Agoraphobia...anyone with experience? - pg.2 | allnurses

Agoraphobia...anyone with experience? - page 2

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... Read More

  1. Visit  AngelfireRN profile page
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    Quote from TraceyMarino
    What state do you live in? Can NP's in your state even sign disability papers? I am in Michigan, and an NP or PA cannot sign any papers for disabilty claims...you better check before you get yourself involved in this.....there is a great site that has all the states scope of practice summarized, and from what I see, most states restrict an NP's ability to sign these forms. Just my advice....I have seen several patients in our area who went to court with papers filled out by NP's, and their case was thrown out of court. There are physicians and psychiatrists who specialize in evaluating patients for disability...I would refer the patient to one of them.

    Good luck!
    I'm in Alabama. I am not certain about whether or not I am even able to sign off on disability...Doc won't do disability cases, period. He refers to a third-party physician who has no vested interest and therefore cannot be accused of favoritism.

    I don't blame him. It's seems like it could be quite the sticky wicket if you determine that a regular patient is not as disabled as they claim to be.

    Oh, and we did refer. She won't go. Sigh.
  2. Visit  zenman profile page
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    Where is she getting her benzos from?
  3. Visit  AngelfireRN profile page
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    Doc agreed to treat her anxiety. This was before she refused to continue seeing her psych ( who did not Rx for an unknown reason). Since then, I have suggested ceasing her benzos until she complies with seeing a psych. Doc is considering this measure.
  4. Visit  juan de la cruz profile page
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    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.
  5. Visit  AngelfireRN profile page
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    I'm not sure what the entire regime was. I can say that, since my inception, I have offered and ordered at least 3 different SSRI meds. Either she claimed they didn't work, or she outright refused to take them.

    I'm truly about at my wit's end with her. A part of what I'm dealing with... Doc has historically babied a significant percentage of our people, and as such, they feel they have carte blanche to do or not do whatever.
    Makes for a difficult course. It's working with most, the adherence to rules. Some, however, he doesn't want to deal with anymore, so I inherited them. I still discuss every patient with Doc, as per state requirements. Just some things require a 'Stern Mommy' approach. I do Stern Mommy very well.
  6. Visit  Psychcns profile page
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    Quote from AngelfireRN
    I'm not sure what the entire regime was. I can say that, since my inception, I have offered and ordered at least 3 different SSRI meds. Either she claimed they didn't work, or she outright refused to take them.

    I'm truly about at my wit's end with her. A part of what I'm dealing with... Doc has historically babied a significant percentage of our people, and as such, they feel they have carte blanche to do or not do whatever.
    Makes for a difficult course. It's working with most, the adherence to rules. Some, however, he doesn't want to deal with anymore, so I inherited them. I still discuss every patient with Doc, as per state requirements. Just some things require a 'Stern Mommy' approach. I do Stern Mommy very well.
    Has she had a full psych diagnostic evaluation? Is she in therapy? She seems to need more treatment than you can give her at a pain clinic. Also, it doesn't seem like the benzos are working.
    Does she have strategies to cope with her anxiety? Substance abuse hx etc.
  7. Visit  AngelfireRN profile page
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    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.
  8. Visit  Psychcns profile page
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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..
  9. Visit  zenman profile page
    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.
  10. Visit  AngelfireRN profile page
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    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.
  11. Visit  AngelfireRN profile page
    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.
  12. Visit  Psychcns profile page
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    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.
  13. Visit  AngelfireRN profile page
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    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.


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