Why Schizophrenia Is SUCH a Big problem- and how AI can help

Enhancing AVATAR therapy for Auditory-Visual Hallucinations using NLP

If I asked you what type of illness you thought accounts for the second highest total bed days of admitted patient care, you would: a) ask me why I’m asking such a specific and random question and b) probably guess cancer or heart disease.

What you most likely wouldn’t guess is that the correct answer is Schizophrenia, with 2.5 million bed days in a year- second in any mental and physical illness.

Now that’s a big word, and it sounds like something thrown around with medical jargon in a hospital reality tv show. For those of us who are unfamiliar with the term, Schizophrenia is a “chronic and severe mental disorder that affects how a person thinks, feels, and behaves”.

And if 2.5 million didn’t seem to be big enough, let me quantify that a bit more. Around £3 billion was spent on patients and research(and that’s just in the UK), with the numbers only rising as the patients increase. That’s a lot of the limited healthcare resources and attention needed.

Okay, so this is a common illness, lots of medical care is required, but the problems are resolved with treatment right? It's not that simple.

The Auditory-Verbal Hallucination

60–70% of these patients experience auditory verbal hallucinations (AVH) with voices that generate “noise” in one’s head, causing many schizophrenic patients to be distracted, angry or irritated. There have also been many cases of schizophrenic patients attempting suicide because of these voices.

On average, people with schizophrenia have about 37 contacts with healthcare professionals on a yearly basis. That’s 3–4 long-winded and time-consuming treatment processes on a monthly basis. Even then, it would be a small price to pay to be free of the burden — if it were successful. Treatment for these symptoms is “lacklustre at best”, with many patients claiming that their auditory hallucinations persist even with prescription medicine.

Avatar Therapy

Effective treatment strategies remain very challenging, and limited options are available. But recently, there has been a silver lining.

An example of a specialized medical professional facilitating AVATAR therapy

Avatar Therapy (AT), an innovative experiential approach enables patients to create an avatar of their persecutor (the voice in their auditory verbal hallucinations) and allows them to gain control over their symptoms while confronting their fears head-on. Talking to these avatars also shifts control from the avatar to the patient.

Authors of the randomized blind study said that avatar therapy reduced hallucinations significantly after 12 weeks(half of the normal treatment span) and had a more impactful effect on alleviating other symptoms of schizophrenia. In some cases, it has even to completely stop seizures altogether.

“Our study provides early evidence that avatar therapy rapidly improves auditory hallucinations for people with schizophrenia, reducing their frequency and how distressing they are, compared to a type of counselling”

That. is. HUGE.

How it works.

The therapy is divided over a 24-week span. There are 3 main phases/ parts, that incrementally help patients control their symptoms and hallucinations: 
1. Changes in beliefs about voices (specifically related to omnipotence and malevolence) and appraisal of the voice relationship (specifically relative power and assertiveness) are likely mechanisms of action.

2. The second phase specifically targets improvements in self-concept and development of a more positive identity, work that is consistent with recent approaches emphasizing the importance of self-esteem and self-compassion in working with distressing voices

3. Finally, given that anxiety processes are seen as central in the maintenance of distressing voices and that AVATAR therapy involves exposure to a distressing stimulus (voice content and image), reductions in anxiety may also be an important mechanism of action.
You can check out the whole paper here.

The catch

It would be great if this article stopped right here, and I said,” thanks for reading, everything is fine and dandy”. But sadly, there is a reason why AVATAR therapy is only a couple of studies and not being deployed all around the world.

“The researchers did note, however, that avatar therapy is not viable as a mass treatment (as of yet) for schizophrenics because it requires highly trained mental health professionals to conduct these sessions. Current data show that the mental health workforce cannot yet handle it.”

Basically, in these studies, the treatment is administered through very experienced/specialized doctors (who played two roles- the mediator/supporter and the avatar ) — something that cannot be scaled because of the difficulty to provide specialized care for a high number of patients. Additionally, these weekly treatments are generalized simulation rather than treatment optimized based on the patient’s history, which is not ideal either.

But, never fear, here is where my favourite superhero comes in.

Is it a bird? Is it a plane? No, its artificial intelligence (and its subfields of Conversational AI and Deep video synthesis)

Using AI to innovate in this space

Most of the main scalability and effectiveness issues can be resolved using Natural language processing, the category of ai that deals with understanding and processing the human language. As a bonus, deep video synthesis (or deep fakes) can be used to augment the avatar process itself, and further the idea of bringing these persecutors to life.

The idea is to use a chatbot like structure that uses NLP to initiate dialogue and generate responses for the avatar and the mediator. Using capabilities such as sentiment analysis, and harnessing data from previous sessions, the entire process will be much more efficient and deployable by any non-specialized professional.

To check out an in-depth explanation of how this will work, check out my article here on the technical aspects of this project.

Theoretically, if this were to be deployed, the treatment time and directly correlated facility space used by Schizophrenia patients throughout the world will be significantly reduced(by almost half); the amount of admitted patient care days will be lowered so schizophrenia is nowhere near top 3. Using these techniques the high usage of healthcare resources and billions required for funding will be lowered while treatment accessibility will raise.

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