As smartphones continue to play an ever-growing part of our everyday lives, the implications of this new generation of mobile technology for medicine and psychiatry will be profound.
Most people in the U.S. own a smartphone and the devices offer an unprecedented capability to gather continuous, real-time data on people’s everyday lives through GPS, accelerometers, light sensors, microphones, and cameras, among other features.
Other electronics, such as wristband tracking devices, are already in widespread use for physical activity. These capabilities have already started to extend into more advanced physiological parameters, such as keeping track of heart rate, blood pressure and glucose levels.
To psychiatrists, these tools offer to bring a glimpse into their patients’ lives outside of clinical encounters. Even more importantly, they may potentially aid in providing care, from identifying people at risk for a psychiatric disorder, to making a diagnosis and monitoring outcomes. The good news is many such tools are already available.
While all of this technology is fantastic, what is it actually like to use it in clinical practice? Take Mr. H, a patient with bipolar disorder, for example.
Making the diagnosis of bipolar disorder requires the patient to have experienced either hypomania or mania in the past or currently. However, it can be difficult to diagnose bipolar disorder in a patient who is not hypomanic or manic at the time of the evaluation and even more challenging when a patient is experiencing bipolar depression. Imagine that you are evaluating Mr. H, who presents with depressive symptoms, which is how the majority of patients with bipolar disorder present.
According to DSM-5, hypomania and mania both require a change in mood state and activity level. In standard practice, these are both typically assessed through a retrospective self-report. However, many patients do not recall past episodes of hypomania or mania accurately when they are depressed.
Like many patients, Mr. H struggles to describe his experience before becoming depressed. Ideally, you might reach out to Mr. H’s family members to get more information about his prior mood and activity levels. But in many settings, this might not be feasible. You may be left wondering what the patient’s life was like before the episode of depression started.
In this case, how would an activity tracking device be helpful?
Readily available devices by manufacturers such as Fitbit, Jawbone and Nike act as advanced pedometers which not only track total number of steps and distance in a day but also when the activity occurred, among other parameters.
This information can be summarized through graphics in smartphone apps and web-based portals, which patients can see and share with family members and clinicians, allowing straightforward visualization of physical activity in a day and over time. Pairing objective information obtained in real-time with a patient report and clinical exam may transform how we approach patients.
Suppose Mr. H tells you he was more physically active in the past, but now has stopped tracking his activity. Although Mr. H could not tell you about his activity, you notice he is wearing an activity tracker. You wonder how much more active the patient was before the onset of depression, so you ask if you could look at his activity log together.
Strikingly, you learn that about one month ago the patient logged physical activity throughout the day and night except for an hour or two each night for one week. You inquire about this high amount of activity, and the patient tells you that he needed to walk for hours on end, because it was the only way he could become tired enough to sleep for a few hours.
Further examination led to identification of a hypomanic episode. By using his activity log as a source of collateral information, you have uncovered a critical piece of history that informs your diagnosis and care plan.
Clinical encounters like the one involving Mr. H are not just substance of the future. Many people already wear activity monitoring devices. While it is up to the clinician to decide whether to inquire about the information gathered by the device and how to interpret the information, patients may be bringing up information about their devices and we should know how to respond.
Amy M. Bauer, MD, is an assistant professor in the Department of Psychiatry & Behavioral Sciences at the University of Washington School of Medicine. Joseph M. Cerimele, MD, MPH, is an acting assistant professor there.