CONTEXT IN THE DISEASE AREA
Psychiatric conditions are extremely complex diseases which aren’t always well understood and often require a bespoke and multifaceted treatment approaches. Patients diagnosed with conditions such as bipolar disorder or schizophrenia often go through different disease phases and consequently dip in and out of inpatient and outpatient settings.
Although holistic approaches (medical and psychological) have gone someway to improve treatment, unmet needs are still high, and many patients’ quality of life and overall level of functioning is still impacted by their diagnosis. With this in mind, I wanted to understand the extent to which cutting-edge technology can help to address these unmet needs.
DEFINING AND CATEGORIZING DIGITAL MEDICINES
Digital medicine in psychiatry is the use of technology to ameliorate any psychiatric condition. Digital medicine can be separated into three broad categories:
- Psychotherapy-based apps
- Research-based apps
- Medication-based apps
Psychotherapy based apps
Within this category of digital medicine there are a whole host of different types of apps to help with psychotherapy:
Digital assistant app
These apps act as “digital assistants” to help psychiatrists, social therapist and psychologist manage the patients’ psychological treatment. Examples of these are apps such as PE Coach 2. These apps include a conglomeration of different sessions for a patient to complete (including breathing exercises, prolonged exposure technique or allowing patients to record and play back their sessions which may involve trauma (PTSD)
Behavioural activation app
A focus on behaviour change using evidenced based cognitive behaviour therapy (CBT). For example, patients with anhedonia tend to feel lack of pleasure in their lives. By creating a positive feedback loop in place on a negative one patient are able to change their behaviours which can help alleviate symptoms of anhedonia.
Activity scheduling app
Working alongside other apps, these apps can help a patient schedule different activities to complete during the week. Patients choose activities and rate how they feel before and after sessions. These can be monitored by healthcare professionals to understand patient’s state of mind and how changes through each task.
Research based research apps
These exercises can help change how the brain works. An example can be facial emotional recognition therapy or tone therapy. In some disorders, such as schizophrenia or autism, the areas involving recognizing emotions and tone can become disconnected. These applications aim to help re-connect the brain’s and neuroplasticity.
Medication based apps
A foundational cornerstone of digital medicine within psychiatry is medication-based apps which help track treatment compliance.
One of the most important advancements has been Abilify MyCite. This novel cutting edge technology involves radiotracer within the therapeutic itself. When the patient ingests the pill, the tracer inside will notify the app that the patient has taken their medication. Healthcare professionals can have a more accurate understanding in treatment decision making and next steps through this novel approach.
There are also some recent advances in medicine-based psychotherapy. This can be used outside of a face-to-face psychotherapy session. This set up allows patients to complete therapy in their own time without assistance of an HCP (e.g., ResetO).
Perceived benefits and drawbacks behind digital medicine apps
These apps give insight to HCPs on how patients are progressing outside of the practice and their level of compliance with taking medication or attending psychotherapy. Often this is a key unmet need and HCPs will rely on social workers or caregivers for this type of objective point of view. The data the app collects can be leveraged to better manage and more accurately treat patients in a holistic manner.
There are however a few different drawbacks to these applications:
Social economic status: As the medicines are app based, it may favour those patients who are able to afford smartphones over those with lower social economic status
Disease stage: Patients who may be acute or show signs of cognitive impairment may not have the ability to engage with the apps long-term resulting in a barrier for use for a subset of patients
Protection of personal data – HCPs and other stakeholders will have greater access and insights into the patients’ lives which can raise questions data protection concerns and how data will be utilised
Although the success of the application doesn’t favour a single psychiatrist condition, there are some clinical patient factors which would impact on likely uptake:
Level of disease insight: there will need to be a baseline understanding from the patients and the need to comply with treatment
Disease severity: those with severe symptoms (e.g., severe anhedonia) will not be motivated to complete tasks
This means that those who are at most need will likely not be the ones benefits from these recent treatment advances.
FUTURE OF DIGITAL MEDICINE IN PSYCHIATRY
Tracking based apps
Some apps can help track episodes within a patient’s life which then feeds into their therapy and management. For example, an app which can help patients with cataplexy or narcolepsy. Some apps can link with patient’s belongings such as glasses which can record every time a patient has a fall (still in development).
Artificial Intelligence (AI)
AI has become more interwoven in consumers lives. This means there could be potential to develop applications which leverage pre-existing technologies and use them for the purposes of digital medicine.
For example, Amazon Halo could help to recognise patient tone. This can be beneficial for patients who are depressed and develop speech latency or patients who become manic and speed up their speech patterns.
When looking to the future and to the ‘greatest opportunity’ the KOL stated:
“The greatest opportunity is leveraging the saturation of digital technology and using those type of tech in mental health outcomes. These include voice tracking, activity tracking, habit tracking which targets prodromes before patients progress too far in their condition. Ultimately you want to help bridge the inpatient and outpatient worlds as best you can through these technologies.”
Overall, it’s clear that digital technology and medicine will have a prominent role in the future of psychiatry. We know every patient is different and requires an individualised treatment approach: digital therapy could help to provide this by enhancing a fully customisable and holistic treatment approach.
For more information about digital therapies and our experience in this field, please contact HRW Synapse: HRW_Synapse@hrwhealthcare.com
By Vincent Huart