Misc

精神科領域は大部分が互いの顔を見ながらの会話で診療が成り立つことから,ビデオ通話を用いた遠隔医療が古くから行われてきた.新型コロナウイルス感染症(COVID-19)のパンデミックは世界的に遠隔医療の利用を拡大させ,日本でもオンライン診療の診療報酬などに大きな変化を起こしたが,精神科領域では規制の問題が残っている.筆者らは日本医療研究開発機構(AMED)の委託研究として,わが国におけるオンライン診療と対面診療を比較した研究として最大規模のものとなるpragmatic trialを行い,エビデンスの確立に努めてきた.また同じくAMEDの委託研究として,ウェアラブルデバイスと機械学習を組み合わせた,うつ病検出,重症度評価支援プログラムの開発を行っており,プログラム医療機器(SaMD)としての実用化を目指している.本稿ではこれらの研究を紹介し,今後の精神科領域におけるオンライン診療や人工知能(AI)を活用した医療の展望,課題につき議論する.(著者抄録)

In psychiatry, where a significant part of medical treatment is based on conversations between patient and physician, telemedicine using video calls has long been utilized. The COVID-19 pandemic that began in 2020 has further accelerated the use of telemedicine worldwide. Moreover, with the development of information and communication technology, remote monitoring of patients’ conditions outside of hospitals is expected to increase in all medical fields. Wearable devices are also expected to be used in psychiatry for patient monitoring and prevention. A pragmatic trial was initiated to compare the effects of telemedicine and face-to-face care in 17 hospitals and clinics, including five universities, as a research project commissioned by the Japan Agency for Medical Development (AMED). A depression screening technology is also developed using machine learning with wearable devices in an AMED-commissioned study. This paper aimed to introduce J-PROTECT and the use of a wearable device. Furthermore, we discuss the future prospects and issues of telemedicine and AI-based medicine in psychiatry.

Biomarkers for diagnosis and severity assessment of psychiatric disorders are currently unavailable for many psychiatric conditions, which results in discrepancies in diagnoses, inaccurate evaluation of treatment efficacy, and failure of clinical trials. Development of careful and close symptom monitoring, symptom quantification techniques, and treatment modalities that utilize digital technology are gaining momentum worldwide as potentially useful approaches to address the aforementioned concerns. Additionally, the COVID-19 pandemic has significantly affected psychiatry worldwide, and digital health solutions, including telemedicine and artificial intelligence have emerged as major models of care during the pandemic. Application of digital technologies is reshaping psychiatry and opens new possibilities. In this article, we discuss trends in psychiatric care using digital technology and its prospects in Japan, focused on our research activities.