Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease

Craig Chepke; Lynn W Shaughnessy; Stephen Brunton; Jill G Farmer; Andrew S Rosenzweig; George T Grossberg; Wendy L Wright

doi:10.2147/IJGM.S335739

Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease

Int J Gen Med. 2021 Dec 23:14:10271-10280. doi: 10.2147/IJGM.S335739. eCollection 2021.

Authors

Craig Chepke^{1

2

3}, Lynn W Shaughnessy⁴, Stephen Brunton^{5

6}, Jill G Farmer^{7

8}, Andrew S Rosenzweig⁹, George T Grossberg¹⁰, Wendy L Wright¹¹

Affiliations

¹ Excel Psychiatric Associates, Huntersville, NC, USA.
² Atrium Health, Charlotte, NC, USA.
³ University of North Carolina School of Medicine, Chapel Hill, NC, USA.
⁴ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁵ Primary Care Education Consortium, Winnsboro, SC, USA.
⁶ Department of Family Medicine, Touro University, Vallejo, CA, USA.
⁷ Parkinson's Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA.
⁸ Department of Emergency Medicine, Drexel College of Medicine, Philadelphia, PA, USA.
⁹ Forefront TeleCare, Providence, RI, USA.
¹⁰ Department of Psychiatry, St. Louis University School of Medicine, St. Louis, MO, USA.
¹¹ Wright & Associates Family Health Care, Concord and Amherst, NH, USA.

Abstract

The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any tele-visit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson's disease psychosis or dementia-related psychosis.

Keywords: Parkinson’s disease; delusions; hallucinations; primary care; psychosis; telemedicine.

Grants and funding

Acadia Pharmaceuticals Inc. funded medical writing and editorial support for this manuscript, as well as the advisory board meeting during which the authors initially discussed ideas for this paper.