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Purpose Telepsychiatry, a subset of telemedicine, has been increasingly studied to meet the growing demands for psychiatric care. The utility of telepsychiatry is relevant now more than ever as the world endures the COVID-19 global pandemic. This paper describes the prior state and the changes that the COVID-19 outbreak brought to telepsychiatry in a selected group of Arab countries of the Middle East and North Africa (MENA) region. Patients and Methods We invited twelve early-career psychiatrists from different Arab nations to share information related to telepsychiatry in their respective countries before and during the COVID-19 pandemic. The information was collected using a semi-structured guide. This was complemented by a search for relevant articles in five search engines using terms such as “COVID-19,” “telepsychiatry,” and “Arab world”. Results Before the pandemic, digital mental health services were provided in several Arab countries, mainly through hotlines and messaging services. The COVID-19 pandemic has marked a major shift in digital psychiatric services in the Arab MENA world, through the transformation of many clinics and some hospitals into digital mental health systems. Many non-governmental organizations also started remote initiatives for psychological support and psychiatric counseling. Three main barriers of patient-related, healthcare-related, and system-related hurdles of using telepsychiatry emanated from the analysis. Conclusion The use of digital mental health services varies between different Arab countries. Even though some nations have laws that regulate the provision of such services, most struggle with multifactorial barriers. As affordable and attainable solutions cannot only rely on training and recruiting more psychiatrists, telepsychiatry would help meet the exceeding demands in the Arab world, particularly after the COVID-19 outbreak.

Samer El Hayek,1 Marwa Nofal,2 Doaa Abdelrahman,3 Ali Adra,4 Mansour Al Harthi,5 Siham Al Shamli,6 Nawaf AlNuaimi,7 Lynda Bensid,8 Mohamad Ali Cheaito,9 Alkhansa Mahdi Emberish,10 Amine Larnaout,11 Ahmed Radwan,12 Mohammad Slaih,13 Firas Kobeissy,14 Maya Bizri1 1Department of Psychiatry, American University of Beirut, Beirut, Lebanon; 2Helwan Mental Health Hospital, Cairo, Egypt; 3The Sudan Medical Specialization Board, Khartoum, Sudan; 4Department of Psychiatry, Damascus University, Damascus, Syria; 5Department of Psychiatry, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; 6Oman Medical Specialty Board, Psychiatry Program, Muscat, Sultanet of Oman; 7Psychiatric Department, Al Ain Hospital, Abu Dhabi, United Arab Emirates; 8Department a, University of Algiers, Drid Hocine Hospital Specialized in Psychiatry, Algiers, Algeria; 9Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon; 10Alrazi Hospital for Mental Health, Tripoli, Libya; 11Psychiatry Department D, Razi Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia; 12Mental Health Service, Hamad Medical Corporation, Doha, Qatar; 13National Center for Mental Health, Ministry of Health, Amman, Jordan; 14Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, LebanonCorrespondence: Samer El HayekDepartment of Psychiatry, American University of Beirut, Bliss Street, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, LebanonTel +961 70941362Email samer.elhayek@gmail.comPurpose: Telepsychiatry, a subset of telemedicine, has been increasingly studied to meet the growing demands for psychiatric care. The utility of telepsychiatry is relevant now more than ever as the world endures the COVID-19 global pandemic. This paper describes the prior state and the changes that the COVID-19 outbreak brought to telepsychiatry in a selected group of Arab countries of the Middle East and North Africa (MENA) region.Patients and Methods: We invited twelve early-career psychiatrists from different Arab nations to share information related to telepsychiatry in their respective countries before and during the COVID-19 pandemic. The information was collected using a semi-structured guide. This was complemented by a search for relevant articles in five search engines using terms such as “COVID-19,” “telepsychiatry,” and “Arab world”.Results: Before the pandemic, digital mental health services were provided in several Arab countries, mainly through hotlines and messaging services. The COVID-19 pandemic has marked a major shift in digital psychiatric services in the Arab MENA world, through the transformation of many clinics and some hospitals into digital mental health systems. Many non-governmental organizations also started remote initiatives for psychological support and psychiatric counseling. Three main barriers of patient-related, healthcare-related, and system-related hurdles of using telepsychiatry emanated from the analysis.Conclusion: The use of digital mental health services varies between different Arab countries. Even though some nations have laws that regulate the provision of such services, most struggle with multifactorial barriers. As affordable and attainable solutions cannot only rely on training and recruiting more psychiatrists, telepsychiatry would help meet the exceeding demands in the Arab world, particularly after the COVID-19 outbreak.Keywords: telepsychiatry, mental health, Arab, COVID-19

The emergence of mental health (MH) problems during a pandemic is extremely common, though difficult to address due to the complexities of pandemics and the scarcity of evidence about the epidemiology of pandemic-related MH problems and the potential interventions to tackle them. Little attention has been devoted so far to this topic from policymakers, stakeholders and researchers, resulting in a lack of replicable, scalable and applicable frameworks to help plan, develop and deliver MH care during pandemics. As a response, we have attempted to develop a conceptual framework (CF) that could guide the development, implementation, and evaluation of MH interventions during the ongoing COVID-19 pandemic. This CF was developed by early career psychiatrists from 16 countries that cover all the WHO regions. Their opinions were elicited via a semi-structured questionnaire. They were asked to provide their views about the current MH situation in their countries and to elaborate on existing 'myths' and misinformation. They were also asked to name the resources available and to propose solutions and approaches to provide accessible and affordable care. The CF was prepared based on the extant literature and the views discussed in this group; it illustrates the epidemiology of MH problems, preparedness plans, stage-specific plans or innovative solutions, opportunities to integrate those plans and possible outcomes at policy level. This CF can serve as a technical guide for future research regarding pandemics. It can be used to monitor trends and to optimize efforts, and to develop evidence based MH interventions. Still, further research focusing on the individual components of this framework is needed.

Background With the uncertainties of COVID-19, people infected by coronavirus present with diverse psychiatric presentations. Some centers have had to manage their patients with existing protocols, others have had to come up with innovations. We aim to report the challenges and good practices recorded in the management of psychiatric conditions and delirium coexisting with COVID-19 and during the COVID-19 era across continents. Material and Methods Early Career Psychiatrists (ECPs) from across five continents were approached to provide their perspective on the management of psychiatric conditions in patients with COVID-19 and during the current pandemic. Results We collected information about the experiences from ten countries. Commonalities were similar psychiatric presentations and poor preparedness across countries. Differences were varying innovations and adjustments made in the management of psychiatric conditions coexisting with COVID-19. Good practices which can be adopted by other countries are novel approaches such as telepsychiatry, proactive consultation-liaison units and enhanced community services targeted at circumventing challenges faced yet providing mental health services. Conclusions This publication highlights the need for global preparedness in the mental health sector during outbreaks of infectious diseases. With our results we can conclude that there is the need for concerted efforts targeted at global and locally sensitive adaptation of existing protocols and the development of new guidelines for the management of psychiatric conditions for the present pandemic and subsequent occurrences., Highlights • Twenty-one Early Career Psychiatrists (ECPs) from thirteen countries across five continents, provided their perspective on the management of psychiatric conditions in patients with COVID-19. • We found commonalities such as similar psychiatric presentations, poor preparedness and alterations in the management of psychiatric conditions coexisting with COVID-19. • There are shared similarities and differences, likewise modifications in pre-existing protocols in the management of delirium and other psychiatric conditions in patients with COVID-19 and during the current era across continents. • A common factor is the need for preparedness in the mental health sector; the need for concerted efforts targeted at globally and locally sensitive adaptation of guidelines and protocols for the management of psychiatric conditions for the present pandemic and subsequent occurrences.

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