Source: Charfi, F., Hamouda, A. B., Bourgou, S., Hamza, M., & Belhadj, A. (2020). Covid-19 and mental disorders in children and adolescents: Experience of the child and adolescent psychiatry department of the Mongi Slim Hospital of Tunis. La Tunisie Médicale , 98(08), 619-624.
Keywords: Covid-19, Telemedicine, Mental Health, Child and adolescent psychiatry
Introduction
This article is a descriptive and retrospective study of medical data from patients who were monitored remotely in the Child Psychiatry Department at Mongi Slim Hospital during the period of confinement and travel restrictions from March 30 to May 2, 2020. The objective of this work is to describe the experience of remote monitoring of patients with child psychiatric disorders during the Covid-19 pandemic.
Summary
The Covid-19 pandemic due to infection with the SARS-CoV-2 coronavirus (1,2) has caused considerable upheaval and change in the daily lives of families. Thus, a total containment for a period of 3 months has been implemented by most countries including Tunisia as well.
The Covid-19 pandemic had a major psychosocial impact on the mental health of children and adolescents, especially when the child has mental health problems. During containment, the healthcare structures were subject to a significant restriction of their activities. The children in particular, witnessed several anxiety-provoking events, subjected to the restriction of their social activities and the reorganization of family dynamics imposed by confinement. This impact is all the more important when dealing with a population of children suffering from pre-existing mental disorders.
The child and adolescent psychiatry department of the Mongi Slim Hospital in Tunis has set up telephone follow-up for patients deemed to be at risk. This follow-up involved 166 cases, the majority of them were suffering from neurodevelopmental disorders, followed by depressive disorders and adjustment disorders. A third of the patients had reported a worsening of the symptoms during the containment and a third had reported clinical improvement. During this
follow-up, recommendations were made to parents to limit the negative impact of Covid-19 pandemic.
Method
The hospital’s child psychiatric team has set up remote monitoring of 166 children and adolescents aged between 2 and 20 years. These children had either ADHD, autism or depressive disorders.
This telephone follow-up with the parents of children already followed up in the child psychiatry service consisted of providing parental guidance in relation to the child’s disorder, listening to parents’ complaints and providing recommendations to minimize the impact of confinement.
The data collected was then stored in an Excel spreadsheet for easy follow-up. These included the person called, the reason for follow-up, the child’s condition during the confinement, the evolution of symptoms (worsening, improvement or steady state), the type of pharmacological treatment if the child was taking it, the existence of violence on the child and the proposed mode of follow-up (continue telephone follow-up during the confinement period, propose a prescription renewal, propose an urgent face-to-face appointment or see the patient again at a later date during the period of deconfinement).
Result
The authors found that confinement worsened symptoms in children with autism. On the other hand, for those with ADHD, there was an improvement in symptomatology (which can be explained by stopping the use of psychostimulants and the presence of parents at home or the absence of school anxiety).
As for the worsening of symptoms reported by parents, these were mainly behavioural disorders, opposition, emotional disturbances, boredom, anxiety and sometimes instinctual disorders (eating, sleeping). Also, the authors were able to identify a few cases of victims of violence.
Critical Evaluation
The authors noted some limitations to their work. First, telemedicine was generally only done with parents and this may have biased the results, especially with regard to violence. Secondly, telemedicine was only implemented for children who were already experiencing difficulties, and in the context of the Covid-19 pandemic, some children without a history of the disease presented psychological difficulties and sometimes psychiatric decompensation such as acute stress, post-traumatic stress disorder or anxiety and depression.
CONCLUSION
This article is very interesting because it underlines both the aggravation of the difficulties encountered by children with neurodevelopmental or depressive disorders, but also the importance of monitoring this public in this period of pandemic which leads to a restriction of the majority of activities. This experience shows that maintaining the follow-up of patients with mental disorders through telemedicine is a major challenge in preventing the long-term repercussions of this pandemic.
Vocabulary
- Witnessed: Témoins
- follow-up: Suivi
- upheaval : bouleversement
- ADHD: attention-deficit hyperactivity disorder (TDAH)
- disorders: troubles
- Underline: souligné
- implement: Mise en oeuvre