Future of Psychiatry — by Arshya Vahabzadeh, MD — at Singularity University’s Exponential Medicine

December 17, 2019

One area that’s really ripe for
change and new thinking is not just in neuroscience but the world of mental health, and, uh um, our next faculty member , uh, comes to us in the Bay Area via, via the Harvard system — wrong slide, um uh — Arshya is a
psychiatrist, uh, trained at Mass General, and, uh, now through a variety of initiatives is helping rethink the future of mental health, connected health, and new ways we
can empower all of us and in mental health, physical health and beyond. Arshya.
>Thank you so much. Good morning. So I wanna talk about the future of psychiatry and
I want to actually tell you something. People with serious mental health
disorders die on average twenty years younger than the rest of us, and one in
five Americans in any given year will have a mental health condition. The bottom line is that mental health
and psychiatry are critical to the well-being of the nation. So I want to talk
to you about the future of psychiatry, and part of that is that we’re dealing
with that the brain the most complex structure in the universe and the
intersection of the brain alongside the mind and the human body and what we’re
seeing is transformational change in the neurosciences and data science and the
fusion of both of these disciplines will herald unprecedented change in terms of
the research that we conduct, the impact of that research on our clinical
populations, and — more broadly — wellness amongst the community. So, let’s think
about the landscape of psychiatry, and this is something that’s changing
dramatically. So, mental health is a spectrum, and we may often focus on
severe mental illness. But many of us were deemed healthy or asymptomatic by
normal standards may also do many things to improve our mental health. Is mental health important?
Absolutely. Depression is the leading cause of disability in the world and has
many risk factors that contribute to depression. Things that we’re all looking
at: obesity, smoking, diet, exercise, and in all these things, mental health is linked to physical
health. Mental — these, these factors, actually driving chronic health care
costs across all these conditions like diabetes and coronary artery disease.
Neuropsychiatric disorders as a group is the biggest cause of disability in the
US —in the US — as a cluster. That’s excluding self-harm and self-injury. The landscape
is changing. Google hired the head of the National Institute of Mental Health this
month to work with a life sciences division. Mobile medical app downloads
continue to exponentially grow year by year. And, we have initiatives like the
BRAIN initiative — public and private initiatives — funded to further understand
the brain. By hiring the head of the National Institute of Mental Health,
Google and other technology companies are sending us a message and that
message is that they believe that technology is gonna cause a
transformational impact in how we deliver mental health care. And, the fact
is, that people want these technologies that patients that we see want to be empowered. They’re already using smartphones. They already have these
sensors in their pockets, and they want to use them. And, research is showing that. So let’s go beyond just simply apps, and look at the entire landscape. We are
seeing truly dramatic changes, not only in what’s happening in the landscape, but
also the size. We’re seeing things like provider platforms. Valera Health. Lyra Health, coming in transforming the
system. We’re seeing big data and machine learning. We’re seeing telemedicine: a huge
market full of potential, and we’re seeing new wearables. We mentioned MUSE
and think today some of the work we’re doing at Brain Power to empower children
with autism using smart glasses. The White House BRAIN initiative: 300 million dollars of private
and public funding to help us understand the brain and understand psychiatric
illness. This map explains why technologies are so essential: because every
single area in blue on this map is where there are zero, zero child psychiatrists for
every hundred thousand children and adolescents. This tells you that humans
are simply not enough to deliver the mental health care that we need. So what
are we gonna do? What’s on the agenda? What are the game changers? And here they
are: Brain stimulation. Neuroimaging. Genetics.
Informatics and digital mental health. Understanding and breaking down the
silos between mind and body. And — a personal interest of mine — is neuroinflammation. These technologies are going to empower the next line of research and
develop clinical solutions that are better for patients. So I’m a
psychiatrist. I practice clinically and what do I do? I listen to patients. I
observe their behavior. As I listen to their relatives and what am I — what am I
looking for — and looking at specific changes, behavior
changes. Sleep and appetite. Things like speech and thoughts. Changes in digital
and other behaviors. And the thing is, all of these different things, we can monitor
by using smartphone technologies and other sensors, and Valera Health, for example,
started by one of my colleagues at Harvard, again is looking to preempt and
detect deterioration via sensors in mental health populations so we can
intervene earlier and have impact. And we know it’s not just phones, it’s eye movement. Eye
movement abnormalities have been identified in conditions like
schizophrenia, in conditions like autism, for example. In autism, many people
struggle to make eye contact. They struggle to look at the central part of
the face, where so much socially salient data is being transmitted. And new
technologies enabling us to diagnose autism as early as 18 months using
eye-tracking solutions for this stuff is coming and it’s on the horizon. Can we
predict suicide? Suicide is the top 5 killer in people aged 10 to 54. That’s a lot of
people in this room. And, new biomarkers in new research has shown that we can
predict who’s likely to develop suicidal thoughts based on things like immune and
inflammatory markets. It’s kind of a bit same some of the research coming up for
schizophrenia. Those people at high risk are actually going to develop schizophrenia.
There’s some blood markers that are coming out again. A lot of immune and
inflammatory changes helping us to predict this with 90% + accuracy. These
things are coming to clinical practice. Not quite there yet, but they’re coming. Informatics research: combination of
genetics and neuro sciences. Informatics is helping us to understand that these
conditions are present very differently in person may actually share much of their
genetic underpinnings. In this particular study, fifteen different genes identified
across five different major psychiatric disorders speech patterns may be very
different amongst the mental health conditions: bipolar disorder and schizophrenia. If we
know that difference, we can use computer algorithms not only to detect those
conditions, but to actually put together a model to help helped us to predict who
will get a condition like schizophrenia from high risk populations. Neuroimaging
is helping us to identify this — this is just out this month — identify who’s healthy and who’s high
risk, and who’s got schizophrenia in terms of inflammatory changes in their
brain. Microglial activation. We’ve talked a bit about the microbiome, but it won’t
be complete unless I mention the microbiome’s also big deal. The chemicals that are released by the
microbiome — inflammatory cytokines and neuropeptide Y transmitter precursors —
impact mood and behavior. And people investigating this in mental health. So what
are the innovations on the agenda? We have avatars. We have digital therapists, able to look at us, analyze our speech,
outline our body movements, and respond to us much like a human trying to
emotionally connect with us, filling the gap between because of the lack of human
providers. We have X2AI labs, developing a test. This is at the Singularity
Accelerator. This is stuff that’s happening at Singularity, and developing an AI tool to bridge the gap between patient
and therapist intervening and using artificial intelligence. Some of the things that we’re doing it
Brain Power, developing small class solutions to teach children with autism
critical social and cognitive skills. This is a video from our Boston research
lab. Two hundred children have undergone beta testing, helping them in real time heads up hands-free interact with their
loved ones and learn these crucial life skills. As you can see, Sean doing a
remarkable job of racking up these points and in real time with his mother, engaging on demand. You can use it
anytime they want in the privacy of their own homes. Psychiatry may be the first field of medicine to get
the first digital medicine. And what do I mean by digital medicine? Let me clarify. An
antipsychotic with a sensor that’s built-in, and this sensor becomes
activated when it’s in the stomach and sends important patient metrics and a
time print to the patient, also can be shared with a clinician tackling the
issue of adherence, which is huge in mental health, especially with more severe
conditions and illnesses. Virtual reality. This is a big deal. Costs are decreasing,
the amount of research is increasing and this is particularly pertinent. It’s Veterans’
Day. Many of the veterans are treated from Iraq and Afghanistan, they’ve had
some kind of exposure to virtual reality and research studies and this is a hugely
beneficial deal that will only continue to develop further. We talked a lot about
wearables, and let’s think about that from developmental perspective. So this
is some work being done at UC Davis into the actually using clothing and actually
using things that are fun for children to engage, because we have to also think
developmentally about a lot of these conditions. The needs of children: they’re
not just small adults. The concept of asynchronous telepsychiatry. We hear a
lot about tele —um — telehealth and telemedicine. What happens if it’s asynchronous? So a psychiatrist will review a lot
of interviews at the end of a day, similar to what a radiologist would do
with scans, but these interviews may be done and enhanced by computer learning
and emotion analysis, and this is some of the work being done by my colleague
Steve Chan at UC Davis. This can have major cost savings and improvements in
terms of accessibility. And what does the future look like? We’ve talked a lot
about bringing machine interfaces and technologies. We have readily accepted
technologies and implantable for the heart pacemakers. So what does it look
like if we have a brain pacemaker? A piece of technology that helps us
overcome mental illness? The first image actually shows some of the work being
done at Mass General, and this is a 30 million dollar research plan by DARPA to
develop implantable brain technologies that will help with psychiatric illness.
The second picture you see is actually some primate research and this actually,
this particular people looked at networking primate brains together in a
brain net, and these brands can collaboratively solve problems. In this
case, of a motor, that they had to do a virtual motor task but raised the
question in the future, but we have brain networks connected together for people.
Can we overcome not just motor issues but cognitive and emotional issues?
There’s a lot of ethical implications but a lot of this up-and-coming. I like
to thank my colleagues at MIT, Harvard, UC Davis and Mass General, the work I do at Brain Power, and thank you for your time. I’d love to collaborate in talk to you about
developmental approaches to mental health — mental health — in general. I
collaborate with a great deal of people at Singularity and across the country. So
thank you very much for time. And other faculty from this morning
session one of the breakout sessions discuss neural medicine, neural health , mental health and beyond. So, brain nets. You heard it here first.

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