Diagnostics in mental health

The subsequent rise in global fuel prices and the economic impact of the war in Ukraine have also focused the minds of medical technology company bosses and health budget planners on the need to do more with fewer resources.

All of these developments, coupled with greater use of artificial intelligence (AI) in medicine, means that technology has never been more important to the health of populations.

This is particularly true of in vitro diagnostics – with the pandemic accelerating investment in infectious disease diagnoses to unprecedented levels – and with activity now spinning out to other areas.

A market research study published this week by Data Bridge, predicts a 12.9% rise in the global immunodiagnostics sector over the next seven years.

This has positive implications for the diagnosis of infectious and chronic diseases, including cancers and autoimmune disorders, as well as cardiovascular diseases, endocrinology, and others.

But what about another branch of healthcare that is placing an ever-increasing burden on public spending, but which appears not to have been impacted by the diagnostics revolution? What about mental health?

Depression and anxiety continue to be treated using pharmaceuticals and therapy techniques. Diagnosis invariably involves time-consuming and costly, face-to-face consultations with practitioners. Can these processes be automated and, if so, how?

Mental health is an area of increasing interest in digital health space, with mobile and connected devices offering greater diagnostic and interventional possibilities in psychiatric care.

More and more industries are seeking access to real-time data, to help improve the experience of patients, grow revenues, and solve problems more quickly and efficiently.

Along with the pandemic, greater use of medical devices and cloud computing technology have created new openings for medical diagnostics, treatments, and remote patient monitoring. Yet many of the potential uses and advantages of these new technologies appear to remain unexplored and unused in mental health settings.

Policymakers and health professionals are only now recognising the potential benefits.

 
Mental health diagnoses continue to rely principally on patients reporting, retrospectively to GPs and psychiatrists, behavioural patterns such as perceived mood, disruption to sleep, lack of appetite and weight loss.

But these traditional methods can be problematic in the diagnoses of serious psychiatric disorders such as schizophrenia, major depressive disorders, and neurocognitive disorders such as dementia.

Mobile and connected devices can offer quicker and more efficient means of self-reporting information in real time, moving data collection from the GP surgery into everyday world of patients’ lives.

Smartphones and smartwatches can monitor a range of behaviours and other data, including location, acceleration, and social activities through patterns in phone calls, text messages, and social media posts.

This ‘passive data’ can be used to help diagnose a mental illness, for example a bipolar patient entering a manic phase might record greater phone activity, demonstrated through more GPS position changes, erratic accelerometer movements, and greater social media
activity.

Voice data can also be used to provide behavioural markers, for example the pitch, tempo, and loudness of a patient’s voice can indicate particular psychiatric illnesses and states, such as depression, anxiety, and even suicidal tendencies.

Other physiological data collected from such devices can be equally informative, for example in measuring heart rate, sleep quality and skin conductance.

While it may be that no one single test or assay of markers is capable of providing a definitive psychiatric diagnosis, a combination of several, real-time data streams can be useful in generating accurate personalised diagnostic information.

In addition to the gathering of data using smartphones and smartwatches and apps, bespoke technologies are now available, for purchase or rent, to treat symptoms such as anxiety and depression.

A headset manufactured by Malmo-based Flow Neuroscience, for example, targets the dorsolateral prefrontal cortex (DLPFC) – an area of the brain associated with cognitive reasoning and the regulation of negative emotion and depression.

Using a technique known as transcranial Direct Current Stimulation (tDCS), the device sends tiny electrical pulses into the patient’s scalp to increase the rate at which neurons fire.

Another device called the Relivion, from Neurolief, based in Tampa, Florida, uses small electrical pulses to targets six branches of the occipital and trigeminal nerves, which are responsible for sensation in the face, ears, and scalp.

The company claims that 90% of patients in an open-label clinical study showed improvement in depression using the technology, after having not sufficiently responded to previous pharmaceutical treatment.

Meanwhile, the Alpha-Stim device from Electromedical Products International claims to treat anxiety, insomnia, and depression.

It comes with clips on the end of wires that attach to the device, which fasten against the earlobes and send electrical pulses through to the skull.

While reports on the effectiveness of such devices tend to rely on small sample sizes, meaning their clinical efficacy is far from established, there is anecdotal evidence from patients and mental health professionals suggesting they can have a role to play, particularly in the treatment of patients averse to drugs or therapies, as well as those who are resistant to both.

Ivor Campbell is Chief Executive of Callander-based Snedden Campbell, a specialist recruitment consultant for the medical technology industry.