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At a restaurant in San Diego, Ipsit Vahia, MD, had his “aha” moment. He and his wife were dining with friends and their four-year-old son, who was restless and disruptive. Vahia handed over his iPhone, and the boy was quietly absorbed until it was time to leave.
Distracting children with technology is not new, but Dr. Vahia left the experience with the genesis of a research question: could technology be used to quell the agitation of a person with dementia? “If you can engage a child, could you engage an adult who is functioning at the level of a four-year-old?” asked Dr. Vahia, medical director of McLean’s Geriatric Psychiatry Outpatient Services. The answer was “yes.” He is the chief author of a 2017 paper in The American Journal of Psychiatry on a study that confirmed his hunch.
At McLean, that nexus where psychiatry meets technology is located at the Institute for Technology in Psychiatry, or ITP. The one-year-old ITP was founded on the concept that technological solutions to mental health challenges could transcend traditional diagnostic boundaries and benefit from a hospital-wide initiative. The institute is bringing McLean clinicians and researchers together with data scientists and collaborators from outside the hospital to develop, test, and support technologies that can better diagnose, monitor, and treat psychiatric illnesses. About two dozen projects currently fall under its purview.
“We’re not developing technologies in search of a problem, but rather starting with the problems and building the technologies to solve them,” explained Justin T. Baker, MD, PhD, scientific director of the ITP. “It’s an iterative culture, with clinicians on the ground using the tools to make sure what we are building is optimized for their needs.”
Those needs range from how to remotely monitor a patient to avert a sudden exacerbation of illness, to how to objectively measure “psychiatric vital signs”—like sleeplessness or speech rate—that traditionally have depended on self-reporting or observation.
Dr. Baker, who also is director of Functional Neuroimaging and Bioinformatics for the Schizophrenia and Bipolar Disorder Research Program, is leading a longitudinal study in which patients with bipolar disorder or schizophrenia use fitness trackers and smartphones to map their daily routines, including how much they sleep, how often they leave their homes, and the frequency of their text and phone conversations. Patients also visit McLean for interviews and brain scans so researchers can better understand the underlying biology of any behavioral changes. Researchers hope that this data may lead to the development of “illness detection systems,” that pick up on early warning signs of someone entering a depression or psychotic relapse, with the ultimate goal of developing more effective treatments.
Technology’s potential to extend psychiatry’s reach beyond the confines of the hospital is an important focus of the ITP as well as the research of ITP Assistant Director Laura Germine, PhD. Millions of people have taken cognitive assessment tests on her website TestMyBrain.org, which can help identify conditions like autism spectrum disorder and prosopagnosia—difficulty recognizing familiar faces.
“Traditionally, you come into a clinic, spend time with a neuropsychologist, and do assessments using paper and pencil,” said Germine. “With these types of web-based tools—which will become more and more refined as time goes on—the clinic is no longer in one place. It’s located wherever the patient is.”
Donors Anne and Andy Heller, whose son was treated successfully at McLean, view their support of two obsessive compulsive disorder (OCD) studies, using smartphones and wearables, as a smart investment in science. “It’s an exciting concept. You can collect a large amount of valuable data using available technology with no impact to the patients—and all of this data will ultimately be used to improve OCD treatments,” said Andy.
Advancing this field will depend on donors like the Hellers, whose support is needed to take the most promising pilot studies to the next level. “At the end of the day, the way you go from innovative to transformative is to scale the technologies,” said Dr. Baker. “We want to develop the most successful tools and deploy them not only with the 10 to 20 patients enrolled in current studies, but to hundreds or thousands of people.”
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