of Ruggiero Corcella
Some technology solutions have gained regulatory approval as digital therapies. Much remains to be done on data security and privacy
Mental health is one of the fields of medicine where digital tools are finding application with great frequency and interest. In some cases it is already digital therapies, that is, based on clinical trials of efficacy, approved by regulatory bodies (Food and drug administration above all) or in an advanced development phase. Based on recent funding and literature trends, psychiatry appears to be betting on digital psychiatry to provide better mental health on a large scale. And why not? Digital sources of mental health data are available and growing exponentially, and the methods of analysis are constantly improving, write the authors of an editorial published in April in The Lancet Psychiatry (text here). In another editorial, bought on instead The Lancet Digital Health(here the text), the authors underline the fundamental role that the telemedicine or remote therapy they played during the pandemic. A World Health Organization survey found that qhis consultation methods were in fact adopted in full Covid-19 by 91 (70%) of the 130 countries interviewed and proven to be effective in improving and treating mental health conditions, including anxiety and substance abuse.
More and more scientific articles deal with it
Not only. typing e-mental health, on the search engine PubMed are found indexed 508 scientific articles. By inserting instead digital mental health, items go up to 3.053 with a sharp increase in publications starting in 2016 and a peak in 2020. This trend started about ten years ago and has accelerated sharply with the Covid-19 pandemic he explains Giancarlo cerveri, director of the Department of Mental Health of the Lodi Healthcare Company. Distancing, isolation or quarantine made direct contact between patient and mental health worker (psychiatrist, nurse, psychologist, rehabilitation therapist, social worker etc.) impossible in many cases. It was therefore necessary to try to reinvent a way to guarantee treatment to all those who needed it. This condition obviously increased the interest of researchers in trying to understand whether this new way of dealing with mental health was as effective as the previous one.
Interventions in addition to ordinary care, not as a substitute
Mental health apps are also spreading online: 20,000 are circulating in the US stores and many of the most popular have millions of users. But what reliability do these solutions offer, from a scientific point of view? It is necessary to make some distinctions about what we call e-mental health. For several years they have been out or in the studio of extremely interesting applications on the habits of life that can have a beneficial effect on the quality of existence of all and in particular of subjects with specific characteristics. For example, there are several applications dealing withsleep hygiene with enormous benefits because they provide extremely useful advice to fall asleep better, to avoid situations that can disturb the usual sleep cycles. It is important to remember that effective interventions in curing insomnia cannot be considered. These are useful applications for the quality of life but they are not “medical devices” that is, those devices which alone or in combination can be used for diagnostic, therapeutic, control purposes or for the alleviation of a disease. However, some applications can help many people reduce their stress levels and in those suffering from an anxious or depressive pathology, constant use can help maintain well-being. There is also valid for those applications that help us keep fit with regular physical activity which, as has been observed in numerous researches, has a significant effect in maintaining a state of well-being in subjects suffering from psychic pathologies such as anxiety and depression. In summary, these applications are interventions that can add to ordinary treatments but not replace them.
The first attempts to produce medical devices
March 26, 2020 la Food and Drug Administration has granted use authorization for a prescription digital therapy for the treatment of adult patients with chronic insomnia using Cognitive Behavioral Therapy for Insomnia (CBTi). On June 16, 2020, the Food and Drug Administration granted the use authorization for another intended for the treatment of children diagnosed with Attention deficit disorder with hyperactivity (Adhd), first video game-based digital prescription therapy: what do you think? Are the first attempts to produce “medical devices” capable of bringing about a significant improvement in a disease or a significant attenuation of the disturbances it entails. They are obviously specific interventions on limited functions but they represent an exciting start of the journey to have more and more effective intervention tools. Psychiatry has long remained a very low-tech specialty compared to other medical disciplines. It seems that something is changing and, of course, American tech companies are at the forefront of experimenting with these new opportunities which I believe will eventually surprise us in the coming years.
The positions taken by scientific societies
The World Psychiatric Association (WPA) was one of the first scientific societies to tackle the problem ea propose a position statement on mental health in the digital age, abbreviated in the document as e-Mental Health (e-MH): in Italy and at a European level, have there been positions taken on the issue? Have any documents been produced? With what conclusions? The issue of mental illness during the Covid pandemic has been very much felt for several reasons, first of all i mental health services continued to perform their function without ever interrupting the response, especially for the most serious pathologiesthe. Personally, I direct the Lodi and Codogno mental health department. Even during the establishment of the Red Zone in the Codogno area we have maintained, albeit with enormous difficulties, the response to the conditions of urgency, the psychiatry department remained open and functioning, the local services continued to guarantee visits, the administration of therapies and even home interventions. The same thing happened for the Addiction and Child Neuropsychiatry services. We have activated all possible responses, even through remote interventions to ensure continuity of care, so as not to forget any of the people who needed assistance. Telepsychiatry has thus become essential, all scientific societies both nationally and internationally have activated working groups to provide technical tools, but above all to build shared knowledge. The Lombardy region immediately activated forms of monitoring of this type of activity. As a Department in collaboration with the University of Milan and the University of Oxford we have launched a research which starts from the analysis of data on the use of telepsychiatry, passing through an assessment of needs and then arriving at specific training projects on this new area of activity that spread widely during the months of the pandemic but which, for some pathological forms it will remain a modality of intervention also in the next years.
The weaknesses and advantages
The pandemic has made digital healthcare take a leap into hyperspace, not so much from the technological point of view (the solutions already existed) but from the use both by the facilities and healthcare personnel, and by patients. The area of mental health has been equally involved (at least so it appears): how have operators and patients benefited from it? What are the weaknesses highlighted? And what are the future developments? Since the first months of the pandemic in the Department directed by me, we have had tools available to carry out interventions remotely through video calls or webcall platforms. This made it possible to keep one good ability to share between the different operators in the phases in which the meeting even between health workers was to be avoided, when not necessary. Furthermore, it was possible guarantee continuity of intervention for patients and family members. This result has also been widely achieved in child and adolescent neuropsychiatry services. The weaknesses, not yet completely resolved, concern the issue of data security and the need to maintain privacy. On this aspect, I believe that there is still work to be done. For future developments, I believe a path has begun that will not slow down with the end of the pandemic on the contrary, I believe that in the coming years it will undergo a strong acceleration thanks to the new technological possibilities that make it possible to reduce the distance between healthcare personnel and patients.
Prescribe digital therapy
Have you ever used or recommended a therapy based on technological tools?For the know for the no, why? If digital therapy for mental health were recognized in Italy, would you prescribe it? Personally, to date I have not yet used a therapy based only on technological tools. Constantly, like many of my colleagues, in this period, I have made use of remote interventions which, while requiring further study and training, are already a reality for Italian psychiatry.. As for an entirely digital therapy, I think it is useful to remember that the “recognition” by the regulatory bodies would take place only if the efficacy data were indisputable. Therefore, if today it was possible to prescribe a digital intervention to obtain a benefit for one of my patients, I would have no doubts in using it, how I use all the other therapeutic tools of proven efficacy, concludes Cerveri.
July 16, 2021 (change July 16, 2021 | 15:13)
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