Remote Monitoring for Understanding Mechanisms and Prediction in Psychiatry

Abstract

Purpose of Review Technological advances offer the potential to better characterise the symptoms and mechanisms of psychiatric disorders. This review provides an overview of how remote monitoring might inform understanding of mood and anxiety disorders, and may be used by clinicians to predict clinical outcomes and treatment response. The review also discusses salient ethical issues and the field's future directions. Recent Findings A range of psychological and physiological remotely-collected data have been associated with clinical symptoms and outcomes, including momentary self-report, actigraphy, geolocation and heart-rate variability. Remote monitoring has shown promise in phenotyping, predicting symptoms and clinical severity, predicting treatment response and has informed psychological models of anxiety disorders. Summary Remote monitoring is a diverse field involving the collection of clinically relevant data in naturalistic settings. Although facing significant practical and ethical challenges, it has shown much potential in developing understanding in the context of mood and anxiety disorders.

Smartphones and Wearables as a Method for Understanding Symptom Mechanisms

“…data collected from individuals in their natural environment (10). This approach, sometimes referred to as 'digital phenotyping' (11), is defined as momentby-moment quantification of the individual-level human phenotype in-situ using data from personal digital devices (12). Previously, data collection and treatment monitoring has been limited to being carried out in person in clinical settings, thus providing data sets of limited size and utility.…”

A day in the life of a psychiatrist in 2050: where will the algorithm take us?

“…The qualitative studies had identified that some found it too intrusive, whereas others worried they would become fixated on their own mental health, causing an anxiety of its own. 10 After seeing her last patient for the day, Dr Singh turned back to her computer. Flicking through the screens, she glanced through a collection of records the remote-monitoring outreach programme had flagged for her attention.…”

“…The qualitative studies had identified that some found it too intrusive, whereas others worried they would become fixated on their own mental health, causing an anxiety of its own. 10 Historical concerns around the medicalisation of everyday experience persisted in new forms. Part of her was relieved when Steve declined.…”

Digital Communication Biomarkers of Mood and Diagnosis in Borderline Personality Disorder, Bipolar Disorder, and Healthy Control Populations

“…Remote monitoring is concerned with the collection of clinically relevant data in ecologically-valid settings (9). Collecting time-stamped, longitudinal data in a patient's natural environment may provide a richer phenotype of mental distress than traditional forms of clinical assessment.…”

“…Digital phenotyping represents a form of remote monitoring where personal digital devices, such as smartphones or wearables, are used to collect clinically relevant data (10,11). This data may be used to identify new behavioral digital biomarkers, leading to the identification of novel phenotypes of psychiatric disorder and mental distress (9,12). Previous research, for instance, has identified geolocation and actigraphy variables associated with clinical features in BD (13,14).…”