Family Practice

[NP14]

For any NPs who work in a family practice setting, how much of your patient population is treated for psych conditions and when would you refer these patients to psychiatrists?

[Power2020]

Hello

In our family practice clinic we used to usually only treat depression/anxiety and ADHD sometimes- bipolar we usually referred out but one NP would treat that...So very limited

or Lets say you treat for depression/anxiety and they aren't responding to treatment etc...we would refer

[Oldmahubbard]

A few years back, a 45 y/o male with a long history of poor functioning, to include incarceration, went to his PCP complaining of depression.

He had no insurance, so the PCP physician did him a favor and gave him lexapro samples.

I saw him a few weeks later and he was in hypomania.

Just a thought. You probably don't have the time to evaluate people in primary care.

Fast forward 6 months, and he was a different person on a mood stabilizer.

[NP14]

Thank you for your responses and for sharing a patient case! It’s very helpful to get input from those who have been in practice. That patient case is exactly why I would be concerned—- If for some reason the patient responds poorly due to a misdiagnosis or reaction to a medication. I would prefer to refer all patients if I could, but uncertain if that would be accepted by the practice. My FNP program had one class on psych, but did not have a clinical rotation so there was no hands on experience in evaluating patients and medication management.