2023/05/11

Utilization of Digital Technology in Mental Health and Psychiatry (Part 4)

Operation and Current Status of Apps for Eating Disorder Treatment

Digital Therapeutics (DTx), Patient data, Japan, Clinical Doctor, Medical communication, Disease management and Patient monitoring

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Expectations for Psychotherapy through Self-Monitoring

Eating Disorders and Their Treatment
Eating disorders are one of psychiatric disorders characterized by abnormal eating behavior and weight control. You may think they are rare compared to other psychiatric disorders. However, it has the highest mortality rate of any mental illness. It is often comorbid with other mental health problems, including physical complications such as hypoglycemia, electrolyte abnormalities, and heart failure. 1) Although there are many theories as to what causes the onset of the disease, it is currently believed that there is no single factor but rather a complex interaction of multiple factors, including genetic and environmental factors, at critical periods of development.

Treatment is primarily psychosocial intervention, with pharmacotherapy playing only an adjunctive role. However, in the case of severe (BMI less than 15) anorexia nervosa, nutritional intake therapy is the priority, as weight loss and poor nutritional status increase the risk of serious physical complications and associated life-threatening conditions. As weight is gained, psychotherapy will also be focused on. Psychotherapy consists of treatments focused on behavioral change, including cognitive behavioral therapy modified for eating disorders. These can help promote improved weight regain and reduce physical distress and symptoms of the eating disorder itself. However, eating disorders often remain undiagnosed, and those who are diagnosed and need help tend not to receive it. In recent years, this has led to attention to a different approach: Internet-based self-help intervention based on a cognitive-behavioral approach. Some reports have shown that such interventions are more effective than those for untreated patients, 2) and evidence for the use of not only the Internet but also mobile health has been reviewed. 3)

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It is said that self-monitoring is essential as a form of psychotherapy. Many applications for health management purposes are now recognized inside and outside the country. However, there are still few apps targeting patients with eating disorders. 

The Eating Disorder Support App and To Utilize it for Medical Treatment
Outpatient treatment for eating disorders involves self-management of eating habits but often interrupts the patient during treatment. Suppose patients can use an app for eating disorders. In that case, the content and progress can be accurately monitored and used to adjust treatment strategies during outpatient visits by recording them in the app. The contents to be recorded include the schedule of eating activities, actual activity records (eating activities, non-meal activities, and daily self-assessment), and so on.
If the medical institution can centralize and check these activity records, and if there is a function to graph the input data related to meals, it will help understand changes over time and can be utilized for medical treatment.

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During routine outpatient consultations, patients may tell us what they have recorded in their notes. Each time this happens, we track changes accurately over time by writing the necessary information in the medical record. Still, there are times when we feel that verbal or written descriptions are limited in their accuracy and specificity. If we can use the data from these apps in daily medical care, we will allocate more time to psychological issues other than eating behavior and physical treatment. We can also expect the quality of medical care for eating disorders to improve further.
 
If there is a function that allows patients to enter reactions and comments from health care providers in the records they keep, and if it can be incorporated effectively, it may help to maintain motivation for self-monitoring and deter the number of dropouts.

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