Table 2.

Case Studies of Asynchronous Telepsychiatry

	A 54-year-old man, Brian, was referred for alcohol abuse and depression. In the interview, Brian stated that he had a long history of alcohol use and that since he stopped drinking 2 months previously, despite regular attendance at Alcoholics Anonymous, his depression had increased. Brian's ATP consultation occurred within a few days of referral, and the psychiatrist was able to send his recommendations of sertraline for depression and naltrexone for alcohol use disorder to the primary care physician within 3 days. The PCP agreed with the recommendations and was able follow-up with Brian a few days later to implement them.
This case demonstrates that ATP consultations can be completed in a fraction of the time that a patient would typically wait to see a psychiatrist where average wait times for a first time psychiatry visit were reported to be 25 days in 2014.19
	Angela, a 67-year-old woman had a history of depression that had increased in the past 2 years due to her overwhelming medical problems and dissatisfaction with her marriage. Throughout the long interview, her thought process was tangential and circumstantial often going off topic for lengthy amounts of time. After the interview, the clinician noted down times Angela spoke about relevant information pertaining to antidepressant medications, her changes in affect, and her specific psychiatric and medical symptoms. This allowed the psychiatrist as he reviewed the video, to jump to the specific times noted by the interviewer making his review more efficient, and enabling him to more rapidly assess this highly circumstantial individual, provide a diagnosis of bipolar disorder, and develop a treatment plan for her PCP.
This case demonstrates one way that ATP consults can lead to more efficient use of the time of psychiatrists who are the most expensive mental health providers.
	Janet, was a 50-year-old female with multiple sclerosis, depression, and chronic pain. She was referred to the study for assessment of her cognition and memory difficulties, which she thought were “possible ADHD.” During her first ATP consult, she reported slowly worsening cognitive symptoms and minimal depressive symptoms, except for irritability and frustration related to her poor cognition. The psychiatrist recommended lowering the dose of amitriptyline that she had been taking for 20 years to treat her nerve pain from multiple sclerosis, as it might be contributing to her cognitive difficulties. Janet was very reticent to do this but her PCP eventually persuaded her to agree to a very slow reduction. At her 6-month ATP study interview, she reported improved memory and concentration after finally lowering the amitriptyline from 100 to 75 mg nightly, while at her 12-month ATP follow-up, when she was taking only 50 mg, her cognitive status was markedly improved, and she stated on video that she was “very pleased” with her outcome and thanked the psychiatrist during her video interview.
This case demonstrates how a PCP and psychiatrist can work together to gradually improve the health of patients over time

ATP, asynchronous telepsychiatry.