Agoraphobia...anyone with experience?

[AngelfireRN]

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 disability claim reason is reportedly agoraphobia. The patient states that they are unable to attend the hearing because the location of the trial requires them to travel over a bridge and into another city. They state that their agoraphobia won't allow them to go to the hearing. They further state that they have tried to speak to the disability board by telephone but, "they hung up on them when they could not stop crying".

Patient repeatedly requests that Doc write them a note that states they cannot attend. Doc's position is that if the patient can stand to leave their house to come to the clinic, then they can go to their hearing.

Some other tidbits...

*The patient was seen by the entire office eating out at restaurant, in no apparent distress.

*The patient has two children that always accompany them to appointments, with various excuses about why they are not in school. (We are currently making inquiries regarding a truancy violation.)

My question:

Is agoraphobia selective? Can it be that the patient is comfortable coming to clinic and eating out, but for some reason can't tolerate a courtroom?

We are of the opinion that the patient simply does not want to put forth the effort, and is using this complaint as a crutch. However, having limited experience with this particular diagnosis, I would be very glad for some other views. Thank you.

[Psychcns]

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.

[AngelfireRN, MSN, RN, APRN]

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.

[redhead_NURSE98!, ADN, BSN]

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.

[lilshrimp]

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.

[morte, LPN, LVN]

has she been drug tested, is she actually taking the med, or is she selling it?

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.

[AngelfireRN, MSN, RN, APRN]

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.

[NPAlby]

I'm a Psych NP and would recommend weaning her off the benzos. Apparently what she is currently doing is not helping her "agoraphobia." I'm a lil suspicious of her saying no to another other med other than benzo. I would like a UDS to see what else she is doing. Of course this is just reading these posts and not reviewing her chart or meeting the lady. But eh doesnt sound like she's your patient so I would just continue to say NO if she asks you to sign off on her "agoraphobia." My thing is you want to get a paycheck for your condition fine,. But then you better be working towards getting better and not just collecting a check and popping pills.

[NPAlby]

Not in my practice. I use vistaril buspar SSRI's. I have to see psychotic agitation before I write for a benzo. Just coming to the office and telling me you are anxious and the only thing that works for you is a xanax, valium is not going to fly. Of course sometimes you end up inheriting pts on boat loads of meds and you work with what you got.