Photo of Adjoa Amoah - Aya Integrative Psychiatry And Wellness, Psychiatric Nurse Practitioner in Pennsylvania
Adjoa Amoah - Aya Integrative Psychiatry And Wellness
Psychiatric Nurse Practitioner, PMHNP, FNP
Verified Verified
Harleysville, PA 19438
Hello and Welcome! Are you looking for services for you or your child? Our practice is accepting new clients. Call us for psychiatric evaluations, medication treatment, coaching, yoga, nutritional assessment & supplementation, herbs, Ayurveda, and genetic testing. A thorough history, including that of traumatic experiences helps us identify the root cause of the presenting problem for a more comprehensive solution. Additional support for parents is included in our mindful parent coaching sessions. We address behavioral challenges in children including children diagnosed with autism.
Hello and Welcome! Are you looking for services for you or your child? Our practice is accepting new clients. Call us for psychiatric evaluations, medication treatment, coaching, yoga, nutritional assessment & supplementation, herbs, Ayurveda, and genetic testing. A thorough history, including that of traumatic experiences helps us identify the root cause of the presenting problem for a more comprehensive solution. Additional support for parents is included in our mindful parent coaching sessions. We address behavioral challenges in children including children diagnosed with autism.
(267) 668-0205 View (267) 668-0205
Photo of Carolyn Morris, Psychiatric Nurse Practitioner in Pennsylvania
Carolyn Morris
Psychiatric Nurse Practitioner, APN, PMHNPBC, CRNP
Verified Verified
1 Endorsed
This includes ADHD, Autism/ASD, depression, anxiety, bipolar spectrum, Schizophrenia, and intergenerational trauma.
Are you longing for peace in your home? Is your family struggling daily with unsolved problems? Are you or your child impacted by ADHD? Has your child’s behavior impacted your relationship?
This includes ADHD, Autism/ASD, depression, anxiety, bipolar spectrum, Schizophrenia, and intergenerational trauma.
Are you longing for peace in your home? Is your family struggling daily with unsolved problems? Are you or your child impacted by ADHD? Has your child’s behavior impacted your relationship?
(215) 795-5181 View (215) 795-5181
Photo of Michelle Marino - Mental Health Psychiatry, Psychiatric Nurse Practitioner in Pennsylvania
Michelle Marino - Mental Health Psychiatry
Psychiatric Nurse Practitioner, PMHNP-, BC
Verified Verified
Pittsburgh, PA 15217
She treats patients with a variety of mental health disorders including anxiety, depression, bipolar disorder, autism, ADHD, and PTSD.
Michelle completed her post master's certificate in the psychiatric mental health nurse practitioner program at Robert Morris University and her master's degree in nursing at the University of Pittsburgh. She has half a decade of experience working in behavioral health and over 20 years of experience in health care in general, including private practice, hospitals, home care, and most recently a pediatrician's office where she worked as part of the integrated care team. ‍
She treats patients with a variety of mental health disorders including anxiety, depression, bipolar disorder, autism, ADHD, and PTSD.
Michelle completed her post master's certificate in the psychiatric mental health nurse practitioner program at Robert Morris University and her master's degree in nursing at the University of Pittsburgh. She has half a decade of experience working in behavioral health and over 20 years of experience in health care in general, including private practice, hospitals, home care, and most recently a pediatrician's office where she worked as part of the integrated care team. ‍
(412) 214-0042 View (412) 214-0042
Photo of Melanie Valenti - Mental Health Psychiatry, Psychiatric Nurse Practitioner in Pennsylvania
Melanie Valenti - Mental Health Psychiatry
Psychiatric Nurse Practitioner, DNP, PMHNP, BC
Verified Verified
Pittsburgh, PA 15217
Melanie Valenti is a Board Certified Doctor of Nursing Practitioner (DNP) specializing in Psychiatry and Mental Health at the Nexus Group. She completed her doctorate degree at the University of Pittsburgh. Prior to joining the Nexus Group, Melanie had over 6 years of experience working at Western Psychiatric Hospital, caring for children, adolescents, and adults diagnosed with autism spectrum disorder, intellectual disability, and ADHD.
Melanie Valenti is a Board Certified Doctor of Nursing Practitioner (DNP) specializing in Psychiatry and Mental Health at the Nexus Group. She completed her doctorate degree at the University of Pittsburgh. Prior to joining the Nexus Group, Melanie had over 6 years of experience working at Western Psychiatric Hospital, caring for children, adolescents, and adults diagnosed with autism spectrum disorder, intellectual disability, and ADHD.
(412) 214-0042 View (412) 214-0042
Photo of Greg Thorkelson, Psychiatrist in Pennsylvania
Greg Thorkelson
Psychiatrist, MD
Verified Verified
Pittsburgh, PA 15217
Dr. Thorkelson is an Assistant Clinical Professor of Psychiatry and Medicine at The University of Pittsburgh. He completed his adult residency training at Temple University and his child and adolescent psychiatry fellowship at The University of Pittsburgh where he continued on in three roles: As Associate Medical Director at the Center for Integrative Medicine, as a staff psychiatrist at the John Merck Center for Autism and Developmental Disorders, and through the Visceral Inflammation and Pain (VIP) Center in the Department of Gastroenterology. Dr. Thorkelson specializes in the treatment of anxiety, mood disorders, autism, and ADHD.
Dr. Thorkelson is an Assistant Clinical Professor of Psychiatry and Medicine at The University of Pittsburgh. He completed his adult residency training at Temple University and his child and adolescent psychiatry fellowship at The University of Pittsburgh where he continued on in three roles: As Associate Medical Director at the Center for Integrative Medicine, as a staff psychiatrist at the John Merck Center for Autism and Developmental Disorders, and through the Visceral Inflammation and Pain (VIP) Center in the Department of Gastroenterology. Dr. Thorkelson specializes in the treatment of anxiety, mood disorders, autism, and ADHD.
(412) 214-0042 View (412) 214-0042
Photo of Brittani Farmer - Mental Health Psychiatry, Psychiatric Nurse Practitioner in Pennsylvania
Brittani Farmer - Mental Health Psychiatry
Psychiatric Nurse Practitioner, PMHNP-, BC
Verified Verified
Pittsburgh, PA 15205
Brittani provides medication management and supportive psychotherapy for patients with depressive and mood disorders, anxiety, OCD, PTSD, and autism.
After years of caring for patients with different psychiatric conditions in both inpatient and outpatient environments, Brittani developed a strong passion for mental health care and completed her graduate degree in Psychiatric Mental Health Nurse Practitioner at Wilkes University in Wilkes-Barre, Pennsylvania.
Brittani provides medication management and supportive psychotherapy for patients with depressive and mood disorders, anxiety, OCD, PTSD, and autism.
After years of caring for patients with different psychiatric conditions in both inpatient and outpatient environments, Brittani developed a strong passion for mental health care and completed her graduate degree in Psychiatric Mental Health Nurse Practitioner at Wilkes University in Wilkes-Barre, Pennsylvania.
(412) 214-0042 View (412) 214-0042
Photo of Rachel Kosciusko - Mental Health Psychiatry, Physician Assistant in Pennsylvania
Rachel Kosciusko - Mental Health Psychiatry
Physician Assistant, PA-C
Verified Verified
Pittsburgh, PA 15217
Rachel studied psychology at the University of Pittsburgh, where she published research with the UPMC Liver Cancer Center Quality of Life Program. She continued her training at Western Psychiatric Hospital & spent three years leading therapy groups at the John Merck Center for Autism & Developmental Disabilities, where she processed anxiety, mood, and attention challenges. Rachel completed her Master of Science in Physician Assistant degree at DeSales University & is a Certified PA specializing in Psychiatry. While at DeSales, she completed additional training in neurology and served as a mental health mentor at the University.
Rachel studied psychology at the University of Pittsburgh, where she published research with the UPMC Liver Cancer Center Quality of Life Program. She continued her training at Western Psychiatric Hospital & spent three years leading therapy groups at the John Merck Center for Autism & Developmental Disabilities, where she processed anxiety, mood, and attention challenges. Rachel completed her Master of Science in Physician Assistant degree at DeSales University & is a Certified PA specializing in Psychiatry. While at DeSales, she completed additional training in neurology and served as a mental health mentor at the University.
(412) 214-0042 View (412) 214-0042
Photo of Jayne Dalessio - Mental Health Psychiatry, Psychiatric Nurse Practitioner in Pennsylvania
Jayne Dalessio - Mental Health Psychiatry
Psychiatric Nurse Practitioner, PMHNP-, BC
Verified Verified
Pittsburgh, PA 15205
Jayne obtained her MSN from Drexel University, studying in the psychiatric mental health nurse practitioner program. She has a wealth of knowledge, having practiced in the mental health field since graduating from Penn State main campus in 2000 with a degree in psychology. Jayne has worked in various settings such as residential facilities for clients with autism, intellectual disabilities and started working as a nurse in 2009 at Western Psychiatric Hospital on the dual diagnosis unit after graduating from Heritage Valley Sewickley School of Nursing.
Jayne obtained her MSN from Drexel University, studying in the psychiatric mental health nurse practitioner program. She has a wealth of knowledge, having practiced in the mental health field since graduating from Penn State main campus in 2000 with a degree in psychology. Jayne has worked in various settings such as residential facilities for clients with autism, intellectual disabilities and started working as a nurse in 2009 at Western Psychiatric Hospital on the dual diagnosis unit after graduating from Heritage Valley Sewickley School of Nursing.
(412) 214-0042 View (412) 214-0042
Photo of Rebekah DeChicko - Mental Health Psychiatry, Psychiatric Nurse Practitioner in Pennsylvania
Rebekah DeChicko - Mental Health Psychiatry
Psychiatric Nurse Practitioner, PMHNP, BC
Verified Verified
Pittsburgh, PA 15205
Rebekah started her career path as a Registered Nurse working at Western Psychiatric Hospital. This experience ignited her passion for mental wellness. She earned her Master of Science in Nursing and completed her certification for Psychiatric Mental Health Nurse Practitioner at Wilkes University. She has over 15 years of experience and has cared for individuals with a variety of mental health challenges, including autism, mood disorders, depression, OCD, and anxiety. In addition to Rebekah's impressive education & work history, she also received her certification for Cognitive Behavioral Therapy from Beck Institute.
Rebekah started her career path as a Registered Nurse working at Western Psychiatric Hospital. This experience ignited her passion for mental wellness. She earned her Master of Science in Nursing and completed her certification for Psychiatric Mental Health Nurse Practitioner at Wilkes University. She has over 15 years of experience and has cared for individuals with a variety of mental health challenges, including autism, mood disorders, depression, OCD, and anxiety. In addition to Rebekah's impressive education & work history, she also received her certification for Cognitive Behavioral Therapy from Beck Institute.
(412) 214-0042 View (412) 214-0042
Photo of Michelle Staley - Mental Health Psychiatry, Physician Assistant in Pennsylvania
Michelle Staley - Mental Health Psychiatry
Physician Assistant, PA-C
Verified Verified
Pittsburgh, PA 15217
Michelle joined Nexus team with many years of experience as mental health physician assistant in both inpatient and outpatient settings. She received her undergraduate degree in Health Sciences and her Master of Physician Assistant Studies Degree from Duquesne University. Michelle also received Master Psychopharmacology Certificate from the Neuroscience Education Institute and Cognitive Behavioral Therapy from Beck Institute.
Michelle joined Nexus team with many years of experience as mental health physician assistant in both inpatient and outpatient settings. She received her undergraduate degree in Health Sciences and her Master of Physician Assistant Studies Degree from Duquesne University. Michelle also received Master Psychopharmacology Certificate from the Neuroscience Education Institute and Cognitive Behavioral Therapy from Beck Institute.
(412) 214-0042 View (412) 214-0042
Photo of Psychiatric Edge LLC, Psychiatric Nurse Practitioner in Pennsylvania
Psychiatric Edge LLC
Psychiatric Nurse Practitioner, CRNP, PMHNP
Verified Verified
Collegeville, PA 19426  (Online Only)
At Psychiatric Edge, we believe that mental health care should be accessible, convenient, and compassionate. Our telepsychiatry practice is committed to providing high-quality psychiatric services to individuals across New Jersey, Pennsylvania, and New York, right in the comfort of their own homes. We strive to empower our clients to overcome challenges and achieve their mental health goals. Our team of experienced and compassionate providers offer comprehensive psychiatric evaluations, medication management, and psychotherapy. Schedule an appointment today and take the first step towards a brighter tomorrow!
At Psychiatric Edge, we believe that mental health care should be accessible, convenient, and compassionate. Our telepsychiatry practice is committed to providing high-quality psychiatric services to individuals across New Jersey, Pennsylvania, and New York, right in the comfort of their own homes. We strive to empower our clients to overcome challenges and achieve their mental health goals. Our team of experienced and compassionate providers offer comprehensive psychiatric evaluations, medication management, and psychotherapy. Schedule an appointment today and take the first step towards a brighter tomorrow!
(908) 650-1373 View (908) 650-1373
Photo of Melissa Lopez-Larson, Psychiatrist in Pennsylvania
Melissa Lopez-Larson
Psychiatrist, MD
Verified Verified
State College, PA 16801
Don't wait 2 weeks, appointments available! Dr. Lopez-Larson is a board certified child, adolescent and adult psychiatrist and received her MD from the University of Cincinnati School of Medicine. She performed her adult and child psychiatry training at Harvard Medical School training sites including Massachusetts General Hospital/McLean Hospital and Cambridge Hospital, respectively. She has been practicing for over 15 years in a variety of settings including academic research, inpatient, residential and outpatient psychiatric services.
Don't wait 2 weeks, appointments available! Dr. Lopez-Larson is a board certified child, adolescent and adult psychiatrist and received her MD from the University of Cincinnati School of Medicine. She performed her adult and child psychiatry training at Harvard Medical School training sites including Massachusetts General Hospital/McLean Hospital and Cambridge Hospital, respectively. She has been practicing for over 15 years in a variety of settings including academic research, inpatient, residential and outpatient psychiatric services.
(814) 261-3729 View (814) 261-3729
Photo of Ethos Clinic, Psychiatrist in Pennsylvania
Ethos Clinic
Psychiatrist, MD
Verified Verified
Emmaus, PA 18049
A holistic approach to wellness, including emotional, physical and spiritual health. A central focus of Ethos is our encouragement of mindfulness, meditation, spirituality and healthy living in general for all of our patients. We can either refer our patients to these therapies or provide guidance onsite. Medications, therapy and various other modalities mentioned above are used as an appropriate part of your treatment plan. Regardless of the treatment recommended in your plan, our goal is healing through a holistic and balanced approach to wellness
A holistic approach to wellness, including emotional, physical and spiritual health. A central focus of Ethos is our encouragement of mindfulness, meditation, spirituality and healthy living in general for all of our patients. We can either refer our patients to these therapies or provide guidance onsite. Medications, therapy and various other modalities mentioned above are used as an appropriate part of your treatment plan. Regardless of the treatment recommended in your plan, our goal is healing through a holistic and balanced approach to wellness
(484) 232-5288 View (484) 232-5288
Photo of LJS Psychiatry, Psychiatrist in Pennsylvania
LJS Psychiatry
Psychiatrist, MD
Verified Verified
Pittsburgh, PA 15224
LJS Psychiatry is a unique psychiatry practice that provides truly holistic psychiatric care. LJS Psychiatry providers are psychotherapists who can prescribe medications, when needed, in the context of individual psychotherapy. That means you no longer need to see one person for psychotherapy and another for medication treatment. Instead, we provide genuine whole person care that proves to be highly effective. When you're navigating trauma, depression, anxiety, or identity challenges, you need a space where you are met with genuine empathy, active curiosity, and a willingness to encourage honest self-examination.
LJS Psychiatry is a unique psychiatry practice that provides truly holistic psychiatric care. LJS Psychiatry providers are psychotherapists who can prescribe medications, when needed, in the context of individual psychotherapy. That means you no longer need to see one person for psychotherapy and another for medication treatment. Instead, we provide genuine whole person care that proves to be highly effective. When you're navigating trauma, depression, anxiety, or identity challenges, you need a space where you are met with genuine empathy, active curiosity, and a willingness to encourage honest self-examination.
(412) 991-1144 View (412) 991-1144
Photo of Jason Benton, Psychiatric Nurse Practitioner in Pennsylvania
Jason Benton
Psychiatric Nurse Practitioner, CRNP, CPHom, CST-T
Verified Verified
1 Endorsed
Portersville, PA 16051
Psychiatric medications are life-saving and effective, yet also come with immediate and long-term risks. I can help those who are looking to reduce side effects, find medication options more suitable, or avoid the risks of conventional meds altogether. Overall, when prescribing, I aim to find a balance which allows for personal growth, vitality, and autonomy.
Psychiatric medications are life-saving and effective, yet also come with immediate and long-term risks. I can help those who are looking to reduce side effects, find medication options more suitable, or avoid the risks of conventional meds altogether. Overall, when prescribing, I aim to find a balance which allows for personal growth, vitality, and autonomy.
(724) 307-4722 View (724) 307-4722
Photo of Roxanne Swistock, Psychiatric Nurse Practitioner in Pennsylvania
Roxanne Swistock
Psychiatric Nurse Practitioner, FNP-BC
Verified Verified
Bridgeville, PA 15017  (Online Only)
Hello, I’m Roxy. I have been an adult nurse practitioner for 10 years and I reside in Central PA. I have a passion for authenticity and connecting with my patients on a personal level. Throughout my practice experiences, I have found the best outcomes for patients are provided when we, the providers, understand the patient's needs and desires as they relate to reaching our treatment goals. By helping patients reach their healthcare goals, physically, mentally, emotionally, and aesthetically, I hope to add an extra touch of caring and compassion to your healthcare experience.
Hello, I’m Roxy. I have been an adult nurse practitioner for 10 years and I reside in Central PA. I have a passion for authenticity and connecting with my patients on a personal level. Throughout my practice experiences, I have found the best outcomes for patients are provided when we, the providers, understand the patient's needs and desires as they relate to reaching our treatment goals. By helping patients reach their healthcare goals, physically, mentally, emotionally, and aesthetically, I hope to add an extra touch of caring and compassion to your healthcare experience.
(831) 851-3215 View (831) 851-3215
Photo of Novitsky MD - boutique mind doctors, Psychiatrist in Pennsylvania
Novitsky MD - boutique mind doctors
Psychiatrist, MD
Verified Verified
5 Endorsed
Chadds Ford, PA 19317
Rethink traditional psychiatry! Offering Virtual Personalized medication treatment guided by your unique DNA profile. Dr. Mark is a dual-board certified Child and Adolescent and Adult Psychiatrist. Dr. Ali is a Certified Life and Weight Loss Coach, Board Certified Pediatrician, Board Certified Neonatologist, Blogger, International Speaker, and Podcast. Dr. Mark believes that effective work with children involves working closely with parents, schools, and other providers - to achieve a joint goal of optimizing a child’s well-being. ***At this time, due to COVID-19, we will are only doing virtual sessions ***
Rethink traditional psychiatry! Offering Virtual Personalized medication treatment guided by your unique DNA profile. Dr. Mark is a dual-board certified Child and Adolescent and Adult Psychiatrist. Dr. Ali is a Certified Life and Weight Loss Coach, Board Certified Pediatrician, Board Certified Neonatologist, Blogger, International Speaker, and Podcast. Dr. Mark believes that effective work with children involves working closely with parents, schools, and other providers - to achieve a joint goal of optimizing a child’s well-being. ***At this time, due to COVID-19, we will are only doing virtual sessions ***
(610) 708-1521 View (610) 708-1521
Photo of SolCentered Integrative Psychiatric Care, Psychiatric Nurse Practitioner in Pennsylvania
SolCentered Integrative Psychiatric Care
Psychiatric Nurse Practitioner, DNP, CRNP, PMHNP
Verified Verified
3 Endorsed
Kingston, PA 18704
My name is Dr. Kristen Cheslick and I am a board certified Psychiatric Mental Health Nurse Practitioner with over 20 years of nursing experience in providing compassionate, evidence-based care to patients across the lifespan (children/adolescents, adults and older adults). My available services include mental health evaluations, medication management, brief solution-based/supportive psychotherapy, and appropriate referrals as necessary. Email my office for an appointment today at contact@solcenteredcare.com. We have appointments available Monday through Friday and some weekends.
My name is Dr. Kristen Cheslick and I am a board certified Psychiatric Mental Health Nurse Practitioner with over 20 years of nursing experience in providing compassionate, evidence-based care to patients across the lifespan (children/adolescents, adults and older adults). My available services include mental health evaluations, medication management, brief solution-based/supportive psychotherapy, and appropriate referrals as necessary. Email my office for an appointment today at contact@solcenteredcare.com. We have appointments available Monday through Friday and some weekends.
(272) 200-4618 View (272) 200-4618
Photo of Dr. Monica Conn, Psychiatric Nurse Practitioner in Pennsylvania
Dr. Monica Conn
Psychiatric Nurse Practitioner, PMHNP, CRNP
Verified Verified
1 Endorsed
Pittsburgh, PA 15233
I understand that seeking help for mental health concerns can be difficult and challenging. I want you to know that you are not alone, and there is hope for your recovery. I know that dealing with mental health conditions can be overwhelming and affect various aspects of your life, including work, relationships, and daily activities. However, I am here to provide you with the support and guidance you need to manage your symptoms and improve your quality of life. I want to assure you that seeking mental health care is a brave and proactive step towards healing.
I understand that seeking help for mental health concerns can be difficult and challenging. I want you to know that you are not alone, and there is hope for your recovery. I know that dealing with mental health conditions can be overwhelming and affect various aspects of your life, including work, relationships, and daily activities. However, I am here to provide you with the support and guidance you need to manage your symptoms and improve your quality of life. I want to assure you that seeking mental health care is a brave and proactive step towards healing.
(412) 946-8045 View (412) 946-8045
Photo of Newton Psychiatric Clinic, LLC, Psychiatrist in Pennsylvania
Newton Psychiatric Clinic, LLC
Psychiatrist, MD, MSc, DABPN
Verified Verified
Mount Carmel, PA 17851
Working in both administrative and clinically driven roles, he remains highly involved and up-to-date in innovative approaches to mental health treatment. Dr. Newton has provided mental health care in all treatment settings including but not limited to, acute inpatient, outpatient, residential, corrections, long term inpatient settings, partial hospitalization programs, and any other imaginable setting that provides mental health treatment.
Working in both administrative and clinically driven roles, he remains highly involved and up-to-date in innovative approaches to mental health treatment. Dr. Newton has provided mental health care in all treatment settings including but not limited to, acute inpatient, outpatient, residential, corrections, long term inpatient settings, partial hospitalization programs, and any other imaginable setting that provides mental health treatment.
(570) 673-0954 View (570) 673-0954

See more therapy options for Pennsylvania

Autism Psychiatrists

What is the most effective treatment for autism?

Applied Behavior Analysis (ABA) has come to be considered the standard treatment for children with autism spectrum disorder, and research has confirmed its effectiveness for many children. Therapists trained in ABA techniques work with children (and their parents) on developing social skills, communication and learning abilities, and everyday habits of hygiene and grooming. The clinician will tailor their program to the child’s particular need but the overarching goal will be to help them advance as far as possible toward independence based on their level of symptoms and decrease the need for additional special services. Families should seek a mental health professional specifically trained in ABA, and holding special certification in the technique, who has extensive experience not only with the approach but in using it with children with the same level of symptoms as the child who needs care.

How does ABA work?

Applied Behavior Analysis (ABA) sessions, which typically focus on positive reinforcement, can be intensive, lasting two or more hours several times a week, and continuing for two years or more. Therapists can also be expected to ask parents to take an active role in reinforcing lessons. Research has found that the technique can lead to major improvements that decrease the need for additional special services.

How does treatment for autism work?

Therapy sessions based on Applied Behavior Analysis will likely be frequent, intensive, and highly structured. After a thorough assessment, a therapist will help a child understand and develop skills in a range of areas, including communication, motor skills, social skills, self-care, play, and academic skills, as well as routines of daily living like hygiene. Typically, the therapist will help a child break down the components of a behavior—often referred to as the antecedent (what prompts an action), the behavior, and the consequence(what immediately follows)—and then reward the child at every step, while also asking parents to reinforce the lessons, and the rewards, throughout the day. This core therapy may be supplemented by occupational or speech therapy, and antidepressants, antipsychotics, and anticonvulsants may be prescribed to address specific severe symptoms.

How long does therapy for autism take?

Some people with autism spectrum disorder may be engaged in some level of therapy for many years, but research shows that treatment will be most effective if it is begun early and delivered intensively. When therapy begins by age 3, children tend to be better able to grasp and adopt the skills needed to manage everyday life, including attending school and establishing social relationships. This type of early-intervention treatment regimen is highly structured, typically involving 20 to 40 hours of one-on-one therapy per week, along with additional hours of engagement managed by parents, for a period of two years or more, although the duration of treatment is dependent on the child’s level of symptoms and pace of progress.