Current Regulation of Mobile Mental Health Applications.

In recent years, the availability of software that is targeted toward the general public and designed to assist in the diagnosis and treatment of mental illness or to promote general mental health has expanded greatly. Regulation of more traditional health care providers and health care-associated devices is well established by statute, regulatory guidelines, and common law precedents. Applications (apps), in contrast, pose a novel regulatory challenge. This review examines the current regulatory guidelines for psychiatric mobile mental health apps, as well as the current state of case law in the psychiatric mobile mental health realm.

A Resident Perspective on the Goldwater Rule.

Section 7.3 of the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry, more commonly known as the Goldwater rule, admonishes psychiatrists to avoid offering professional opinions about public figures in the absence of an in-person evaluation. To our knowledge, no peer-reviewed articles have been published considering resident perspectives on the Goldwater rule. Furthermore, we have found little published guidance that deals specifically with teaching the Goldwater rule in a general residency curriculum. We propose that residency programs should incorporate a brief (one hour) but thoughtful discussion of the Goldwater rule into their general curriculum. We recommend that such a didactic hour should introduce arguments for and against the rule in its present form. Covered topics could include whether there should be exceptions to the rule, whether the rule is defensible on ethical grounds, and what contexts exist in which psychiatric opinions can be rendered without personal examination. We hope to make the case that a more nuanced exploration of the Goldwater rule could help open a door to discussions that would foster the growth of a mature professional identity.

Mobile Mental Health: Navigating New Rules and Regulations for Digital Tools.

Mobile health (mHealth) apps are becoming much more widely available. As more patients learn about and download apps, clinicians are sure to face more questions about the role these apps can play in treatment. Clinicians thus need to familiarize themselves with the clinical and legal risks that apps may introduce. Regulatory rules and organizations that oversee the safety and efficacy of mHealth apps are currently fragmentary in nature and clinicians should pay special attention to categories of apps which are currently exempt from significant regulation. Uniform HIPAA protection does not apply to personal health data that are shared with apps in many contexts which creates a number of clinically relevant privacy and security concerns. Clinicians should also consider several relatively novel potential adverse clinical outcomes and liability concerns that may be relevant to specific categories of apps, including apps that target (i) medication adherence, (ii) collection of self-reported data, (iii) collection of passive data, and (iv) generation of treatment recommendations for psychotherapeutic and behavioral interventions. Considering these potential pitfalls (and disclosing them to patients as a part of obtaining informed consent) is necessary as clinicians consider incorporating apps into treatment.

Do Consultation Psychiatrists, Forensic Psychiatrists, Psychiatry Trainees, and Health Care Lawyers Differ in Opinion on Gray Area Decision-Making Capacity Cases? A Vignette-Based Survey.

BACKGROUND: Previous research in the area of medical decision-making capacity has demonstrated relatively poor agreement between experienced evaluators in "gray area" cases. We performed a survey to determine the level of agreement about gray area decision-making capacity case scenarios within and between individuals of different professional backgrounds. METHOD: Participants received a survey consisting of 3 complicated decision-making capacity vignettes with an accompanying "yes/no" question regarding capacity and a certainty scale for each vignette. Participants were identified from mailing lists of professional organizations and local hospitals. We received responses from psychiatry trainees, consultation-liaison psychiatrists, forensic psychiatrists, and lawyers with experience in health care law. Results were analyzed using SPSS. RESULTS: Across the 3 vignettes, the percentage agreeing that the individual described had capacity to refuse medical treatment ranged between 35% and 40% for trainees, 33% and 67% for consult psychiatrists, 41% and 76% for forensic psychiatrists, and 40% and 83% for health care lawyers. Only question 2 reached significance between-group differences (Pearson χ(2) = 11.473, p < 0.01). Across vignettes, trainees were less likely to consider patients to have capacity for decision-making than were forensic psychiatrists and lawyers. CONCLUSIONS: As found in previous research, agreement among experienced evaluators appears generally low in gray area capacity cases. It is noteworthy that individuals of different professional backgrounds at times offer divergent between-group opinions on capacity.

Visual determinants of a cross-modal illusion.

Contrary to the predictions of established theory, Schutz and Lipscomb (2007) have shown that visual information can influence the perceived duration of concurrent sounds. In the present study, we deconstruct the visual component of their illusion, showing that (1) cross-modal influence depends on visible cues signaling an impact event (namely, a sudden change of direction concurrent with tone onset) and (2) the illusion is controlled primarily by the duration of post-impact motion. Other aspects of the post-impact motion--distance traveled, velocity, acceleration, and the rate of its change (i.e., its derivative, jerk)--play a minor role, if any. Together, these results demonstrate that visual event duration can influence the perception of auditory event duration, but only when stimulus cues are sufficient to give rise to the perception of a causal cross-modal relationship. This refined understanding of the illusion's visual aspects is helpful in comprehending why it contrasts so markedly with previous research on cross-modal integration, demonstrating that vision does not appreciably influence auditory judgments of event duration (Walker & Scott, 1981).