John Torous MD

Digital Psychiatry: New Tools and

Advances in Diagnostic and Treatment
Modalities for Mental Health

About

Outline
Digital Psychiatry
New Inputs: Active Data / Passive Data
Digital Phenoytping
New Outputs: Apps, AR, VR
Finding a Good App

Why Digital Psychiatry

Convergence of
technological and
societal forces
have made the use
of new digital tools
viable for mental
health care.
Can they help
extend services
and care?

Why Digital Psychiatry

Increased
Ownership

Increased Interest

Mobile Phone Ownership and Endorsement of mHealth

Among People With Psychosis: A Meta-analysis of Crosssectional Studies.J Firth, J Cotter, J Torous, S Bucci, JA Firth,
AR Yung. Schizophrenia Bulletin, sbv132

Torous J, Chan SR, Yee-Marie Tan S, Behrens J, Mathew I, Conrad EJ,

Hinton L, Yellowlees P, Keshavan M. Patient Smartphone Ownership
and Interest in Mobile Apps to Monitor Symptoms of Mental Health
Conditions: A Survey in Four Geographically Distinct Psychiatric

Why Digital Psychiatry

Current Inputs

Digital Inputs

Why Digital Psychiatry

Current Outputs

Digital Outputs

https://pixabay.com/p-1015488/

Ben-zeev D, Brenner
CJ, Begale M, Duffecy
J, Mohr DC, Mueser KT.
Feasibility,
acceptability, and
preliminary efficacy of
a smartphone
intervention for
schizophrenia.
Schizophr Bull.
2014;40(6):1244-53.

Why Digital Psychiatry

Increased Ownership
and Interest in Apps
etc.

+
Potential of
Technology to Assist
in Care Delivery

Active Data

Major Depressive Disorder

Five (or more) of the following symptoms have been
present during the same 2-week period and
represent a change from previous functioning; at
least one of the symptoms is either (1) depressed
mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly

attributable to another medical condition.
Depressed mood most of the day
Markedly diminished interest or pleasure
Significant weight loss or gain
Insomnia or hypersomnia nearly every day.
Psychomotor agitation or retardation nearly every
day (observable by others)
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or
inappropriate guilt
Diminished ability to think or concentrate, or
indecisiveness, nearly every day
Recurrent thoughts of death (not just fear of dying),
recurrent suicidal ideation without a specific plan, or
a suicide attempt or a specific plan for committing
suicide.

The symptoms cause clinically significant distress or

impairment in social, occupational, or other
important areas of functioning.
The episode is not attributable to the physiological
effects of a substance or to another medical condition.
The occurrence of the major depressive episode is not
better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional
disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic disorders.

Active Data
Mindful Moods

PHQ-9 on smartphones
of patients with clinical
depression in treatment.
3 questions, 3 times per
day for one months
Low Cost Study /
Intervention
N = 13

Torous J, Staples P, Shanahan M, Lin C, Peck P, Keshavan M, Onnela JP. Utilizing a Personal Smartphone Custom App to Assess the
Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder. JMIR Mental Health

Active Data

???

Active Data

Challenges of Active Data

(+)
Adherence

Owen JE, Jaworski BK, Kuhn E, Makin-Byrd KN, Ramsey KM, Hoffman JE
mHealth in the Wild: Using Novel Data to Examine the Reach, Use, and
Impact of PTSD Coach. JMIR Mental Health 2015;2(1):e7

Challenges of Active Data

(+)
Validity/Symptoms/
Dx

Saeb S, Zhang M, Karr CJ, Schueller SM, Corden ME, Kording KP, Mohr DC. Mobile Phone Sensor Correlates of
Depressive Symptom Severity in Daily-Life Behavior: An Exploratory Study
J Med Internet Res 2015;17(7):e175

Challenges of Active Data

(+)
Digital Placebo Effect

Passive Data
Many mental
health conditions
have behavioral
and physiological
components (in
addition to the
patients
experience / self
report)

Digital Phenotyping
Utilizing the phones
(or wearables) many
sensors such as GPS,
accelerometer, call /
text logs, ambient
light, wife/bluetooth,
power on/off,
charging etc to learn
about behavior.
Physiological sensors
like heart rate on
wearables.

Passive Data/Digital
Phenoytping

Passive Data

Passive Data
Our group is
currently
conducting two
studies of passive
data in 1) patients
with schizophrenia
and 2) patients
with depression
undergoing
cognitive therapy

Passive Data

Challenges of Passive Data

Data Processing /
Reproducibility

Challenges of Passive Data

(+)
Privacy and
Security

Digital Therapeutics / Apps

Shortage of Mental
Health Provides
Hope that Apps Can
Augment Services,
esp for cognitive
therapies

How Many Mental

Health Apps?
~5,000?

Therapeutic Apps
Therapy
With Therapists
With Peers

Med Trackers
Sleep
Mood Trackers
Psychoeducation

Therapeutic Apps

Challenges of Apps (+)

Transparency /
Ethics

Augmented Reality

Augmented Reality

https://medium.com/achievemint/can-augmented-reality-alter-reality-quantifying-the-pok
%C3%A9mon-go-effect-561bf996d4b9#.1tjn9e8gp

Virtual Reality
More research in PTSD
with the military but now
more interest as VR
becomes more
affordable (like with
apps)

Freeman et al. Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study
testing how to reduce delusional conviction. BJP Psych. May 2016

Challenges
Do they work?

Are they scalable /

accessible?

Finding a Good App

How do you find a
good mental health
app?
Why it matters.

Finding an App
APA Workgroup on
App Evaluation.
Why Static App
Ratings Dont Work
There is no A+ or
88/100
medication or
therapy
Each person is
different
Apps are dynamic

Picking an App

GROUND

Picking an App
Can it share data with EMR
Can you print out your data
Can you export/download you data
Can it share data with other user data
tools (eg, Apple HealthKit, FitBit)

Is there a privacy policy

What data is collected
Is personal data de-identified
Can you opt out of data collection
Can you delete data
Are cookies placed
Who is data shared with; what data is
shared
Is data maintained on the device or the web
What security measures are in place? Is
data encrypted on the device and server?
Does it say it meets HIPAA / (or not need to)

Is it easy to access for the patient at hand

Would it be easy to use on a long term basis
Customizable
Does it need internet to work
What platforms does it work on
Accessible for those with impaired vision or other
disabilities

What does it claim to do vs actually do

Is there peer-reviewed, published evidence
about tool or science behind it
Is there any feedback from users to support
claims (App store, website, review sites, etc)
Does the content appear of at least reasonable
value

Digital Psychiatry at BIDMC

The End
Checklist of Challenges
Adherence Rates
Or with $ or services

Actual Illness?
Students/Craigslist

Digital Placebo
Any control group

Privacy and Security

Scalable / Accessible
Data Reproduciblity
Raw data accessible?