Introduction

The most recently discovered coronavirus causes coronavirus disease-19 (COVID-19) [1] that originated in Wuhan, China and has spread widely to all over the world [2] World Health Organization (WHO) are announced a pandemic [3]. An important factor in decreasing the virus's transmission is the "social gap" or social distancing made possible by reducing person-to-person contact [4,5].

The use of telehealth technology is a twenty-first-century approach that is both patient-centered and protects patients, physicians, as well as others [6,7]. Telehealth delivers healthcare services by health care professionals by using information and communication technologies to exchange valid and correct information. With the rapid evolution and downsizing of portable electronics, most families have at least one digital device, such as smartphones [8] and webcams that provide communication between patients and healthcare providers [9].

During the COVID-19 pandemic, telepsychiatry services like other telehealth services have received increased attention and had developed worldwide with the help of digital health experts and IT professionals, and mental health professionals are using a different application like Zoom, Skype, WhatsApp, Facebook, and other popular freely available platforms to provide online psychiatric services. Although there are insufficient data on the acceptability and reliability of digital health services, this time is suitable for improving and evaluating this article's effectiveness. It intends to present our experience using online visit software for a psychiatric patient and describe its challenges, benefits, and limitations. The current article reported one patient in the inpatient setting of a psychiatric hospital visited by a psychiatrist through a newly designed platform, Sabatavan. This experience is one of the new experiences in our society, and we believe it’s valuable to share with others.

Description

Razi Psychiatric Hospital is an extensive educational and medical psychiatric hospital affiliated to the University of Social Welfare and Rehabilitation Sciences in Tehran, which has psychiatric wards, an emergency department, and electroconvulsive therapy unit, and a follow-up clinic. At the COVID-19 pandemic, we had significant challenges in preventing patients admitted to psychiatric wards from contracting the coronavirus. Also, follow-up visits from discharged patients were another challenge. With the help of technology and computer science experts, software called Sabatvan was designed in this center. In this software, doctors, psychologists, and psychiatric residents record their professional information and determine their online visit schedule. By entering this software, patients select the desired visit with the preferred doctor according to the existing program, and at the same time, online, and video communication is established.

A 54-year-old woman, married, housewife, third grade, resident of Tehran, went to the emergency room of Razi Hospital on June 9. Her signs and symptoms were depressed moods, anhedonia death wish, self-talk, persecutory and being-monitored delusion, and auditory hallucinations. The patient's symptoms started about 8 years ago, and she had a history of hospitalization. With the diagnosis of schizophrenia spectrum disorder and depression, the patient has been prescribed Perphenazine (10 mg in divided dose), sertraline (100 mg daily), and Biperiden (4 mg divided dose). The patient had diabetes.

The patient was hospitalized for 32 days, and during hospitalization, her symptoms were relatively improved by adjusting the dose of the drug and establishing a proper rapport. At the time of discharge, the patient was referred to a Tele psychiatric unit, and the patient and her family were instructed on how to use Sabatovan software for follow-up visits. Two weeks after discharge, the patient was visited in person for follow-up and control regarding drug side effects. And then, planning to continue the visits was done online with this software. The four sessions On August 19, September 5, September 21, and October 6 was done. In the first session, the patient has explained the behavioral activation therapy and the treatment structure for 45 minutes. The patient was then asked to make a list of activities performed during the day in one week. The side effects of the drugs and symptoms were asked. It was recommended to continue taking the medication as before. In the second online session, a list of the patient's daily activities was reviewed. The patient was inactive for a long time during the day and had negative thoughts in mind. The patient's favorite activity was cooking. It was recommended that he prepare a diet plan accordingly. She cooks every day and takes pictures of the dining table, and sends them to her children. In this session, the patient's family (daughter and spouse) was talked about, and they were given psycho education about her illness and significant symptoms, the definition of psychosis and delusion, and how to socialize with the patient. The family was asked to accompany the patient in the behavioral activation program. In the third session, the patient was satisfied with the treatment process. He wrote down his daily memories and events and felt good about it. In this session, other activities of the patient's interest were discussed. The patient stated that he always liked to paint but never did. It was decided that the patient should start painting simple designs and coloring books until the next session. The patient feels that he is mainly out of a state of depression and apathy. The patient was asked about his psychotic symptoms. The symptoms are in a state of relative improvement as before. There were no side effects. In the fourth session, the patient began to draw and color the coloring books and enjoyed the activity very much. After 4 sessions, since the patient did not have the appropriate treatment compliance during the previous years, they were pleased and satisfied with this communication method to contact the treating physician at home and perform basic psychotherapy programs.

Results

In our case report, the benefits of such software are the availability and ease of use of the home and no need to be in crowded places, the possibility of more communication with the therapist, order and communication through the official software system of the hospital and not personal programs, performing various methods of psychotherapy and educating the family and the patient. One of the essential features of this software that can be used in the future and with planning is the possibility of online visits of hospitalized patients.

One of the crucial challenges and limitations is the lack of telepharmacy to change or renew the drug prescription and the impossibility of close examination and observation to investigate the drugs' possible side effects. Another critical point is to document the patient's progress and changes. Another critical point is to document the course of the patient's progress and changes. In the patient's face-to-face visit, the course is recorded in the file. Unfortunately, in our country, official instructions have not yet been issued by the relevant institutions regarding the mechanism of providing telethon services, which it is hoped will be addressed due to the necessity of this matter.

Lessons learned

• Possibility of more communication between the therapists and patient,

• Easy use both patient and clinicians,

• More Accessibility of the patients and their families to psycho educational data

• Lack of Tele pharmacy and electronic prescriptions that the patient must visit in person to renew and change the medication.

• Lack of Guidelines according to its local needs and facilities and legal conditions.

Conclusion

Telepsychiatry is an excellent mechanism for providing high-level care to physicians and psychiatrists on complex cases for diagnostic purposes and treatment. Our experience showed that it has some advantages such as more communication between the therapist and patient, friendly use of both patient and clinicians, and more accessibility to information. But Tele prescription and comprehensive examination and documentation of the patient's progress, and lack of standard and official guidelines is challenging for Telepsychiatry. Especially, Telepsychiatry is a nascent phenomenon in İran that needs further research in the future.

References

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