Depression is a leading cause of disability affecting over 300 million indivuals worldwide. About 1/3 of patients with depression fail to achive remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression (TRD). In view of such facts, vagus nerve stimulation (VNS) therapy was approved as an adjunctive long-term treatment for TRD.

The authors elaborate a narrative literature review about de effectiveness of VNS in treatment for TRD.

PubMed database searched using the terms “treatment-resistant depression”, “vagus nerve stimulation”

The pathophysiology of depression is complex and includes social environmental stress factors, genetic and biological processes, inflammation, and disturbances in monoamine neurotransmission. The overdrive of the HPA axis is most consistently seen in subjects with more severe depression, when the cortisol feedback inhibitory mechanisms are impaired, contributing to cytokine oversecretion. It has been shown that chronic exposure to elevated inflammatory cytokines can lead to depression. The vagus nerve represents the main component of the parasympathetic nervous system, which oversees a vast array of crucial bodily functions, including control of mood and imune response. VNS therapy has a demonstrated anti-inflammatory effect which might be a significant reason for its efficacy in patients who did not respond to antidepressants. Treatments thar target the vagus nerve increase the vagal tone and inhibit cytokine production and the stimulation of vagal aferente fibers in the gut influences monaminergic brain systems.

The mecanismos by which VNS may benefit patients nonresponsive to conventional antidepressants is unclear, with further research need to clarify this.

No significant relationships.

Post-partum depression may occur in the first year after childbirth in approximately 25% of women, at times presenting with psychotic symptoms and catatonic states. Catatonia is a psychomotor syndrome that occurs in association with various neuropsychiatric disorders and can be described according to the characteristics of its manifestation in types such as retarded or agitated.

We report the case of a patient with postpartum depression and catatonic syndrome who, after a session of electroconvulsive therapy, was infected with Sars-COV-2, suspended treatment, and had her condition aggravated with distinct clinical manifestations.

Clinical case report and non-systematic review of articles consulted in the PubMed platform.

A 24-year-old patient develops depressive symptoms and obsessive behaviour 6 months after delivery and deteriorates with mutism, stupor and motor immobility. She was hospitalised and medicated with lorazepam, with no improvement. One session of electroconvulsive therapy was carried out with improvement of the symptoms. Due to an inpatient Covid-19 outbreak, in which the patient was infected, treatment was suspended. During isolation, deterioration of the patient’s condition was observed with psychomotor agitation, bizarre behaviour, and perseverative speech. The patient resumed treatment with ECT, with total remission of the catatonic syndrome and improvement of the affective symptoms.

Catatonic syndromes are relatively rare, but its association with post-partum depression is not so uncommon. The occurrence of different presentations of catatonia, although described as possible in the same episode in the literature, were not found in any clinical studies reviewed, which leads us to conclude that it is an uncommon situation.

No significant relationships.

The lack of a standardised definition for the concept of TRD and an adequate criteria for therapeutic response make difficult the management of patients with MDD who do not achieve remission with one or more courses of treatment. All classifications suggested to define TRD are arbitrary, partially evidence-based, subordinated to the pharmacological findings of the time in which they are written and with serious inconsistencies, making it difficult to construct a universal and enduring diagnostic system.

Considering that the most important goal in treating a patient with Major Depressive Disorder (MDD) should be remission and return to previous functionality, the search for a standardised, evidence-based classification system will allow timely and effective interventions leading to the reduction of this devastating condition.

Bibliographic review

The proposed therapeutic algorithm arises from the combination of several fundamental principles for the management of treatment-resistant depression: the different classification systems of the concept, as well as the concepts of response, relapse, recurrence and remission; the scientific evidence found in the current literature, routine clinical practice, knowledge of switching and augmentation strategies, the new pharmacological targets and neurobiological hypothesis discovered, without forgetting finally the different clinical profiles of depressive symptomatology and the specific indications of each antidepressant.

Resistant depression is difficult to treat successfully and is not a uniform entity. Recently there has been a move to characterise treatment-resistant depression as ‘difficult-to-treat’ depression on the basis that the former description implies that depression treatments are normally effective and that non-response is therefore somehow abnormal.

No significant relationships.

There is overwhelming evidence to show that achieving full remission in depression is important — especially in reducing the indirect costs of depression. Evidence further demonstrates that in primary care, clinicians are not optimising treatments for depression in a timely way —resulting in them not being able to achieve early remission for their clients experiencing depression. Presently, secondary care is unable to provide specialist input for this client cohort.

This project is implementing a model which extends specialist care to primary care. This project assists GP’s through optimising treatments for clients presenting with moderate to severe depression This model uses nurse practitioner led care, with ‘Psynary’, an online system which optimises treatments for moderate to severe depression.

Mixed methods pilot service implementation study, utilising: literature review of published service implementation models; service data gap analysis; qualitative interviews and focus group methodology.

GP and client focus group outcomes, as well as client remission rates in the OptiMA2 trial demonstrate that this healthcare pathway is effective.

The OptiMA2 trial focused on the qualitative analysis of the co-design process to implement the initial care pathway.The OptiMA3 trial will examine the cumulative clinical outcomes to consider if increased rates of remission are achieved and identify potential predictive factors. The long term goal for the system is to support the development of community based care-extender models, including specialist nurses, pharmacists and GPs, to extend specialist mental health expertise to larger primary care populations where the greatest burden of mental illness occurs.

No significant relationships.

1.Introduction MDD is a heterogeneous disorder, with a wide variety of symptoms and inconsistent treatment response, and is not completely understood. A dysregulated stress system is a consistent finding, however, and exhaustion is a consistent trait in adolescent patients. In order to open up our thinking about MDD we take up the challenge to reframe depression, specifically focusing on the possible role of the Microbiota-Gut-Brain-Axis in the etiology of MDD.

We propose a ‘bidirectional feedback hypothesis’: microbiota can promote or inhibit a pro-inflammatory state, (in)directly altering the hypothalamic pituitary adrenal (HPA) axis response and the microbiome and further increasing or decreasing its pro-inflammatory state. The aim is to show that the pro-inflammatory state is an integral part of a HPA axis stress spiralling mechanism that plays a role in the etiology of MDD.

A systematic review based on publications from PubMed, Embase and PsycInfo

The etiology of MDD can be understood as sliding down a spiral. This stress spiralling mechanism can be promoted or inhibited by: 1.factors such as a poor lifestyle or (pre-existing) illness 2.bettering someone’s lifestyle, coping behavior or providing pro-/prebiotics in combination with personalised therapeutics.

We argue that an interdisciplinary One Health approach is the most promising preventive and therapeutic option for MDD.

No significant relationships.

Major depressive disorder (MDD) affects around 10% of the French population annually and significantly impacts patient functioning. Efficacy of vortioxetine was demonstrated in randomised controlled trials, data on its real-world performance is needed.

To describe the effectiveness and safety of vortioxetine in real-world setting from patients enrolled from France in the global RELIEVE study.

RELIEVE was a prospective, multi-national, observational study of outpatients initiating vortioxetine treatment for MDD at physician’s discretion. Data were collected at routine clinical visits. Here we present the outcomes of treatment of patients in France. The primary outcome was functioning measured by SDS. Secondary outcomes included depressive symptoms measured by PHQ-9, cognitive symptoms measured by PDQ-5 and DSST. Changes from baseline to month 6 were estimated with a linear mixed model of repeated measures approach.

A total of 184 patients (mean age, 50.2 years, 65% female, 67.9% of patients had at least one comorbidity) were enrolled from France and included in the analysis. Mean(SD) SDS total score, PHQ-9, PDQ-5 scores at baseline were 21.1(5.4), 17.5(4.7) and 11.7(4.4), the scores(SE) decreased by 10.9(0.59), 9.3(0.48) and 6.1(0.37) from baseline to month 6. Mean(SD) DSST improved from 41.6(15.2) at baseline to 49.1(19.0) at month 6. Safety and tolerability profile of vortioxetine was in line with previous studies.

Sustained improvements in overall functioning, depressive symptoms, cognitive function were observed in patients treated with vortioxetine in a real-world setting, which provided further evidence of effectiveness and safety of vortioxetine in a broad MDD population in France.

M. Rabbani is an employee of Lundbeck France. K. Simonsen and H. Ren are employees of H. Lundbeck A/S.

New insights into the pathophysiology of mental disorders and innovations in psychiatric care depend on the availability of representative, longitudinal and multidimensional datasets across diverse, transdiagnostic populations. Biobanks usually attempt to collect such data in parallel to clinical routine, which is resource-intensive, puts additional burden on health-care providers, and may reduce the generalizability of the results. Despite containing rich phenotypic and biological information, data generated in routine clinical care is seldomly used for research purposes, because it is usually unstructured and locked in data silos. To truly link clinical practice and research, solutions that optimize the generation and scientific utilization of real-world clinical data are needed.

Evaluation of a new digital infrastructure which warrants the efficient, automatized, and structured collection of real-world data in psychiatric care, and integrates the generated data into existing biobanking efforts.

We have developed a new documentation system which augments the existing IT-structures, enables the collection of routine clinical data in a structured format and involves patients in the data generation process. In an implementation science approach, to replicate and extend the findings of Blitz et al. (JMIR Ment Health 2021), we are investigating the acceptance, efficacy, and safety of the system in our outpatient clinic for affective disorders.

First results describing the technical safety, usage metrics, and acceptance of the system, and the quality of the collected data will be presented.

Challenges of collecting real-world data for biobanking and research purposes and perspectives on future digital solutions will be discussed.

No significant relationships.

According to the World Health Organization, addressing the mental health care gap for adolescents, especially in low-resource contexts, is a priority. Evidence-based assessment is crucial for selecting treatment strategies and for quality management.

To develop a digital platform for evidence-based assessments and implement it in different low-resource settings.

The project operates according to the principles of digital development (https://digitalprinciples.org/), including designing with the user, user testing, understanding the ecosystem, resusing software and being open source, think about sustainability and addressing privacy and security.

Different implementation contexts (in Tanzania, Kosovo and Chile) will be presented.

The learned lessons will be presented to the audience.

MHIRA is a promising tool that helps bridge the gap regarding adolescent mental health in low-resource settings. Challenges include the clinicans attitude towards evidence based assessment, sustainability of the project and integration with the existing information technology eco-system and regulations.

No significant relationships.

There is a significant psychiatry workforce shortage in Australia, particularly in rural and remote communities. Given the large distances involved, telehealth – providing consultation via videoconference – has been widely accepted. Psychiatrists were among the highest users of telehealth services in Australia before the COVID-19 pandemic. However, the outbreak of COVID-19 resulted in a major transformation to service delivery across Australia. Private psychiatrists and state public mental health services had to rapidly transition to largely telehealth delivery to ensure continuity of care for consumers.

In March 2020, additional telehealth item numbers were added to the Australian Medicare Benefits Schedule (MBS) to encourage physical distancing for those accessing medical services during the pandemic.

To provide an overview of the increase in telehealth activity since the COVID-19 pandemic.

The MBS is the list of services for which the Australian Government will pay a rebate. Key data on MBS telehealth activity since March 2020 was examined.

The use of telehealth has increased during the pandemic. A survey of Royal Australian and New College of Psychiatrists (RANZCP) psychiatrists found that 93% supported retention of telehealth MBS item number numbers following the COVID-19 pandemic, noting increased accessibility for consumers. Positive feedback has been received from consumers.

During 2020 and 2021, the RANZCP worked with the Australian Government to ensure there were appropriate MBS telehealth services available for consumers. The RANZCP continues to work with the Government as they plan for a longer-term transformation of telehealth services beyond 2021.

No significant relationships.

The Covid-19 pandemic profoundly affected delivery and accessibility of mental health care services at a time when most needed. The OPTIMA Mood Disorder Service, a specialist bipolar disorder service, adapted group psychoeducation programme for delivery on-line.

We report the feasibility of creating a digital psychoeducation programme.

The OPTIMA ten session group psychoeducation programme was converted into a ‘Digital’ intervention using video-conferencing. Sessions offered a range of key topics, derived from the initial Barcelona Group Psychoeducation Programme. At the time of writing, OPTIMA had fully completed two 10 session digital courses.

A total of 12 people (6 in each group) consented to be part of a service evaluation of the digital groups. Just over half of the participants were women (7/12; 58.3%) and one identified as being non-binary (8.3); remaining participants were men. Age of participants ranged from 25 years to 65 years (Mean=42.3; SD=13.1). Data showed a high level of engagement (77%) All participants reported some improvement with a mean Bipolar Self-Efficacy scale (BPSES) post-group score of 105.6 (SD=14.8). At group level, this change was not statistically significant (F (1, 15) = 0.71, p=0.41). At an individual level, two out of five showed a reliable change index >1.96.

Delivering a ‘digital’ group psychoeducation programme was possible due to careful planning and programme development. There was good uptake from service users suggesting it is a feasible approach with preliminary evidence of clinical benefit.

No significant relationships.

The COVID-19 pandemic presented a global public-health crisis that demanded healthcare to adapt at an unprecedented pace. While challenging, it also created opportunities for the advancement of novel electronic-treatment-modalities. Telepsychiatry has emerged as an effective method to ensure continuity of care and ensure social distancing.1 Studies indicate that mental-health patients have higher rates of noncompliance to follow-up,1 thus finding means to increase compliance is critical.

The objectives of this study are to determine the impact of telepsychiatry on compliance to follow-up and to identify numbers of psychiatric/medical emergency-room visits, most common contributing factors for admission, and compliance in terms of diagnosis.

This IRB approved study is a retrospective chart-review, that aims to study children/adolescents (5-18 years) who presented to the Child&Adolescent-Psychiatry Outpatient-clinic from July-December 2020 and engaged in telepsychiatry, compared to a group of patients presented in July-December 2019-Pre-Covid19-Pandemic. A review of clinical characteristics including diagnosis, demographic information, medication, and treatment compliance will be compared as well as admissions to inpatient-psychiatry/emergency-room visits.

Our total sample (N=252) included patients from 2019-Pre-COVID19 (N=111) and 2020 Telehealth during COVID19-Pandemic (N=141). Our data analysis using SPSF and T-test has shown that Telehealth has significantly increased follow-up compliance (Two-tailed P-value=0.04); 2019-Pre-COVID outreach mean=0.06, 2020-Telehealth-during COVID outreach mean=0.02); significantly decreased ER/CPEP visits (P-value=0.02), and decreased In-patient-unit admissions (P-value=0.02).

According to the presented study, the incorporation of telepsychiatry has increased the compliance to psychiatric-care in outpatient and decreased the emergency-room visits and inpatient admission. Sufficient resources and steps need to be taken to further strengthen telehealth services.

No significant relationships.

Although several studies preliminary supported the effects of using smartphone mental health application (app) in patients with bipolar disorder (BD), patients’ subjective experience deserves more attention.

The present study aimed to explore how the BD patient experienced while using the APP in detecting their mood relapse warning signs (MRW app) which has been developed by our team (Su et al., 2021).

The MRW app collects 2 passive (location and GPS removal distance) and 6 self-reported data (daily mood, wake and sleep time, the brief record of mood and life, voice pitch, speech tone and rhythm, facial expression, and weekly emotional scale). By using qualitative research design, 15 patients recruited from the psychiatric outpatient department in a medical center were in-depth interviewed.

Four themes were identified as their subjective experience to use the app as: including positive and negative experience, facilitators, price, and barriers. Interconnected relationship was found in each theme; and counterbalancing associations between positive vs. negative experience, facilitators vs. price and barriers were also demonstrated.

Such first-person experience of using the app in illness detection could unveil technological myths and present its impacts upon patients’ lives in the real world. Implication for practice and future studies were be discussed.

No significant relationships.

The problem of diagnosis and treatment of ADHD in adults in the Russian Federation remains very relevant. Unfortunately, very little time is devoted to the topic of adult ADHD in standard and advanced training programs. In connection with these problems, it is important to study the prevalence of ADHD in the Russian population.

To determine the prevalence of an increased risk of adult ADHD on the example of Russian Instagram users.

In the professional blog of one of the authors of the article in Instagram (@gentlepsydoc), a link was posted to an anonymous survey conducted using Google docs, in which patients filled out the Adult ADHD Self-Report Scale (ASRS v1.1) in the author’s translation

A total of 144 people took part in the screening, 87.5% of them were women, the average age of the participants was 35.5±12.3 years (from 20 to 56). An increased risk of ADHD according to the indicators of the ASRS scale was detected in 13.2 % of participants.

Among Instagram users, the prevalence of an increased risk of ADHD was higher than according to epidemiology data. This indicator could be influenced by a sample of patients, mainly consisting of subscribers of a professional blog of a psychiatrist, as well as the prevalence of women among the participants. In any case, these data speak in favor of the importance of diagnosing this condition in the Russian population, as well as including information about adult ADHD in training programs for mental health professionals.

No significant relationships.

Patients attending psychiatric specialist health services in Northern Norway have since 2015 had the opportunity to access their medical records online. Prior to implementation, there were some concerns in the professional field that patient accessible electronic health records might introduce some challenges.

In this study, we asked psychiatric providers in outpatient psychiatric care about the impact of patients’ online access to documentation practices and whether they felt the access impacted the provider-patient relationship. We also examined whether the providers sought to deny patients’ access to any information.

16 qualitative in-depth interviews were performed with mental health providers working in the specialist services in North Norway. Participants had different professional backgrounds, and included doctors, nurses, psychologists and others. The interviews were audio recorded and transcribed verbatim. The data were qualitatively analyzed by means of the framework method.

The providers varied in their encouragement of patients’ online access, but few expressed concerns. There had been little specific training on how to optimize the writing of notes to accomodate patients’ online acces, but several pointed out that there had been an increased focus on the importance of adapting the notes to promote understanding. Increased transparency was in general seen positively, but the service might not fit all patient categories. Very few patients were denied access. In most cases, the service could improve the patients’ understanding of the treatment and the provider-patient relationship.

While some voiced caveats, patients’ online access was in general seen as beneficial to the treatment and the provider-patient relationship.

No significant relationships.

TikTok is a free mobile application, that enables users to create short videos. TikTok has an estimated one billion monthly active users, comprised of a mostly younger audience. There has been a noticed rise in content discussing ADHD – hashtag ADHD on TikTok has 6.3 billion views. The discussions continue on Twitter, where users are reporting watching TikTok content explaining ADHD symptomatology, subsequently relating to the condition and requesting referrals to specialist psychiatry services. This study aims to identify key themes in discussions around TikTok and ADHD, and its ramifications.

This study’s objective is to discuss the relationship between viewing ADHD content of TikTok and self-diagnoses of ADHD in young people.

In our study, Twitter posts were identified with the words ‘ADHD’ and ‘TikTok’ and established key themes relating to self-diagnosis of ADHD.

Numerous tweets were found discussing individual’s experiences of self-diagnosis of ADHD after watching TikTok videos and relating with the symptomology. Furthermore, many users discussed their efforts to seek diagnosis from psychiatrists. These posts highlighted positive discussion of mental health, and the improvement in quality of life since diagnosis.

Many young people are self-diagnosing ADHD after viewing TikTok videos. This may improve mental health stigma, however the expertise of the video creators should be scrutinised. Furthermore, the impact on already stretched waiting lists should be considered, with individuals who’s perceived ADHD traits are not impacting on their quality of life.

No significant relationships.

The COVID epidemic has forced psychiatrists to introduce changes in outpatient clinics. A significant proportion of visits began without the patient’s face-to-face contact with the doctor. Are these visits stigmatized with a worse assessment of mental state? We know that much of the information flow takes place outside of verbal contact. In telephone contact, psychiatrists are limited to listening to the patient’s response and we know that non-verbal speech does not always go hand in hand with words.

The aim of the study is to compare face-to-face visits with a psychiatrist with outpatient visits by telephone in terms of changes in the treatment applied by psychiatrists.

The frequency of introducing changes in the current pharmacological treatment of patients was compared. Face-to-face visits to the outpatient clinic and visits where psychiatrists contacted patients via telephone were analyzed. Treatment change was defined as a reduction or increase in drug dose, drug discontinuation or the initiation of a new drug by a psychiatrist.

We assumed that visits without non-verbal contact do not provide as much information as direct visits. Consequently, patients who are often negative about the need to take medications over the phone will present themselves better to psychiatrists, thus the change in treatment will be used less frequently in this group. The results will be presented at the conference.

Currently, various forms of psychiatric care are evolving to adapt to new needs. We should also be aware of the consequences of these changes.

No significant relationships.

Parent training programs have high potential to promote positive parent-child relationships as well as reach and engage parents to participate. Digitally delivered programs may overcome the barriers associated with face-to-face interventions, such as stigma, logistic challenges and limited resources.

To assess the effectiveness and feasibility of digital universal parent training program for families with 3 years-old children, focusing on parenting skills and child´s behavior.

A non-blinded randomized controlled trial (RCT) with two groups: (I) the intervention group, in which participants receive the parent training and (II) the waiting list group, in which participants are placed on a waiting list to receive the parent training intervention after the first follow-up measurement have been completed. Participants must meet the following inclusion criteria: a) guardians having a child age 3 years, b) participating to annual health checkup in child health clinic, c) at least one of the guardian is able to understand the languages that intervention is provided.

Pilot study with feasibility assessment finished at early 2021. Recruitment of the wider RCT study is currently ongoing. The results from the pilot study and more detailed description about the intervention will be presented.

This study with good national geographical coverage is a unique possibility to evaluate universal parenting program on promoting parenting behaviors associated with the promotion of optimal child emotional development. This study also provides population level information about parenting skills and child´s behavior.

No significant relationships.

Nursing is highly demanding and stressful profession. Therefore, maintaining and improving psychological wellbeing among nurses seems essential to have a better life satisfaction and a better productivity.

The aim of this study was to assess the relationship between mental health and life satisfaction among nurses.

The study was conducted in a group of active nurses from Hedi Chaker hospital in Sfax- Tunisia. Standardized questionnaires were used, including the general health questionnaire (GHQ-28) and the satisfaction with life scale (SWLS).

A total of 100 (males = 40; females = 60) nurses participated in this study. The mean age was 50.20 ±7.20 years. The average of job tenure was 25.25 ± 9.70 years. The majority of participants (66.7%) reported having chronic diseases. Rotating shifts work was noted in 72.50% of cases. Average scores for the GHQ-28 and the SWLS were respectively 30.66 ± 11.07 and 21.61± 6.23. The presence of chronic conditions was associated with psychological distress (higher GHQ-28 scores) (p = 0.01). Life satisfaction score was positively correlated with age (r= 0.29, p= 0.023), whereas it was negatively correlated with GHQ-28 scores (r= -0.36, p= 0.01). Low life satisfaction (SWLS scores between 5 and 14) was significantly associated with three domains of the GHQ-28: somatic symptoms (p = 0.008), anxiety (p = 0.001) and social dysfunction (p = 0.01).

According to our study, low life satisfaction was associated with psychological disorder. Hence, nurses need support and subsequent interventions in order to improve psychological wellbeing and life-satisfaction.

No significant relationships.

The COVID-19 pandemic led to the implementation of digital psychiatry (DP) in everyday clinical practice, resulting in the need for a skilled healthcare workforce.

Our purpose was to investigate the level of training, knowledge and expertise of young mental health professionals and medical students in DP, as well as exploring their beliefs and experiences in this field.

An ad hoc cross-sectional survey was designed and administered to Italian medical students, psychiatry trainees, and early career psychiatrists.

Most of the sample declared that the topic of DP was never discussed within their academic training (89.1%), mainly revealing an overall lack of knowledge on DP. Nevertheless, they mostly declared that DP represents a valuable therapeutic tool in mental health (80%) and that the academic background should include a dedicated course/module (54.4%). Moreover, most subjects declared that DP is less effective than in-person interventions (73.2%), despite the emerging evidence that being trained in DP is significantly associated with the belief that digital and in-person interventions are comparable in their effectiveness (p≤0.05).

During the current pandemic, DP represented an ideal response to the need for physical distancing by ensuring the advantage of greater access to care. However, DP interventions are still uncommon, and there remains a certain resistance to their use in mental health care. The lack of formal training during the academic training could be a limiting factor. Therefore, addressing these issues in academic settings could be crucial to spreading this innovative practice also in the post-COVID-19 era.

No significant relationships.

The COVID-19 pandemic brought many new challenges that people had to overcome with ingenuity. However, many patients already suffering with psychiatric diseases saw their access to conventional health care limited, aggravating their statuses. E-Medicine is the branch of health care that provides access through the Internet, and it has been growing in the last few years. During the COVID-19 pandemic, many health care workers shifted towards E-Medicine, aiming to provide support to patients, especially with the social distance policies that were implemented worldwide.

Provide an example of how e-Medicine can be a tool in establishing a therapeutic alliance, and patient follow-up

Case report with a brief literature review on the subject

RG is a 19-year-old female that contacts her family doctor through e-mail, expressing concerns over not being able to leave her house for over a year, also manifesting anxiety and depressed humor. This started in April 2020 and was slowly worsening throughout the year, culminating in a panic attack. RG started counselling and follow-up appointments via Internet and started treatment with vortioxetine. Three months later, improvements were stated, namely decreased anxiety, better sleep patterns, and leaving the house for small periods.

Without E-Medicine, RG wouldn’t be as able to reach out to her family doctor, and follow-up would be much more arduous since the patient avoided leaving her house, and telephone appointments lack the visual aspect of the clinical interview. E-Medicine is a valid alternative to conventional Medicine, providing a safe environment for patients concerned with public space.

No significant relationships.