At the time of the visit, information posters related to the new coronavirus were not displayed in either patients' rest rooms or wards.450 Disinfectant solutions were placed in areas where patients could not reach them. It should be noted that hand hygiene is of particular importance for the prevention of the new coronavirus, but hand washing rules were not placed at the washbasins. Besides, in some cases there was no soap in the sanitary points. Interviews with patients revealed that in many cases they had no soap and could only wash their hands with water. 4.9. Psychiatric Assistance 4.9.1. Treatment with antipsychotic medications Psychiatric assistance in psychiatric hospitals is not of biopsychosocial nature and is practically reduced to pharmacotherapy. According to the Public Defender, a biopsychosocial approach is important to provide adequate psychiatric care, which, in addition to pharmacotherapy, also includes the psycho-social rehabilitation of the patient according to the needs. Against the background of the challenges in terms of psycho-social rehabilitation in psychiatric institutions451 pharmacologic burden is rising. Besides, patients are not properly involved in the process of providing psychiatric care, some of them do not know the the diagnosis and name of the prescribed medication. They also do not have information about the main and expected side effects of the prescribed medications. In 2020, prescription of several antipsychotic medications at the same time was still a problem. A study of medical records at the Senaki Mental Health Center and the Tbilisi Mental Health Center revealed that in several cases patients had been prescribed two, three, or more antipsychotic medications at the same time, including in some cases together with Zopin (clozapine).452 According to the national recommendations for clinical practice in the country,453 for most patients, except for special circumstances, it is recommended to prescribe one antipsychotic medication. It is important to avoid polypharmacy to prolong the QT interval454 and reduce the risk of sudden cardiac death.455 Information posters were posted in the wings of the departments, where the staff work rooms are located at the Center for Drug Prevention and Mental Health and the Senaki Center for Mental Health. Information posters were posted only in the canteen at the Tbilisi Mental Health Center. 451 See the subchapter Psycho-social rehabilitation. 452 One of the patients was prescribed Benzene 2 mg. Cedarex 2 mg. 1 tablet three times a day, "Amitriptyline" ½ tablets 3 times a day, "Azaleptin" 0.1 1/4 tablets and haloperidol 5 mg; One of the patients was prescribed "Olzap" 10 mg, "Amitriptyline" 25 mg, "Truxal" 50 mg. "Carbamazepine" 0.2, "Tryptazine" 5 mg. and benzene 2 mg; Also, one of the patients was prescribed "Sedarex" 6 mg, "Tisercin" 25 mg. "Ketilept" 200 mg. Haloperidol Decanoate; The second patient was prescribed Haloperidol 20 mg and Zopin 200 mg. and Clopixol Depot. 453 National Recommendation for Clinical Practice (Guideline) - "Treatment and Management of Schizophrenia in Adults", p. 46. 454 A heart rhythm disorder that potentially causes a rapid, chaotic heartbeat. 455 Most authors consider the use of 5 to 10 medications or, regardless of the number, the simultaneous use of different drugs of the same group or even the misuse of one medication as polypharmacy. See the link: https://bit.ly/35h14YY [Last visited 30.12.2020]. 450 132

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