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Psychiatry
How Technology Is Personalizing and Progressing Psychiatry
Q&A with Sunny Tang, M.D.
Posted February 26, 2021
The field of psychiatry — much like our society as a whole — is at a turning point. We are beginning to harness the power of the Internet, social media, and digital technologies to improve the ways we diagnose, treat, and connect with our patients. My area of research is focused on how to better leverage our digital footprint, whether through Facebook/social media activity, or Google search history, to develop new tools to deliver the best care possible, especially for youth with schizophrenia.
Colleagues at the Feinstein Institutes for Medical Research and Zucker Hillside Hospital are also investigating other emerging areas to help develop digital biomarkers — or clues to mental illness. New digital health solutions, like augmented reality, for example, are being developed to help treat negative symptoms for those with schizophrenia, increase socialization, reduce unemployment and improve the overall quality of life. One such talented, emerging leader and friend is Sunny X. Tang MD.
I’ve had the recent opportunity to sit down with Sunny to learn more about her work, where she sees psychiatry headed, and what needs to be done to get there.
Michael: Sunny, thank you so much for chatting with me. Let’s dive right in...
Big picture: It’s 2021 and yet psychiatry as a whole still seems to be stuck in the stone ages. Where is the field headed regarding technology and studying new methods to help diagnose and treat patients?
Sunny: It's true! Many of the treatments we use in psychiatry are variations of the same ones developed decades ago. These methods are still used because they are effective for many people and bring a great deal of healing and hope. However, researchers like us are not satisfied with the status quo. It's often a guessing game in terms of finding the right treatment for the right patient. Too many people continue to suffer from disabling symptoms even with the best care we have to offer. Too many patients live in areas or in situations where they cannot access the best-specialized care options. That's where technology comes in!
I see the role of technology in psychiatry as being:
- A platform for new and improved treatments.
- A way to personalize treatments so they are tailored for success for individual patients.
- A way to improve access to care for people who are hard to reach with traditional methods.
Michael: In our research, we are both turning towards things like machine learning, artificial intelligence, even augmented reality. Is this just science fiction, or do you see a time when these technologies can be used day-to-day?
Sunny: I believe that these technologies, along with the internet from not-too-long ago, are the basis of a revolution in how humans engage with the world and with one another — on par with the invention of the printing press. Most of us walk around daily with devices in our pockets that are many times more powerful than the early computers NASA used to help put humans on the moon. To me, there's no question that these technologies will make a real impact on psychiatry. I think we're both trying to figure out how to take the field in that direction, step by step.
Michael: I know you are working on some exciting projects. Tell me about your work around language and the importance it holds.
Sunny: I see language as the key to one of the major roadblocks in psychiatry — the lack of accurate, accessible biomarkers. Biomarkers are signals that doctors and scientists can measure, which reflect what's going on in the body and help with diagnosis or tracking the course of a disease. For example, measuring blood sugar is a good biomarker for diabetes, and many cancers can be tracked with the levels of hormones and enzymes in the blood. However, in psychiatry, we've found that it is difficult to objectively measure and track thoughts and emotions.
We rely on the subjective judgment of experts, which can be costly and time-consuming to obtain and may differ significantly from expert to expert. Neuroimaging and MRIs have been amazing advances in our field, but they are expensive and require specialized equipment, and therefore difficult to implement on a large scale.
On the other hand, a person's speech is perhaps one of the most direct reflections we have for their thoughts and emotions. Speech can be easily captured with a smartphone or digital recorder. With machine learning, artificial intelligence, and natural language processing, speech can be analyzed automatically and transformed into numbers that can be tracked, just like blood sugar. Much of my work focuses on how to extract meaningful markers from speech that are accurate reflections of the brain changes that underlie psychiatric disorders.
Michael: Going beyond those biomarkers or clues to diagnosis, you are trying to understand how schizophrenia is expressed through social interaction and resiliency. What does this line of research mean for treatment down the line?
Sunny: I believe that making meaningful advances in treatment for people with schizophrenia requires understanding the things in life that are meaningful for them. Like any of us, my patients place great importance on relationships with family, partners, and friends and their ability to engage in the world and contribute using their strengths and talents. Unfortunately, the illness can often interfere with people's ability to process social situations and engage in the world around them. Meanwhile, other people with schizophrenia are resilient to these effects. My work seeks to understand these processes better, so we know how and where to make the most meaningful interventions.
Michael: There is a lot of misconception out there, especially in treating those patients with schizophrenia and medication. Antipsychotics are not a magic bullet! What are the challenges in treating patients with schizophrenia?
Sunny: For me, the major challenge is not having the right tools. Sometimes, my patients try medication after medication and still experience symptoms that are debilitating and distressing. These are often "negative symptoms" like decreased motivation, ability to interact socially, or trouble with thinking clearly. Other times, my patients find a medication that works well for controlling symptoms but are then faced with bothersome or even dangerous side effects.
Luckily, we have some fantastic programs and resources here at Zucker Hillside Hospital. Still, I know that many people worldwide struggle to find therapists and psychiatrists who are experts in providing care for people with serious mental illness. We need to do better.
Michael: What new interventions are you trying to use to cut through? Tell me about the use of augmented reality?
Sunny: We're trying to figure out how to use technology to deliver evidence-based treatments for patients with schizophrenia. Because technology can be accessed anywhere, anytime, this creates many new possibilities that clinic-based care cannot accomplish (easily). Augmented reality is one promising platform for new interventions. It allows patients to interact with a digital program while staying anchored in the actual environment around them.
Michael: This all sounds so promising, but what are the challenges? How do we overcome them?
Sunny: Well, it's a good problem to have, but whenever you're doing something truly innovative, it means that no one has done it before! This means there are many basic questions that need to be addressed. Will people with schizophrenia want to use "digital medicine?" Can we make it work? Will we be able to fit new digital interventions into the existing mental health treatment system? I think the only way to overcome these challenges is to make our best effort, based on the best science, and see what we are able to accomplish.
Michael: What else is exciting you? What are you keeping an eye on?
Sunny: Improving treatment for people with schizophrenia and other psychiatric disorders is of critical importance. However, many in our field are now focusing on identifying people who are at risk for developing psychiatric disorders and trying to intervene before the disorder ever takes hold — so it becomes a matter of prevention, not treatment. I think this is a very important approach.
I'm also keeping my eye on my basic science colleagues who work on animal models, single cells, and genes. Some of the recent advances in these areas are also nothing short of science fiction miracles. For example, scientists can now collect cells from people's skin, reprogram them into stem cells, and then grow the stem cells into brain tissue! That stuff is fascinating to me, as well. I can't wait to see what we discover next.
Michael: Thank you, Sunny, for chatting. We are indeed at an exciting time, and I look forward to following your work. I hope that one day everything we spoke about, these new tools and avenues of care, will be at our fingertips.
