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Since the dawn of psychiatry, clinicians have depended primarily on two things to diagnose and treat illness: what they can observe from face-to-face interactions with patients, and what patients choose to share of their own experiences. These are fairly crude tools compared to those of other medical specialties.
“We are at a point where progress in neuroscience is converging with rapidly evolving ways to deploy technologies to enable the capture of vital data on the brain and behavior,” said McLean President and Psychiatrist in Chief Scott L. Rauch, MD. “The McLean Institute for Technology in Psychiatry was founded based on a vision of integrating and accelerating these efforts to advance research and translate findings into better care, pioneering concepts such as digital phenotyping.”
Digital phenotyping is an emerging field that strives to capture and characterize a person’s brain and behavioral profile based on data garnered from digital devices. Such data can be gathered continuously over time in real-world settings where people live. It is one of the many technological frontiers McLean has been exploring over the past decade in its ongoing quest to provide more accurate diagnoses, improve treatment—including prevention—and extend clinical services.
For example, through smartphones and wearable technology, patients now can provide treatment professionals with continuous data streams that offer important insights into their mental health status—how well they’re sleeping, their level of social interaction and exercise, how often they leave their homes, and so on. These insights, combined with other types of quantitative data, promise to revolutionize how psychiatric illnesses are classified, diagnosed, and treated. And McLean is at the forefront of this revolution.
“There are so many ways the brain breaks, and we put them into fairly general categories, such as depressive and stress-related disorders, psychotic illnesses, or substance use disorders, yet there are hundreds of different subtypes for each diagnosis that we don’t understand,” said Chief Scientific Officer Kerry J. Ressler, MD, PhD, who is also chief of McLean’s Center of Excellence in Depression and Anxiety Disorders. “Technology helps improve our understanding of the underlying components of psychiatric illness and offer more personalized treatments that work.”
Consider McLean’s Short Term Inpatient Unit, where digital phenotyping meets biobanking (the collection of biological samples, genetic information, and neuroimaging studies)—all with patient consent. This melding will create among the richest multidisciplinary mental health databases in the world for use by researchers seeking to improve diagnosis, treatment, and prevention.
In the Behavioral Health Partial Hospital Program, Courtney Beard, PhD, is supplementing patients’ in-person cognitive behavior therapy (CBT) with an app-based intervention. CBT is a powerful tool for changing negative patterns of thinking, but it can be challenging for patients to master during their short stays in the program. Dr. Beard’s app offers rapid-fire practice in 10-minute increments to cement their learning.
Meanwhile, Ipsit Vahia, MD, medical director of Geriatric Psychiatry Outpatient Services, is studying a device that uses radio waves to unobtrusively collect data on patients with dementia. The app tracks things like pacing, agitation, and sleeplessness. He hopes this information will yield important insights into the impact of medications and other treatments, and, ultimately, enhance patient care.
“There is an ever-growing need for behavioral health services, and we have highly specialized experts. How can we expand the number of people who we can serve and address access?” said Catharyn Gildesgame, MBA, senior vice president of strategy. “Digital health offers the opportunity for a triple win: expanding access, improving outcomes, and enhancing efficiencies.”
McLean is making inroads into scaling its services throughout the hospital—the modestly staffed College Mental Health Program, for example, has ambitious plans to create a wide range of content for colleges across the country, where the potential to impact the mental health of college-age adults is substantial.
The COVID-19 pandemic has provided the hospital with a crash course in connecting with patients remotely and a glimpse into the future of remote behavioral health treatments.
“We’re learning so much about when and for whom telehealth works,” said Chief Medical Information Officer Alisa Busch, MD, MS. “We will never replace in-person treatment, but this experience will enable us to provide more care remotely. That’s one fantastic thing that has come out of all this misery.”
Technology holds great promise for its ability to extend the hospital’s services to more patients and offer clinicians and researchers around the world the opportunity to benefit from the extraordinary expertise at McLean.
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