Trackable pills offer a breakthrough for the treatment of individuals with mental illness, according to a case study recently published in the AMA Journal of Ethics. However, this technology may lead to unintended complications among individuals with persecutory delusions or poor insight.
This case study included an individual with schizophrenia who was threatening self-harm and interacting with auditory hallucinations. He believed he was being tracked and persecuted by the government and believed a microprocessing chip had been embedded in his wrist, revealing paranoid delusions, tactile hallucinations, and a low decision-making capacity. Introducing an actual tracking device into such an individual raises ethical concerns and threatens to undermine therapeutic trust, underscoring the need for psychiatrists to determine capacity and deliver information for informed consent. The study author illustrates criteria for appropriate nanodrug use and how to apply criteria to the case of this individual.
The first step is to determine decision-making capacity in autonomously taking antipsychotic medications, which includes “factual understanding of the issues,” “appreciation of the situation and its consequences,” and “rational manipulation of information.” In the event of poor insight despite acceptable decision-making capacity, the therapist will have to determine whether more intrusive techniques such as long-acting injectable antipsychotics or pill counts are needed. Trackable pills may be deemed inappropriate if the individual seems capable of self-harm or aggression due to persecutory delusions. If the individual consents to the nanodrug, changes to treatment should be made clear.
The individual in this study desired treatment but displayed poor insight regarding the risks and benefits of taking a trackable drug. It was decided that, since the trackable pill might exacerbate delusions of surveillance and could destroy the trust of his therapeutic team, it would be a poor choice. He was given a long-acting injection of aripiprazole instead.
The study author concludes that “[new] technologies that offer patients with mental illness alleviation from suffering are certainly desirable….Although trackable and other nanotechnologies represent medical breakthroughs for treatment of many diseases, they could have unintended implications and thus their use must be carefully considered in the individual case. The guidelines discussed here offer an approach to determining whether trackable pill technology should be used in cases in which a patient might have poor insight and persecutory delusions.”
Rahman T. Should trackable pill technologies be used to facilitate adherence among patients without insight? AMA J Ethics. 2019;21(4):E332-336.