many clinicians have toward new technologies is understandable.

—Jolynn Tumolo