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-The United Medical & Dental Schools of Guys Kings and St Thomas’s, at King’s College London.
-Mount Sinai School of Medicine, New York
-NYU Psychoanalytic Institute
-American Board of Psychiatry & Neurology
GABA Telepsychiatry is a unique practice, where our US-licensed, trained, and insured urgent psychiatrist offers the closest possible approximation to traditional psychiatric services in a telepsychiatry format.
Gaba telepsychiatry is known to follow US Psychiatry guidelines and standards of care ensuring safe, ethical, legal, and effective psychiatric services.
Our aim is to provide the highest quality care to patients, who cannot access care from the urgent psychiatrist of their choice due to scheduling difficulties or geographic location.
Effective business processes, efficient back office operations, and faster software automation allow more extended visits with more focus on high-quality care.
Our urgent psychiatrist offers services via a HIPAA-compliant video platform as if you were in the office. However, patients are not treated via text message or phone.
We make sure to follow the same APA guidelines similar to an in-office visit, achieving the same outcomes and safety standards. At the same time, we are not a ‘therapy on demand’ or ‘text your psychiatrist’ app.
Peer psychiatrist networks offer only supervision and guidance. However, we offer comprehensive timely services with psychotherapy modalities and medication management after screening the medical causes of illness.
Gaba Telepsychiatry stands out by combining the traditional practice models and standards of care with some concierge features including care provider liaison, extensive patient visits, and your dedicated liaison to assist with scheduling, billing, lab work, as well as prescriptions.
Psychiatric treatment protocols have been developed and refined over hundreds of years, through trial and This is why it is essential that they are adhered to where possible .
Before the emergence of telemedicine the only option was to see a psychiatrist was in the office. Although telepsychiatry is a more practical option for most people, it important not to lose quality of care when conducting psychiatry visits in a telemedicine setting. Ideally a telepsychiatry visit should be the same as an office visit. exactly the same rules, regulations and standards of care should apply.
Some concierge features which have been added, include the dedicated liaison for assistance with billing, scheduling, lab work, and prescription, as although automated, requires more patient initiative than an office visit.
Slightly longer psychiatrist visits return to a more traditional model and are one of the benefits of the private and group psychiatrist practice model over large clinics and hospitals, where layers of corporate overheads and insurance cuts leads to shorter patient visits to cut costs.
Traditionally, patients would sometimes travel for hours to see a psychiatrist. If unable to attend their appointment, they will still be charged for the visit.
Patients would have to use up their sick days or take time away from their business to attend appointments. Finding a psychiatrist on evenings or weekends was hard. People who traveled for work or took long summer vacations would have to miss appointments and would have trouble obtaining prescriptions.
It is essential that patients are not punished for having a productive and full life. The goal is to provide high-quality treatment for everyone, regardless of their lifestyle or location.
Billing, scheduling, and inquiries can be conducted through a patient portal. Prescriptions can be sent directly to the local pharmacy via Electronic Health Records, or can be mailed to the home. A dedicated liaison is available for assistance should there be difficulty with any of these processes.
ONSET:
Early adulthood and with a variety of contexts
A. Presence of obsessions, compulsions, or both
Obsessions:
1. Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted and that causes anxiety or distress.
2. Attempts to ignore or suppress such thoughts, urges, or images or to neutralize them.
Compulsions:
1. Repetitive behaviors or mental acts that you feel driven to do in response to an obsession or rules.
2. Aimed at preventing or reducing anxiety or distress or preventing some dreaded event or situation.
B. Obsession and compulsion are time-consuming, can cause distress, or impairment
C. Not due to substances or a medical disorder
D. Not better explained by another mental disorder
Consult an urgent psychiatrist if symptoms are severe, disabling, or causing distress.
A. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
1. Difficulty initiating sleep (in children, this may manifest as difficulty initiating sleep without caregiver intervention).
2. Trouble in maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (in children, this may manifest as difficulty returning to sleep without caregiver intervention).
3. Early-morning awakening with inability to return to sleep.
B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
C. Sleep difficulty occurs at least 3 nights per week.
D. Sleep difficulty is present for at least severe, months.
E. Sleep difficulty occurs despite fair opportunity for sleep.
F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia).
G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
Consult an urgent psychiatrist if symptoms are severe, disabling, or causing distress.
Menopause is the permanent cessation of menstruation resulting in the loss of ovarian follicle development. It is considered to occur when 12 menstrual cycles are missed. Menopausal transition, or perimenopause, is the period between the onset of irregular menstrual cycles and the last menstrual period. This period is marked by fluctuations in reproductive hormones 3 and is characterized by the following:
Menstrual irregularities
Prolonged and heavy menstruation intermixed with episodes of amenorrhea
Decreased fertility
Depression
Anxiety
Problems with attention, concentration, and memory
Vasomotor symptoms
Insomnia
Some of these symptoms may emerge 4 years before menses cease, with a perimenopausal mean age of onset of 47.5 years. During the menopausal transition, estrogen levels decline and levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) increase. Postmenopause is the phase following the last menstrual period.
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses then it will start to improve within a few days after the beginning of menses, and become minimal or absent in the week post menses.
B. One (or more) of the following symptoms must be present:
1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability, anger, or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five signs when combined with symptoms from Criterion B above.
1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite, overeating, or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. Note: The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.
D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).
E. The disturbance is not merely a worsening of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders).
F. Prospective daily ratings should confirm criterion A during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally before this confirmation).
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).
Cyclothymia (Thyroid Disorders)
A. At least 2 years numerous periods of hypomanic symptom that don’t meet criteria for an episode and multiple periods with a depressive symptom that don’t meet standards for episode.
B. Present at least half the time and not been without for more than 2 months at a time.
C. Criteria for MD, manic, or hypomanic episode never met.
Specifiers: With anxious distress comorbidity of diabetes and psychiatric disorders can present in different patterns. First, the two can present as independent conditions with no apparent direct connection. In such a scenario both are the outcome of separate and parallel pathogenic pathways. Second, the course of diabetes can be complicated by the emergence of psychiatric disorders. In such cases, diabetes contributes to the pathogenesis of mental disorders. Various biological and psychological factors mediate the onset of psychiatric disorders in such a context. Third, certain psychiatric disorders like depression and schizophrenia act as significant independent risk factors for the development of diabetes. Fourth, there could be an overlap between the clinical presentation of hypoglycemic and ketoacidosis episodes and conditions such as panic attacks. Fifth, impaired glucose tolerance and diabetes could emerge as a side effect of the medications used for psychiatric disorders. Treatment of psychiatric disorders could influence diabetes care in other ways also as discussed in subsequent sections.
Anorexia Nervosa
A. Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
B. Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Coding: Restricting type, binge-eating/purging type.
Bulimia Nervosa
A. Recurrent episodes of binge eating. Characterized by both:
Eating in a discrete period of time with an amount of food that is larger than what most individuals would eat in a similar period under similar circumstances.
Sense of lack of control over eating during the episode.
B. Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur on average at least once a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
A. Recurrent unexpected panic attacks. A sudden surge of intense fear or intense discomfort that reaches a peak within minutes and has 4+:
1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feelings of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Chills or heat sensations
9. Paresthesias (numbness or tingling)
10. Derealization or depersonalization
11. Fear of losing control or going crazy
12. Fear of dying
B. At least one of the attacks followed by a month of:
1. Persistent concern or worry about additional panic attacks.
2. Significant maladaptive change in behavior related to the attacks and designed to avoid having panic attacks.
C. Not due to substance or medical condition.
D. Not better explained by another mental disorder.
Mood Disorder Due To A General Medical Condition Should have at least one of the following:
A. Mark lack of interest in all or almost all, activities.
1. A depressed mood state.
2. Heighten or irritable mood.
B. Evidence condition is from a general medical condition.
C. Symptoms not from another disorder.
D. Symptoms not from delirium.
E. Clinically significant distress from symptoms, or impairment in work, social, or other areas of important functioning.
Sexual dysfunctions include:
Delayed ejaculation, erectile disorder, female orgasmic disorder, female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, premature (early) ejaculation, substance/medication-induced sexual dysfunction, other specified sexual dysfunction, and unspecified sexual dysfunction.
Sexual dysfunctions are a heterogeneous group of disorders that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure. An individual may have several sexual dysfunctions at the same time. In such cases, all of the dysfunctions should be diagnosed.
Sex drive and the ability to enjoy sexual activity does not decrease significantly with age after puberty. Once medical causes of sexual dysfunction are excluded, it is reasonable to see an urgent psychiatrist to explore emotional causes of sexual dysfunction, such as anxiety, relationship difficulties or psychic conflict.
A. 2+ for 1 month (1, 2, or 3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms
B. Level of fx in one or more major life areas is below premorbid level.
C. Continuous signs of disturbance for 6 months (must include 1 month of criterion A symptoms, may consist of prodromal or residual phases).
Specifiers: First episode/acute, partial remission, full remission, multiple episodes/acute, partial remission, complete remission with catatonia
Differential Diagnosis: Schizoaffective disorder, Depressive/Bipolar with psychotic features, substance abuse, medical condition, Autism Spectrum/Communication Disorder (Additional diagnosis of Schizophrenia only made if prominent delusions or hallucinations are present for 1 month)
Most people with schizophrenia demonstrate a significant improvement in functioning and relief of distressing symptoms with treatment. Speak to your urgent psychiatrist about symptoms and work closely to find the best treatment for you.
A. 5+ of the following during the same 2 week period and represent a change in function (at least 1 = 1 or 2):
1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost all, activities
3. Significant weight loss when not dieting or weight gain or decrease/increase in appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate or indecisiveness
9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan
B. Causes distress or impairment
C. Not due to a substance or medical condition
Depression can be distressing but is usually treatable; you can consult an urgent psychiatrist if symptoms are causing distress or impairment.
A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
B. Presence, while depressed, of two (or more) of the following:
Poor appetite or overeating.
Insomnia or hypersomnia.
Low energy or fatigue.
Low self-esteem.
Poor concentration or difficulty in making decisions.
Feelings of hopelessness.
C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
D. Criteria for a major depressive disorder may be continuously present for 2 years.
E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).
H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Generalized Anxiety Disorder
A. Excessive anxiety or worry occurring more days than not for 6+ mos
B. Difficulty controlling worry
C. 3+ Sx:
1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance
D. Distress or impairment
Differential Diagnosis: PD, SAD, OCD, PTSD, Anorexia Nervosa, Somatic Symptom Disorder, BDD, Illness Anxiety Disorder, Schizophrenia, Delusional Disorder
Agoraphobia
A. Marked fear or anxiety about 2+:
Using public transportation
Being in open spaces
Being in enclosed spaces
Standing in line or being in a crowd
Being outside of the home alone
B. Personal fears or avoiding these situations because of the thoughts escape will be severe, or help is not available in the event of developing panic-like symptoms, or other incapacitating or embarrassing moments.
C. Situations almost always provoke fear or anxiety.
D. Actively avoided or endured with great fear and anxiety.
E. Out of proportion to the actual danger posed.
F. Persistent, lasting for 6 months or more.
G. Clinically significant distress, impairment in social, occupational, and other important areas of functioning.
H. If another medical condition is present, the fear, anxiety, or avoidance is excessive.
I. Not better explained by another mental disorder.
Differential Diagnosis: SP, OCD, BDD, SAD
A. A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others.
The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.
B. Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack.
C. The person recognizes that this fear is unreasonable or excessive.
D. The feared situations are avoided or else are endured with intense anxiety and distress.
E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
F. In individuals under age 18 years, the duration is at least 6 months.
G. The fear or avoidance is not due to the direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder.
A. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains:
– Learning and memory
– Language
– Executive function
– Complex attention
– Perceptual-motor
B. The cognitive deficits interfere with independence in everyday activities. At a minimum, assistance should be required with complex instrumental activities of daily living, such as paying bills or managing medications.
C. The cognitive deficits do not occur exclusively in the context of a delirium.
D. Another mental disorder does not better explain cognitive deficits (eg., major depressive disorder, schizophrenia).
Some forms of dementia are treatable (pseudodementia ) reversible, or preventable (multi-infarct dementia). There are also medications available to help with Alzheimer’s disease. If you have symptoms of cognitive impairment, you should see an urgent psychiatrist or Neurologist for an evaluation.
A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the beginning of menses and become minimal or absent in the week post menses.
B. One (or more) of the following symptoms must be present:
1. Marked affective lability (e.g., mood swings: feeling suddenly sad or tearful, or increased sensitivity to rejection).
2. Marked irritability or anger or increased interpersonal conflicts.
3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts.
4. Marked anxiety, tension, and/or feelings of being keyed up or on edge.
C. One (or more) of the following symptoms must additionally be present, to reach a total of five signs when combined with symptoms from Criterion B above.
1. Decreased interest in usual activities (e.g., work, school, friends, hobbies).
2. Subjective difficulty in concentration.
3. Lethargy, easy fatigability, or marked lack of energy.
4. Marked change in appetite; overeating; or specific food cravings.
5. Hypersomnia or insomnia.
6. A sense of being overwhelmed or out of control.
7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain. Note: The symptoms in Criteria A-C must have been met for most menstrual cycles that occurred in the preceding year.
D. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others (e.g., avoidance of social activities; decreased productivity and efficiency at work, school, or home).
E. The disturbance is not merely a worsening of the symptoms of another disorder, such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders).
F. Prospective daily ratings should confirm criterion A during at least two symptomatic cycles. (Note: The diagnosis may be made provisionally before this confirmation).
G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or another medical condition (e.g., hyperthyroidism).
Parental Alienation
Child Protective Services
Child Custody Evaluation
PTSD
Civil Law Defense
Psychological Damage
Malingering
Insanity Defense
Fitness For Trial
Guardianship
Undue Influence
Testamentary Capacity
Records Review
Standards of Care
Malpractice Defense
SORA RAI
Violence Risk
Fitness For Discharge
A personalized GABA telepsychiatry staff member will be assigned to help you fill in the online questionnaire and liaise with your primary care doctor.
You will see the urgent psychiatrist for a comprehensive evaluation.
You will fill in our online intake forms. In case of any difficulty, connect with our staff member either via phone or our secure tele- platform and they will help you fill in your paperwork. We’ll also connect you to Gaba Tele-psychiatry’s video platform
YOUR MEDICAL RECORDS
We’ll collect your medical records from your primary care provider. In case, you do not have a primary care provider, we will help you connect to a local care provider or urgent care franchise, (if you are traveling) that accepts your insurance.
YOUR DEDICATED LIAISON
A Gaba Telepsychiatry dedicated staff member will help you navigate the process of scheduling, filling in intake forms, payment, obtaining prescriptions, lab samples, & medical records.
You will consult our urgent psychiatrist via the Gaba telepsychiatry platform for your evaluation. To get the best results, make sure you are in a private room without any background noise and with an adequate speed internet connection.
YOU WILL SEE THE URGENT PSYCHIATRIST
The urgent psychiatrist will ask about your current and past symptoms, including your family, relationship history, developmental, occupational, psychiatric history, medical history, personality style, and coping strategies.
YOUR TREATMENT PLAN
Your medical and psychiatric symptoms, history, responses to medications, psychotherapy, and other treatments are taken into consideration to formulate a personalized treatment plan according to your unique condition.
Medical evaluation will include nutrition and hormonal factors affecting mood as well as screening for underlying medial problems causing mood disturbance.
If you are traveling, we can also help and connect you to a local urgent care center or primary care provider in your area.
Gaba Telepsychiatry has the policy to screen possible medical causes of psychiatric illness. The list includes:
Our team will send a prescription to your local quest diagnostics and follow up on your medical records.
Gaba telepsychiatry also performs nutritional evaluation where you will be asked to maintain a food diary.
Our urgent psychiatrists do not prescribe expensive supplements. Most patients rarely need to take anything more than omega-3, multivitamins. They can either be covered by your insurance or bought over the counter at your local pharmacy.
Our urgent psychiatrist may even prescribe extra supplements if there is a specific deficiency like vitamin D, iron, or thiamine. We also monitor your dietary factors which may be causing fluctuations in your blood sugar, mood, and anxiety levels. It’s the mandatory part of our initial evaluation.
