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Current management of psychiatric disorders relies heavily on retrospective, subjective reports provided by patients and their families. Consequently, psychiatric services are often provisioned inefficiently and with suboptimal outcomes. Recent advances in computing and sensor technologies have enabled the development of real-time monitoring systems for the diagnosis and management of psychiatric disorders. The state of these technologies is rapidly evolving, with passive monitoring and predictive modeling as two areas that have great potential to affect psychiatric care. Although outpatient psychiatry probably stands to benefit the most from the use of real-time monitoring technologies, there are also several ways in which inpatient psychiatry may also benefit. As the capabilities of these technologies increase and their use becomes more common, many ethical and legal issues will need to be considered. The role of governmental regulatory bodies and nongovernmental organizations in providing oversight of the implementation of these technologies is an active area of discussion.Rapid changes in health care technology are advancing mental health care. Telepsychiatry, in the form of live interactive videoconferencing, has demonstrated its ability to improve access to high-quality mental health care, specifically in the treatment of patients with depression and mood disorders. This article reviews the advances in telepsychiatry in the treatment of depression and mood disorders. Epigenetics inhibitor Telepsychiatry is significantly reconfiguring the structures and models of psychiatric care delivery. Such changes include direct-to-home services, blending telepsychiatry with other technologies, and using a team-based care approach. This article also examines the evolving and innovative models of care, synthesizes literature and lessons learned about telehealth, and considers current and future pragmatic implications for the treatment of depression and mood disorders in various clinical settings. Telepsychiatry has an important and expanding role in addressing the individual and societal psychiatric burdens of depression and mood disorders.A surge in the development of computer-assisted cognitive-behavioral therapy (CCBT) and mobile apps for depression has provided many tools with potential for enhancing treatment delivery. This article assesses progress in evaluation and implementation of CCBT and mobile apps for depression, with a focus on providing practical information on clinical applications. Advantage and disadvantages of these technologies are identified, outcome research is reviewed, and recommendations are made for clinical use. With increasing use of computer technology in everyday life, it is likely that clinicians and patients will pursue opportunities to employ computer tools in treatment for depression.Depression is common among patients with neurologic disorders, and it has long been considered more difficult to treat than depression in the general population. In this review, the authors consider challenges in the diagnosis and treatment of depression among patients with stroke, traumatic brain injury, Parkinson's disease, and multiple sclerosis. For each disorder, the authors discuss the epidemiology and time course of depression as well as review the physiologic and psychological etiologies of depression. In addition, for each disorder, they review screening tools and diagnostic considerations, including differential diagnosis; discuss etiological factors, both neurobiological and psychological; and assess evidence for various depression treatments, including pharmacologic, psychosocial, and neuromodulatory therapies. The evidence suggests that depression is common among patients with neurologic disorders and that it is crucial for general psychiatrists to provide treatment for this population.Adolescents often present to treatment with multiple psychiatric diagnoses. The presence of certain co-occurring mental health conditions can significantly affect an individual's treatment course. Adolescence is also a time of developmentally appropriate risk taking and experimenting with novel behaviors. Difficulties in accurate diagnosis and lack of effective treatment options create obstacles to helping this vulnerable patient population. Appropriate management of adolescents' complex symptoms and high-risk behaviors during a developmentally sensitive period can be challenging, even for the most skilled of clinicians. This article focuses on the assessment and management of complex, co-occurring psychiatric disorders during adolescence, with specific guidance on how to manage high-risk behaviors, such as self-harm and suicidality. Controversial topics, including antidepressants and youth suicide risk, as well as "off-label" use of mood stabilizers and antipsychotics, are also reviewed.This article focuses on some common dilemmas facing clinicians, patients, and families in managing the treatment of complicated mood disorders. Specifically, this article reviews the interaction of depressive states, including unipolar, bipolar, and mixed, with other adversities, including comorbid physical and psychological disorders, personality vulnerabilities, misuse of drugs and alcohol, and social and family problems. These issues are not always clearly differentiated from the depressive illness. Each of these adversities can worsen an existing mood disorder and influence the patient's resolve to persist with a treatment plan. Although this article is not focused strictly on treatment-resistant depression, these coexisting issues make depressive states harder to manage therapeutically. For brevity, the aim of this article has been limited to discussion of some complex situations that psychiatrists in general practice may encounter.According to the World Health Organization, major depressive disorder is the world's leading cause of disability. If clinical remission is not attained and sustained, episodes tend to recur with greater severity and with lessening responsivity to conventional treatments. Reasonably well-established clues and guidelines are presented about the high risk and profound consequences of recurrence of major depressive disorder if successful antidepressant treatments are discontinued. The authors describe actions required to achieve a "lifetime wellness" focus for treatment. Current approaches would need to be transformed from attainment of clinical remission to attainment and maintenance of lifetime wellness, with the knowledge that some individuals may need continuous treatment. Risk factors would need to be assessed and used to formulate clinical treatment guidelines for risk of recurrence. Clinical trials would need to be greatly lengthened. Measurement-based care and precision medicine would be the foundation for informing clinical decisions.
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