the future of psychiatry arshya vahabzadeh

Mental health encompasses a variety of hidden illnesses. Mood fluctuations, cognitive disorders, and other behavioral problems are things that may not be visible to the naked eye—or even a 10-minute primary care visit. But, they can help or hinder physical health.

This is something that we see—as physicians practicing in the medical specialty of psychiatry—within our patients. We see a variety of illnesses, such as depression and anxiety, that cause medical conditions to worsen, and vice versa.

In fact, this issue is so important that in 2016, individual U.S. states will start planning implementation of the federal Excellence in Mental Health Act, labeled as “the biggest federal investment in mental health and addiction services in generations.” In The Doctor Weighs In, mental health has been a significant topic (we particularly recommend reading “Can technology fill the gaps in mental health care?“).

 

Six trends in psychiatry

In this year’s four-day Exponential Medicine conference, hundreds of healthcare leaders, researchers, and investors shared the latest cutting-edge developments in healthcare and medicine. Arshya Vahabzadeh MD, Chair of Communications at the American Psychiatric Association and faculty at Massachusetts General Hospital, presented his vision in the talk, The Future of Psychiatry, and discussed six new trends that will shape the way mental health is assessed and treated.

These trends—brain stimulation technologies such as transcranial direct current stimulation (tDCS) and transcranial focused ultrasound (tFUS); neuroimaging; genetics; informatics & “digital mental health”; the connection between mind and other organ systems, and how they influence each other; and neuroinflammation—will influence how physicians and other providers treat illnesses. Henry Nasrallah, MD (@HNasral) discusses these concepts further in “Psychiatry’s Future Shock” in Current Psychiatry.

 

Tales from the clinic

tales from the clinic These technologies are going to empower the next line of research and develop clinical solutions that are better for patients. As psychiatrists, we listen to patients. We observe patients’ behavior. We listen to their friends, family members, and caregivers. This sounds like the classic stereotype of the quiet, bearded psychotherapist who listens to the patient on the couch. But we use all of our senses as we listen to, look for, and feel for specific changes. Behavior. Sleep. Appetite changes. Speech loudness and whether it is fast or slow. The way patients form thoughts. The thing is, all of these different things can be monitored by using smartphone technologies and other sensors. Valera Health, for example, started by one of our colleagues at Harvard University and former Merck executives, is looking to preempt and detect deterioration via sensors in mental health populations so clinicians and medical teams can intervene earlier and have an impact before a mental illness causes someone to deteriorate. Other companies, such as Lyra Health, Ginger.io, along with other academic research projects such as that at Harvard University T.H. Chan School of Public Health, Dartmouth University’s Psychiatric Research Center and the Center for Technology and Behavior Health, and Northwestern University’s Center for Behavioral Intervention Technologies, are looking towards similar concepts.

 

Detecting mental illness with eye movement abnormalities

And we know it’s not just phones that can help sense this: We can use eye movement to detect illnesses. Eye movement abnormalities have been identified in conditions like schizophrenia and autism, for example. In autism, many people struggle to make eye contact. They struggle to look at the central part of the face, where so much socially salient data is being transmitted. And new technologies are enabling us to diagnose autism as early as 18 months using eye-tracking solutions. And smart wearables and eyewear technologies can be used for treatments. Work by neuroscientist Ned Sahin, Ph.D, and his startup Brain Power (@BrainPowerASD) uses Google Glass to help train those with autism—who have difficulties interpreting social cues—to make eye contact with other persons. Similar efforts are underway at Duke University and even the use of facial emotion recognition technologies in work being done at the University of Southern California’s Institute for Creative Technologies.

 

Neuroinformatics genetics research

A combination of genetics and neurosciences can help us to understand that these mental health conditions present very differently, but may actually share many of their genetic underpinnings. In one particular study, fifteen different genes identified across five different major psychiatric disorders speech patterns are shown to be very different amongst these mental health conditions: bipolar disorder and schizophrenia. If we know that difference, we can use computer algorithms not only to detect those conditions, but to actually put together a model to help us predict who will get a condition like schizophrenia from high risk populations.

Finally, neuroimaging may also help us identify disorders in the future. A study released in November 2015 showed that we could identify who’s healthy and who’s at high risk, and who’s got schizophrenia in terms of inflammatory changes in their brain and microglial activation. And, within the microbiome, the chemicals that are released by the microbiome within our intestines—the bacteria that help us process food and nutrients and can also have a detrimental effect—can release inflammatory cytokines and neuropeptide Y transmitter precursors. The things that the microbiome releases can impact mood and behavior. And the stress that we face can cause our brain to also release cortisol and other chemicals that can impact the microbiome. This could mean that diet can play a big role in mental health clinical assessment and treatment.

 

Watch #XMed’s “The Future of Psychiatry”

More exciting developments within psychiatry are discussed in the full 12-minute Exponential Medicine conference presentation, “Future of Psychiatry,” on YouTube, viewable here:

Arshya Vahabzadeh, MD and Steven Chan, MD, MBA
Dr. Arshya Vahabzadeh (@VahabzadehMD) has been recognized as a national leader in medical innovation and digital health. He is faculty in the Department of Psychiatry at Massachusetts General Hospital, Harvard Medical School’s Primary Teaching Hospital. His expertise and accomplishments have led to over 20 national and international awards in medical leadership, healthcare innovation, behavioral neuroscience, communication, and global health. Dr. Vahabzadeh is triple trained in family medicine, psychiatry, and pediatric psychiatry. He is the Chairperson of the Council on Communications of the American Psychiatric Association, the former editor-in-chief of the American Journal of Psychiatry Residents Journal, and the digital strategy lead for autism technology start-up Brain Power. His academic work has been published in high impact medical journals and authoritative texts in neurobiology, with research that has spanned genetics, social neuroscience, experimental psychopharmacology, and neuro-technology. He has been an invited expert speaker and judge for many competitions focusing on innovation and novel therapies, including events at Harvard, Google, and Autism Speaks. Additionally he is a consultant for Khan Academy, Anthem, and Neurolaunch. He has written on health matters for CNN, Boston Magazine, the Huffington Post, the Health Care Blog, and a dozen other outlets. Steven Chan (@StevenChanMD, www.stevenchanMD.com) is regarded as an accomplished top thinker in the intersection of health services delivery, medicine, business, and technology. Steve researches the areas of asynchronous telepsychiatry, smartphones and mobile wearable devices for mental health, and applications for cultural psychiatry and underserved minority health. Steve's ideas, thoughts, and research have been featured in JAMA, Telemedicine and e-Health, and JMIR (Journal of Medical Internet Research). With the support of the U.S. Department of Health & Human Services, Steve serves as current American Psychiatric Association (APA) & SAMHSA MFP Fellow to the APA Council of Communications, APA Committee on Mental Health Information Technology, and the Workgroup on Mental Health & Psychiatric Apps. Dr. Chan draws from his extensive MD, MBA, and informatics training at the University of California’s leading institutes — UC Berkeley, UC Irvine, UC Davis, as well as UCLA, UC San Francisco and Stanford University — and is currently a senior resident physician in psychiatry & behavioral sciences at UC Davis School of Medicine.

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