Clinician view · Patient chart
Progress note
Carmen's telepsychiatry follow up today ran 23 minutes by video from her primary care office, part of Carilion's collaborative care model. She reports mood and sleep unchanged since her last visit six weeks ago, describes her schedule across two jobs and her children's activities as busy but manageable, and denies any new stressors or safety concerns.
This is the second consecutive visit where Haven's read shows fatigue and anxiety both trending up, a pattern that has not come up in conversation on either side. Labs ordered today for the reported fatigue show an elevated TSH and a low vitamin D, which may account for some but not all of the climb.
Plan: continue sertraline 100mg daily, no dose change today given the thyroid finding needs addressing first. Given the two visit voice trend plus the lab result, the next check in was moved from six weeks to three rather than waiting for the standard interval.
Voice assessment
Haven · same audio, second read
Fatigue has climbed from 49 to 72 and anxiety from 44 to 61 across her last two telepsychiatry visits, while she described both visits as about the same on the call itself. The trend, not anything she said, is what moved today's follow up interval from six weeks to three.
Voice trend across visits
| Visit | Mood | Anxiety | Fatigue | Cognitive load |
|---|---|---|---|---|
| Telepsychiatry · 12 wks ago | 58/100 | 44/100 | 49/100 | 38/100 |
| Telepsychiatry · 6 wks ago | 46/100 | 52/100 | 61/100 | 41/100 |
| Telepsychiatry · Today | 34/100 | 61/100 | 72/100 | 45/100 |
Imaging
CT · BrainLabs
Fatigue workup
| Test | Result | Reference range | Flag |
|---|---|---|---|
| TSH | 4.6 mIU/L | 0.4-4.0 | High |
| Vitamin D, 25-OH | 23 ng/mL | 30-100 | Low |
| Hemoglobin | 13.1 g/dL | 12.0-15.5 | Normal |
| Fasting glucose | 91 mg/dL | 70-99 | Normal |