The first prescription ‘digital therapeutic’ authorized for the treatment of major depressive disorder (MDD) symptoms has been approved by the US Food and Drug Administration (FDA). It has been cleared for use as an adjunct to clinician-managed outpatient care for adult patients with MDD aged 22 years and older who are on antidepressant medication.
The smartphone app, named Rejoyn, was developed via a partnership of Click Therapeutics, a company that makes software-based medical treatments, and Otsuka Pharmaceuticals.
The FDA cleared the app based on a 13-week study of 386 people ages 22 to 64, in which participants showed improvement in their baseline depression symptoms when using it, compared to a sham app as measured via established clinical scales. The trial also showed continuing improvement a month after treatment, and reported no adverse effects. Rejoyn aims to further reduce MDD symptoms by complementing standard-of-care drug regimens, with a six-week digital treatment schedule that provides cognitive emotional training exercises and therapeutic lessons. The app also offers personalized reminders and messages to encourage adherence to medication.
Unlike therapy apps that are currently available as a “treatment for depression” or “supplemental treatment” and can be downloaded from smartphone App Stores, a prescription from a healthcare provider is needed to access Rejoyn.
The app is not meant to be used as a standalone therapy nor as a substitute for medication.
Today’s teenagers are more digitally connected than ever. The majority have access to smartphones and use social media, and nearly half say they are online almost constantly. To better understand their experiences, Pew Research Center surveyed both teens and parents on a range of screen time-related topics. The questions explored the emotions teens tie to their devices, the impact of smartphones on youth, and the challenges parents face when raising children in the digital age.
The survey of 1,453 U.S. teens ages 13 to 17 and their parents was conducted Sept. 26-Oct. 23, 2023.
Key findings from the survey:
Phone-less: 72% of U.S. teens say they often or sometimes feel peaceful when they don’t have their smartphone; 44% say it makes them feel anxious.
Good for hobbies, less so for socialization: 69% of teens say smartphones make it easier for youth to pursue hobbies and interests; fewer (30%) say it helps people their age learn good social skills.
Parental snooping: Half of parents say they have looked through their teen’s phone.
Smartphone standoffs: About four-in-ten parents and teens report regularly arguing with one another about time spent on their phone.
Distracted parenting: Nearly half of teens (46%) say their parent is at least sometimes distracted by their phone when they’re trying to talk to them.
Teens’ views on screen time and efforts to cut back
How teens feel when they don’t have their phone
Do teens think smartphones are negatively impacting young people?
Teen Views by Gender and Age
Do parents think they spend too much time on their phone?
How often are parents distracted by their phone when talking with their teen?
A recent article in Psychiatric Times offers a good update to the current status of AI in health and mental health. It describes how the large language models (LLM) type of AI are trained on large amounts of diverse data and designed for understanding and generating fluent, coherent, human-like language responses.
Potential of AI and Generative Language Models to Enhance Productivity
LLM’s have the potential to transform a variety of industries including medicine and healthcare. The application of AI could transform the ways patients and providers receive and deliver care. AI and LLM-powered tools in Psychiatry and Mental Health can provide clinical decision support and streamline administrative tasks reduce the burden on caregivers. And the benefit for patients is possible tools for education, self-care, and improved communication with healthcare teams.
What About Accuracy?
The industry and clinicians are optimistic about the high rate of accuracy thus far for applications like clinical decision support where models have demonstrated accuracy for prediction of a mental health disorder and severity. For example, ChatGPT was able to achieve final diagnosis accuracy of 76.9% in findings from a study of 36 clinical vignettes. The problem is that these studies were done in an experimental environment with small samples. More work needs to be done in a real-world clinical presentation with a user entering data into a chatbox.
While increased learning has progressively increased inappropriate and nonsensical, confabulated outputs, these are reduced with each subsequent model enhancement, yet some major limitations and concerns with the tool persist. Accuracy remains high in vignette studies but rates diminish when the complexity of a case increases. One clinical vignette study revealed that “ChatGPT-4 achieved 100% diagnosis accuracy within the top 3 suggested diagnoses for common cases, whereas human medical doctors solved 90% within the top 2 suggestions but did not reach 100% with up to 10 suggestions.”
How to Improve Current Limitations
One way to improve accuracy and higher quality responses is to target learning and fine tune a custom GPT feature allows individual users to tailor the LLM to their specific parameters using plain language prompts. This new feature allows users to input data sets and resources while also telling the custom GPT which references should be used in responses. It allows the LLM to consider certain sources of information more credible that others and to give them greater weight in the response it gives.
Fine-tuning a Customized Learning Process
The Neuro Scholar reference collection includes textbooks and other resources that encompass a wide range of topics in neuroscience, psychiatry, and related fields.
NeuroScholar Custom GPT Inputs and Training Resources included:
Memorable Psychopharmacology by Jonathan Heldt, MD
Goodman & Gilman’s Manual of Pharmacology and Therapeutics
Adams and Victor’s Principles of Neurology, 6th Edition
The Neuroscience of Clinical Psychiatry: The Pathophysiology of Behavior and Mental Illness, Third Edition
The Ninja’s Guide to PRITE 2022 Study Guide, Loma Linda Department of Psychiatry, 15th Edition
Kaplan & Sadock’s Synopsis of Psychiatry, 12th Edition
Lange Q&A Psychiatry, 10thEdition
To test the accuracy of Neuro Scholar, a standardized practice examination for the American Board of Psychiatry and Neurology was selected. Practice examination 1 of Psychiatry Test Preparation and Review Manual, Third Edition consisted of 150 questions. The practice examination was administered to Neuro Scholar and ChatGPT-3.5
Results
ChatGPT-3.5 correctly answered 125 of 150 questions, whereas Neuro Scholar correctly answered 145 of 150 questions, achieving 96.67% accuracy on the practice exam. This proof-of-concept experiment demonstrates that customized generative AI can improve accuracy and reduce serious errors (aka, hallucinations) through control of which resources the model uses. In medicine, AI hallucinations can have disastrous consequences. Efforts to improve AI accuracy must also include efforts to eliminate inaccurate responses. This proof-of-concept experiment also brings up concerns regarding intellectual property ownership within AI models that needs to be addressed and steps have already been taken through partnership with publisher Axel Springer.
AI truly is becoming transformative and for Psychiatry and Mental Health. has made a major leap in progress, as this proof of concept highlights. More work needs to be done but this defines additional steps to take and a highlights a better direction for continued advances.
A recent column in the daily free press reminds us that six years ago Apple introduced new tools built into iOS 12 to “help customers understand and take control of the time they spend interacting with their iOS devices.” These new features called Screen Time included Activity Reports, App Limits and new Do Not Disturb and Notifications controls.
Photo via Apple
The goal was to offer users detailed information and tools that would help them better understand and control the time they spend with apps and websites, how often they pick up their iPhone or iPad during the day and how they receive notifications.
Ten years earlier Apple had introduced parental controls for iPhone and over that time the developers have worked to add features to help parents manage their children’s content. With Screen Time, these new tools are empowering users who want help managing their device time, and balancing the many things that are important.
So what happened? Did no one use it?
Consumers rejoiced that Apple offered a solution to the issues of screen use. Unfortunately Apple presented us with a useful tool, not a solution.
Today we are still struggling with the negative effects that too much screen time has on our physical, emotional and mental health. A research study recently published in The Journal of Mood & Anxiety Disorders, found that that one-third of youth (aged between 10 and 24 years) spend four or more hours a day engaging with their screens. The effects of such are great, leading to health and mental health problems, among other things. In teenagers, screen media activity (SMA) consumes up to 60% of their after-school time and nearly 97% of US youth have at least one electronic item in their bedroom.
Not An Individual Activity But A Complex and Multifaceted Problem
SMA in youth is often perceived as an individual activity. The authors point out that the relationship between SMA and mental health outcomes in youth is a complex and multifaceted issue that has garnered significant attention among researchers and the public in recent years. The complexity may be due to the diverse nature of screen activities, the rapidly evolving landscape of digital media , and the differential impacts these activities may have across individuals. What is emerging is a nuanced picture, with some evidence suggesting relatively trivial effects of SMA on well-being or life satisfaction and other results indicating stronger associations with mental health problems such as depression or anxiety. More recent research suggests there may be individual differences concerning the impact of SMA. For example, sex-related differences have emerged, with girls generally demonstrating stronger associations between screen media time and mental health indicators than boys; and there is some evidence that effects may differ depending on the broader socioeconomic and environmental context. The COVID-19 pandemic added complexity, influencing screen time habits and mental health outcomes.
An Overeview of the Complexites
To better understand and research SMA, it is more accurate to view it as occurring within a system that encompasses the individual, the immediate caregiver environment, the school, peers and other environmental factors. The authors utilize the Bronfenbrenner’s ecological systems theory, which is a framework for understanding human behavior within a complex system of relationships within and across multiple levels of the environment, from more proximal (e.g., immediate family, academic settings) to more distal (e.g., sociocultural values, laws, etc.). The theory proposes five interrelated systems that influence development:
(1) the microsystem which is the immediate environment with which an individual interacts,
(2) the mesosystem which focuses on interactions between different elements of the microsystem,
(3) the exosystem which involves the larger social system with which the individual does not directly interact but it still impacts their behavior,
(4) the macrosystem comprised of the broader societal and cultural context, and
(5) the chronosystem that is centered on the dimension of time including the timing of specific events and historical context.
Figure 1 shows the Bronfenbrenner model conceptual overview of screen media activity and mental health.
Figure 1
Both clinicians and researchers could benefit from reading this article. It provides an excellent birdseye view of the multifaceted interrelationships that can be an important part of screen media activity in youth today and applicable to society in general in today’s tech-obsessed world.
Handwritten notes may seem ‘old fashioned’ in today’s educational facilities compared to typing or using other digital technology to transcribe recorded class notes. However, research continues to point out that the process of taking notes the traditional way—with pen and paper or even stylus and tablet—is still the best way to learn, especially for young children.
A recent study published in Frontiers in Psychology investigated how digital devices have been progressively replacing traditional handwriting and evaluated the implications for the human brain.
Previous research suggested that when typing notes on a computer keyboard, ” It goes in through your ears and comes out through your fingertips, but you don’t process the incoming information.” When you take notes by hand, you need to be selective and prioritize, consolidate and relate it to previously learned facts. We consciously build onto known concepts and add new concepts.
The Study
Brain electrical activity was recorded in 36 university students as they were handwriting visually presented words using a digital pen and typewriting the words on a keyboard. Connectivity analyses were performed on EEG data recorded with a 256-channel sensor array.
When writing by hand, brain connectivity patterns were far more elaborate than when typewriting on a keyboard, as shown by widespread theta/alpha connectivity coherence patterns between network hubs and nodes in parietal and central brain regions. Existing literature indicates that connectivity patterns in these brain areas and at such frequencies are crucial for memory formation and for encoding new information and, therefore, are beneficial for learning.
Results
Study findings suggest that the spatiotemporal pattern from visual and proprioceptive information obtained through the precisely controlled hand movements when using a pen, contribute extensively to the brain’s connectivity patterns that promote learning. It appears that the movements related to typewriting do not activate these connectivity networks the same way that handwriting does. Researchers urge that children, from an early age, need to be exposed to handwriting activities in school to establish the neuronal connectivity patterns that provide the brain with optimal conditions for learning. Although it is vital to maintain handwriting practice at school, it is also important to keep up with continuously developing technological advances. Therefore, both teachers and students should be aware of which practice has the best learning effect in what context, for example when taking lecture notes or when writing an essay.
Post-research Commentary
In a Scientific American interview with Dr Sophia Vinci-Booher, an assistant professor of educational neuroscience at Vanderbilt University who was not involved in the new study, says these findings are exciting and consistent with past research. It does not mean that technology is a disadvantage in the classroom. Laptops, smartphones and other such devices can be more efficient for writing essays or conducting research and can offer more equitable access to educational resources. The problem is that difficulties can occur when people rely on technology too much. People are increasingly delegating thought processes to digital devices, an act called “cognitive offloading” which is using smartphones to remember tasks, such as taking a photo instead of memorizing information or depending on GPS to navigate. While it may be helpful and easier, the constant offloading means it’s less work for the brain. If we’re not actively using these areas, they may deteriorate over time, whether it’s memory or motor skills.
Van der Weel FR and Van der Meer ALH (2024) Handwriting but not typewriting leads to widespread brain connectivity: a high-density EEG study with implications for the classroom. Front. Psychol. 14:1219945. doi: 10.3389/fpsyg.2023.1219945
“Chatbot Corner,” is a new column in Psychiatric Times® which will explore the intersection of psychiatry and cutting-edge technology.
Dr Steven Hyler, professor emeritus of Psychiatry at Columbia University Medical Center, describes this column as an “innovative space dedicated to exploring the dynamic and sometimes challenging relationship between artificial intelligence (AI) technology and mental health.” He invites insightful readers to contribute articles, ideas, thoughts, commentaries, suggestions and experiences with AI chatboxes.
The goal is to demystify the role of AI and discuss clinical implications of AI in psychiatry and serve as a guide toward responsible use.
Readers are encouraged to share and dissect the most egregious chatbot errors you have encountered in practice or your experience with trying to stump the psychiatry chatbot with complex scenarios, your contributions are vital.
Ideas and articles can be submitted to PTEditor@MMHGroup.com and feel free to participate in this intriguing journey into AI and how it fits into psychiatry and mental health.
The Upcoming 2024 American Psychiatric Association Annual Meeting is in New York City this year.
Saturday, May 4th – Wednesday, May 8th, 2024 At the JAVITS CONVENTION CENTER OF NEW YORK.
Connect with colleagues and industry experts from around the globe. Choose from 500+ educational sessions led by psychiatry and mental health expert educators. Engage with an array of exhibitors featuring the latest therapeutics and technologies in psychiatry.
The Technology Sessions
This year, for the first time, there are 70 technology-related sessions/courses. This is nearly three times the number of technology sessions offered last year and dozens more than previous years.
More so than ever before, technology has become a major component of the fabric of our society and impacts so many aspects of our lives including business, entertainment, health, mental health, education, sports. leisure activities and personal relationships.
It is critical for psychiatry, psychology and mental health professionals to be well informed and sophisticated in understanding how we use technology and how it impacts our lives, our clinical practices and our research in behavioral health and healthcare and the well-being of the world’s populations.
This year APA offers a wide array of educational opportunities to prepare ourselves for the digital challenges that we face now and in the future.
The American Medical Extended Reality Association (@theAMXRA) In collaboration with the editorial board of the newly published Journal of Medical Extended Reality, AMXRA has developed a new guideline to define the emerging field of Medical Extended Reality (MXR).
Medical Extended Reality Defined
The guideline presents a new taxonomy with five core domains, encompassing 13 primary topics and a comprehensive set of 180 secondary topics. This taxonomy is intended to serve as a crucial tool for harmonizing communication and collaboration among researchers, clinicians, educators, and policymakers. The goal is to establish a common language and structure to support the field’s continued growth and integration into health care. With this tool, various stakeholders can systematically classify and navigate the complexities of the MXR field.
Extended Reality in Mental Health
Through the use of virtual reality (VR) and artificial intelligence (AI), XAIA offers personalized cognitive behavioral therapy (CBT)-based mental health support. Users can select from nine nature scenes and interact with a robot avatar. The platform has shown promise in helping individuals with mild to moderate anxiety and depression, with no participants stopping therapy due to distress and no reports of VR-induced vertigo.
Virtual Reality in Healthcare Education
There is increasing interest in VR within healthcare and healthcare education, as it offers a unique opportunity to teach and assess key skills relating to situational awareness (SA) and decision making (DM) across undergraduate healthcare professions.
However, there is a perceived gap in literature regarding the use of VR for these purposes. A scoping review aims to address this gap and further explore the potential of VR, augmented reality (AR), and mixed reality (MR) in healthcare education.
Publication of the Journal of Medical Extended Reality is a step towards advancing the field of MXR. Continuing to explore and understand the potential of these technologies, it is clear that there may be a important role for MXR to play in transforming the future of healthcare.
The FDA began accepting submissions in 2022 for a program to provide support for unconventional drug development tools that can assist, enhance and expedite new drug research. Finally in January 2024, it has accepted its first artificial intelligence-powered tool.
The program called Innovative Science and Technology Approaches for New Drugs(ISTAND) pilot is designed to create a new pathway to FDA review novel tools that may not fit into currently existing routes of evaluation, but that could potentially improve the development of new drugs.
The newest tool accepted into ISTAND comes from Deliberate AI. The AI-generated Clinical Outcome Assessment—AI-COA for short—uses multimodal behavioral signal processing and machine learning technology to record mental health symptoms and assess the severity of cases of anxiety and depression.
“This marks a pioneering step for the ISTAND program as the first artificial intelligence-based, digital health technology project in neuroscience to be accepted into the pilot program,” Peter Stein, M.D., director of the Office of New Drugs within the FDA’s Center for Drug Evaluation and Research, said in an agency announcement this week. “Our acceptance aligns with FDA’s vision of optimizing drug development and evaluation, potentially expediting the availability of safe and effective treatments.”
New York City declared social media ‘Health hazard’ a threat to the mental health of young people, NYC is the first major U.S. city to take such action.
The city’s Health Commissioner, Ashwin Vasan, issued an advisory officially labeling social media as a public health hazard in New York City. Mayor Eric Adams blamed platforms like TikTok, YouTube, and Facebook for contributing to a mental health crisis with their addictive and harmful features and likened this move to how the U.S. surgeon general addressed issues with tobacco and guns in the past.
In response to the concerns raised, Vasan provided guidance in the advisory to young people on promoting healthy social media use. This includes establishing tech-free times and places, being aware of emotions while using social media, and discussing concerns related to social media and mental health with adults.
The advisory pointed out that a large percentage of U.S. teens use social media, but the growing mental health crisis among young people has raised worries about the impact of these platforms and their potential to create addictive habits.
Some social media companies, such as TikTok and YouTube, have taken steps to address concerns by introducing features that allow parents to have more control over their children’s online activity and limit their screen time.
Last year, the U.S. Surgeon General Vivek H. Murthy expressed in an advisory that there isn’t enough evidence to determine whether social media is “sufficiently safe for children and adolescents.” He acknowledged the potential contribution of social media to the ongoing youth mental health crisis.
The advisory from the New York City health commissioner revealed alarming increases in rates of hopelessness and suicidal ideation among high-schoolers in the city between 2011 and 2021, with certain demographics, such as Black, Latino, female, or LGBTQ+ individuals, experiencing disproportionately high rates of hopelessness.
According to Axios News,
NY City’s Department of Health and Mental Hygiene issued an advisory identifying unrestricted access to and use of social media as a public health hazard.
The department urged parents and caregivers to delay giving children access to a smartphone or social media until at least age 14.
They also urged federal and state policymakers to expand on legislative proposals that protect youth from “predatory practices by social media companies.”
NYC Mayor Eric Adams said in his State of the City speech Wednesday, “We won’t let Big Tech endanger our kids.” The advisory urged all New Yorkers to “advocate to hold social media companies accountable and advance reform that protects youth from harmful and predatory practices.”
Recent Pew Research on US teens use of social media. [Link]
