The growth of telemedicine has had a strong impact on psychiatry, where in-person visits have long been the norm. In fact, according to a recent survey of psychiatrists, no doctors who responded had used telemedicine before the COVID-19 pandemic. This transition to telemedicine has had a significant impact on schizophrenia patients, who are twice as likely to die from COVID-19 than those without the psychiatric illness. Fortunately, telemedicine seems to be working well for many psychiatric patients, with research showing a high rate of patient satisfaction. However, it’s important to be aware of both the benefits and challenges of virtual psychiatric visits. Benefits have included:
Increased understanding of family/home dynamic. Zoom, for example, provides a greater opportunity to bring in family members to discuss health history and care plans for patientsAbility to engage with patients in nursing homesNo travel time or costFlexibility in scheduling appointments and potential to lower no-show ratesIncreased access to care for patients in rural areasAbility to remotely consult with other healthcare providers
Challenges have included:
Loss of face-to-face interaction, now substituted with telephone or video visitsDecreased ability to detect nonverbal cues during visitsReliance on patients being able to access and effectively use technology and the internetThe potential to miss or overlook substance abuseInability to see a patient’s full physical condition and statePotential issues with technology, internet connection
During virtual psychiatric visits, physicians can assess symptoms and determine an appropriate treatment plan. One approved treatment option that may be considered is CAPLYTA® (lumateperone), which the FDA approved in 2019 as an effective treatment for schizophrenia in adults. CAPLYTA 42 mg is taken once a day with no need for your doctor to adjust the amount once you start taking CAPLYTA. CAPLYTA was found to help control symptoms of schizophrenia and to be significantly better than placebo at managing schizophrenia symptoms in two separate clinical trials. Patients taking this medication also showed an improvement in the overall severity of their condition, as measured by a clinical global impression rating scale. It’s important for patients and caregivers to know that CAPLYTA is not for everyone. CAPLYTA can cause serious side effects. Elderly dementia patients have increased risk of death or stroke. CAPLYTA is not approved for dementia. Patients taking CAPLYTA should call their doctor about fever, stiff muscles or confusion, which can mean a life-threatening reaction or uncontrollable muscle movements which may be permanent. Dizziness upon standing, falls and impaired judgment may occur. Patients should use caution before driving until they know how the medication affects them. The most common side effects include sleepiness and dry mouth. High cholesterol and weight gain may occur, as can high blood sugar which may be fatal. Monitoring and blood tests may be needed. However, in short-term clinical trials, patients taking CAPLYTA had weight, cholesterol and blood sugar changes similar to a placebo. People should know that each drug has its own specific risk profile. In a long-term study of CAPLYTA for one year, patients had on average weight loss of seven pounds. While we look to a brighter future in controlling the pandemic, telepsychiatry will likely remain an ongoing practice for doctors and patients. If you are diagnosed with schizophrenia, you should speak to your healthcare professional to see if CAPLYTA could be right for you. CAPLYTA® (lumateperone) capsules 42 mg is a prescription medicine used to treat adults with schizophrenia. Important Safety Information Medicines like CAPLYTA can raise the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). CAPLYTA is not approved for treating people with dementia-related psychosis. Tell your doctor right away if you have any of the following serious side effects:
Stroke (cerebrovascular problems) in elderly people that can lead to death.Neuroleptic malignant syndrome (NMS): high fever, confusion, changes in your breathing, heart rate, and blood pressure, stiff muscles, and increased sweating; these may be symptoms of a rare but potentially fatal condition. Contact your doctor or go to the emergency room if you experience signs and symptoms of NMS.Uncontrolled body movements (tardive dyskinesia, TD) in your face, tongue, or other body parts. TD may not go away, even if you stop taking CAPLYTA. It may also occur after you stop taking your medication.Problems with your metabolism including high blood sugar, diabetes, increased fat (cholesterol and triglyceride) levels in your blood and weight gain. Your doctor should check your blood sugar, fat levels and weight before you start and during your treatment with CAPLYTA. Extremely high blood sugar levels can lead to coma or death. Tell your doctor if you have symptoms of high blood sugar, which include feeling very thirsty, hungry, sick to your stomach, weak/tired or needing to urinate more than usual.Low white blood cell count. Your doctor may do blood tests during the first few months of treatment with CAPLYTA.Decreased blood pressure (orthostatic hypotension). You may feel lightheaded, dizzy, or faint when you rise too quickly from a sitting or lying position.Falls. CAPLYTA may make you sleepy or dizzy, may cause a decrease in your blood pressure when changing position (orthostatic hypotension), and can slow your thinking and motor skills which may lead to falls that can cause broken bones or other injuries.Seizures (convulsions).Sleepiness and trouble concentrating: Until you know how CAPLYTA affects you, do not drive, operate heavy machinery, or do other dangerous activities.Problems controlling your body temperature so that you feel too warm. Avoid getting overheated or dehydrated while taking CAPLYTA.Difficulty swallowing.
The most common side effects of CAPLYTA include sleepiness or drowsiness and dry mouth. These are not all the possible side effects of CAPLYTA. You should notify your doctor if you become pregnant or intend to become pregnant while taking CAPLYTA. CAPLYTA may cause extrapyramidal (abnormal involuntary movements) and/or withdrawal symptoms in newborn babies exposed to CAPLYTA during the third trimester. When taking CAPLYTA, you should not breastfeed. Tell your doctor if you have liver problems and about all the medicines you’re taking, since there are some risks for drug interactions. Avoid eating grapefruit or drinking grapefruit juice during treatment with CAPLYTA. Grapefruit and grapefruit juice may affect the amount of CAPLYTA in your blood. You are encouraged to report negative side effects of prescription drugs. Contact Intra-Cellular Therapies, Inc. at 1-888-611-4824 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. Please click here for full Prescribing Information, including Boxed Warning. If you’re affected by schizophrenia, have a conversation with your doctor about CAPLYTA today. CAPLYTA is a registered trademark of Intra-Cellular Therapies, Inc. © 2021 Intra-Cellular Therapies, Inc. All rights reserved. US-CAP-2100321 5/21 SOURCES:
JAMA Network: “Implications for Telehealth in a Postpandemic Future: Regulatory and Privacy Issues”American Psychiatric Association: “Psychiatrists Use of Telepsychiatry During COVID-19 Public Health Emergency: Policy Recommendations”JAMA Network: “Association of Psychiatric Disorders With Mortality Among Patients With COVID-19”American Psychiatric Association: “Geriatric Telepsychiatry”Gen Hosp Psychiatry: “COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future”Clinical Schizophrenia: “Telepsychiatry in the assessment and treatment of schizophrenia”International Journal of Clinical Practice: “Telepsychiatry and other cutting‐edge technologies in COVID‐19 pandemic: Bridging the distance in mental health assistance”JAMA Network: “Patient Characteristics Associated With Telemedicine Access for Primary and Specialty Ambulatory Care During the COVID-19 Pandemic”
