People living with ALS and PD are both affected by neuropsychiatric symptoms which impact quality of life and exacerbate overall disease burden.  Depression and anxiety are predominant neuropsychiatric complaints with a higher risk of suicide compared to the general population. Mental health care access is limited by geographic and mobility challenges and a paucity of resources.  

COCM leverages behavioral health care managers, remote psychiatry, and a registry tracking symptoms.  Despite increasing use in primary care, no reports of COCM in a teleneurology clinic exist.  COCM contrasts with the conventional referral approach, which often results in failure to establish care, fragmented care, and delayed interventions.

COCM was integrated into our teleneurology clinic by incorporating behavioral health care managers, psychologists, psychiatrists, and new workflows to facilitate non-siloed collaboration. A registry was created to track standardized measurements of depression and anxiety (PHQ-9 and GAD-7).  73 ALS, and 47 PD patients were enrolled from 26 different states, and measures of symptom improvement were analyzed. 

There was a significant reduction in both the PHQ-9 (7.92 to 6.58 ALS; 10.88 to 7.29 PD) and GAD-7 (6.66 to 4.79 ALS; 9.49 to 6.64 PD) within the first 4 months. 90% made use of psychological therapy, including individual therapy (86% ALS; 77% PD), family therapy (26% ALS; 19% PD), and group therapy (34% ALS; 45% PD).  Most are managed on psychotropic medications (77% ALS;  83% PD).

Integration of COCM into a national teleneurology clinic improved access for people with ALS and PD. Within four months, there was a reduction in the neuropsychiatric burden through the use of focused therapy, counseling, and psychotropic medications.