Contraindications in Telepsychiatry

Experts agree that telepsychiatry is here to stay and will continue to increase access to mental health care for patients across the board. But are there any disease states that are particularly challenging to treat via telehealth? In this video taken at Psych Congress 2022, Psych Congress Steering Committee Member Edward Kaftarian, MD, CEO of Orbit Health Telepsychiatry, discusses his experiences treating a variety of conditions via telehealth, including dementia, psychotic disorders, and ADHD, each of which has its own challenges and benefits in a remote setting.

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Edward Kaftarian, MD, is chairman and CEO of Orbit Health Telepsychiatry. Dr Kaftarian is a nationally recognized psychiatrist and leader in the field of telepsychiatry and healthcare technology. Trained at the world-renowned Johns Hopkins Hospital, he is board-certified in psychiatry, forensic psychiatry and addiction medicine. Dr Kaftarian has served in a variety of executive roles within the California prison system, including chief psychiatrist, senior psychiatrist, medical director, and director of pharmacy. He is the founder of California’s Statewide Prison Telepsychiatry Program, which is the largest correctional telepsychiatry program in the world.

Read the transcript

Edward Kaftarian, MD: I'm Dr. Edward Kaftarian, CEO of Orbit Health Telepsychiatry, and also on the Steering Committee for Psych Congress.

So in my experience, it's sometimes challenging to treat people with dementia because, just in general, whether it's telehealth or not, it's hard to really connect sometimes with those people. And they may be elderly, unfamiliar with technology. That's becoming less of a factor as even beyond digital natives, people who have not necessarily grown up with technology are used to technology, but sometimes those populations are going to be challenging.

Now, the stereotypical challenging population would be people with psychotic disorders and delusions. That's a bit of a misconception because in my practice, I believe I've only had one paranoid patient that ever refused to do a telehealth appointment because of a psychotic process. And it wasn't even clear that this psychosis was the reason why he refused. I think most people assume that a psychotic patient will be suspicious of the video conferencing session, feel like they're being recorded by the government or something like that—that doesn't really happen very often. It doesn't mean that you can't be aware of it and look out for it and vigilant of it. And if that happens, you deal with it.

But generally speaking, there's no absolute contraindication for telehealth. It can be used for all populations. Some populations, it works, I think, better than on site. For example, children with ADHD, I think it works really well with them because they're used to their attention being captured by a screen. And so when they see somebody on a screen, it is interesting to them. And also I can show them cartoons and pictures to get their attention. Sometimes it can be challenging when the child is so hyperactive that they don't stay on camera and they walk around and that kind of thing. But generally speaking, it's easier to do telemedicine for children, in my opinion. Others may disagree, but in my opinion, it's been easier to do telemedicine rather than in person care with children with ADHD. I'm sure there'll be detractors from that opinion, but generally speaking I think it's a good modality.