Agoraphobia...anyone with experience? - page 3

by AngelfireRN

3,788 Views | 31 Comments

Greetings! I would like some input on a situation we are dealing with. Patient X has lately been denied their disability claim, because they refused to attend the court hearing for the continuation of the benefits. The... Read More


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    Quote from AngelfireRN
    I agree that she needs more treatment. But I can't make her go. She refuses. She says she's seen a psych and been worked up. She refuses to go back.

    As far as the meds...she's on the max Doc will Rx.

    I'm really at a loss.
    Get releases for her psych records. does she think the benzos are working?? Is she abusing them?? Ie running out early, calling for refills before they are due etc?? Can you see her more frequently and teach coping skills?? And sort out why she doesn't want psych tx. I don't think benos without therapy is working for her--she is still agoraphobic..
  2. 1
    Quote from juan de la cruz
    For the Psych guys, are benzos first line treatment for anxiety disorders? I just have been seeing more SSRI's as home meds in our hospitalized patients with a history of anxiety disorders.
    Depends on situation but SSRIs are preferred treatment if possible along with therapy. Sometimes I'll use Vistaril also. You tell her you're going to drop the benzos and she may go elsewhere which then means you won't need any.
    NPAlby likes this.
  3. 0
    Quote from Psychcns
    Get releases for her psych records. does she think the benzos are working?? Is she abusing them?? Ie running out early, calling for refills before they are due etc?? Can you see her more frequently and teach coping skills?? And sort out why she doesn't want psych tx. I don't think benos without therapy is working for her--she is still agoraphobic..
    No, she says that they don't, constantly requesting/demanding more. As far as the more frequent visits and teaching coping skills, neither Doc nor I has training in that. She's not receptive to any sort of therapy, period.

    She wants to dictate her own care and will only do what she wants to do.
  4. 1
    Quote from zenman
    Depends on situation but SSRIs are preferred treatment if possible along with therapy. Sometimes I'll use Vistaril also. You tell her you're going to drop the benzos and she may go elsewhere which then means you won't need any.
    Ultimately, that's what we've decided to do, after much discussion. She's consistently noncompliant, which is enough to dismiss her outright, but usually ceasing the RX of controlled substances is enough to make them leave the practice.

    I guess I sound cold, but I can't help her if she's not going to make the least effort to help herself. And I'm not going to vouch for her reported complaint when all we have seen is evidence to the contrary.
    redhead_NURSE98! likes this.
  5. 0
    Quote from AngelfireRN

    Ultimately, that's what we've decided to do, after much discussion. She's consistently noncompliant, which is enough to dismiss her outright, but usually ceasing the RX of controlled substances is enough to make them leave the practice.

    I guess I sound cold, but I can't help her if she's not going to make the least effort to help herself. And I'm not going to vouch for her reported complaint when all we have seen is evidence to the contrary.
    Rule no 1. Patient has to want treatment. She may have developed herself into a substance abuser. Pts like this are easier to handle as a team. I generally tell people I will not prescribe meds unless pt is in therapy. I tell them meds are one quarter of the treatment. The rest is therapy, and lifestyle changes and coping skills. When you stop her benzos give her directions for a medically safe taper and a list of psych referrals and maybe detoxes.
  6. 0
    Exactly, and she's noncompliant with one quarter of the treatment, and resistant to the other three quarters.

    We always provide the info you mention upon cessation of a medication or treatment, but in this case I hold very little hope that she will comply.
  7. 1
    Was there really a question here? lol Reminds me of the people on Judge Judy when she asks them about their disability, some of them tell her they are on disability for panic disorder, agoraphobia etc. and of course she points out it didn't stop them from boarding a plane, going to a courtroom and getting in front of cameras for millions of viewers.
    NPAlby likes this.
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    I knew someone who had Agoraphobia. I knew of them eating out once...and behavior during the outing was really strange. However that person did attend their disability hearing.
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    has she been drug tested, is she actually taking the med, or is she selling it?
    Quote from AngelfireRN
    Exactly, and she's noncompliant with one quarter of the treatment, and resistant to the other three quarters.

    We always provide the info you mention upon cessation of a medication or treatment, but in this case I hold very little hope that she will comply.
  10. 0
    We drug test on a routine basis, and she is usually positive for the med. But you and I both know she could sell all but enough, take it just before her visit, and still show a positive result.


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