Discontinuing treatment may lead to exacerbation of symptoms, undermining therapeutic progress. In these studies, poor response to treatment and worsening of underlying psychiatric symptoms, and to a lesser extent, intolerability to medication were the primary contributors to treatment being discontinued.
How are psychiatric medications discontinued by a psychiatrist?
Most often, psychiatric medications are discontinued unilaterally by the patient, without the psychiatrist’s input or consent.
What are the consequences of discontinuation of medication?
This creates a burden on the mental health system when discontinuation of medication results in decompensation into a psychotic, manic, or severely depressed state that leads to an emergency psychiatry visit or hospitalization.
What should I do if a patient wants to discontinue medication?
When meeting with a patient who is requesting medication discontinuation, the first step is to engage in a conversation aimed at having the patient reconsider his decision. Exploring all of the reasons that contributed to the patient’s decision for medication discontinuation provides insight that can help address his concerns.
When should Medication discontinuation be considered in patients with bipolar disorder?
With some disorders, including MDD, obsessive-compulsive disorder (OCD), and panic disorder, guidelines exist with a clear recommendation of a time frame for symptom remission before a taper and discontinuation are considered. In disorders such as bipolar I and II disorders and schizophrenia, a strong case can be made for lifelong pharmacotherapy.
Can a patient discontinue treatment?
While withholding treatment and withdrawing treatment refer to actions taken by health care providers, the actual decision to decline or discontinue treatment rests with the patient or the patient's family or substitute decision-maker.
What is it called when a patient does not follow treatment?
Non-adherence: is generally a term which includes unintentional refusalby the patient (i.e. patient is overwhelmed, does not understand, helpless, confused, and/or concerned with healthcare costs).
What is discontinue in medical?
discontinuation. The act of concluding participation, before completing all protocol-required elements, in a trial by an enrolled subject.
What causes patient non-compliance?
These are a few of the common reasons for non-compliance and non-adherence: Cost and affordability. Lack of understanding/comprehension of advice, whether due to language barriers, cognitive abilities, being afraid to ask for clarification or other reasons. Mistrust or a lack of strong patient-provider relationship.
What are some reasons why a patient may become non compliant?
Common Causes of Noncompliant BehaviorFailure of Communication and Lack of Comprehension. ... Cultural Issues. ... “Psychological” Issues. ... Secondary Gain. ... Psychosocial Stress. ... Drug and Alcohol Dependence.
What does it mean to be discontinued?
transitive verb. 1 : to break the continuity of : cease to operate, administer, use, produce, or take. 2 : to abandon or terminate by a legal discontinuance.
Can a nurse discontinue medication?
Legally speaking, can any orders be discontinued by a nurse without a physician signature? Only a physician or other provider authorized by state law to write physician orders has the legal authority to discontinue a physician order.
How do you find out if a medication has been discontinued?
The Drugs.com Discontinued Drug Shortages List is a searchable database that provides up-to-date information related to drug discontinuations, sorted by generic name and latest revision date. The reason for the discontinuation and estimated resupply date, if available, is listed for each individual agent.
What is the decision to discontinue psychiatric medication?
The decision to discontinue a psychiatric medication involves weighing the risks versus the benefits. Abrupt discontinuation, although occasionally necessary, results in a higher incidence of withdrawal symptoms, relapse, and other complications. Once the decision has been made by a competent patient to discontinue medication, even if you disagree with the patient’s decision, a thoughtful and gradual tapering strategy should be designed based on the pharmacodynamic, pharmacokinetic, and disorder-specific factors that exist.
How to meet with a patient who is requesting medication discontinuation?
When meeting with a patient who is requesting medication discontinuation, the first step is to engage in a conversation aimed at having the patient reconsider his decision. Exploring all of the reasons that contributed to the patient’s decision for medication discontinuation provides insight that can help address his concerns. Detailed documentation in the patient’s medical record of this conversation is important. In some cases, it may be prudent to have the patient or guardian acknowledge competent understanding of the risks involved with discontinuation and sign an informed consent.
How long to continue benzodiazepines for panic disorder?
Panic disorder. The practice guideline for the treatment of panic disorder was updated in January 2009. 8 The guidelines recommend continuing pharmacotherapy for 1 or more years after acute symptom response to allow further symptom improvement and to minimize risk of relapse. The recommendation when using SSRIs, SNRIs, and TCAs is to lower the dosage slowly every month or two and monitor for early symptoms of relapse. The recommendation for benzodiazepines is a decrease in dosage no faster than 10% weekly. A course of cognitive-behavioral therapy before medication taper and addressing any underlying psychosocial stressors is also recommended.
How long after acute symptom response can you continue pharmacotherapy?
The practice guideline for the treatment of panic disorder was updated in January 2009. 8 The guidelines recommend continuing pharmacotherapy for 1 or more years after acute symptom response to allow further symptom improvement and to minimize risk of relapse.
When was MDD updated?
Major depressive disorder. The practice guideline for the treatment of MDD was most recently updated in October 2010. 2 The guidelines recommend that patients who have had 3 or more episodes of major depression should remain on a regimen of maintenance pharmacotherapy.
Can medication affect sexual dysfunction?
Although every medication has its common adverse effects, they can vary considerably among patients. A comprehensive discussion about adverse effects may reveal sexual dysfunction that the patient is embarrassed to talk about; switching to a different medication may address this issue.
Can psychiatric medications be discontinued unilaterally?
Most often, psychiatric medications are discontinued unilaterally by the patient, without the psychiatrist’s input or consent. Setting the stage early with a discussion about medication discontinuation is time well spent. More in this CME.
What is planned termination?
Planned terminations that are initiated by either the patient or the therapist also generally allow for thorough pre-termination counseling and a smooth ending of the professional relationship. Planned transitions can occur for many reasons, such as relocation of either party or the psychologist taking a new job or retiring. Planned transitions can also occur when the patient’s insurance benefits change or run out.
Why is it important to maintain a focus on patient welfare?
Even in challenging circumstances, such as a unilateral termination due to a lack of expertise, the psychologist may be able to promote a positive outcome , for example by facilitating a transition to a provider who can better meet the patient’s needs.
What happens if a therapist terminates a treatment?
… If the termination of treatment process is not properly carried out, the attempt to end the professional relationship can constitute, or at least be argued as, an abandonment of the patient/client. This could lead to a lawsuit for damages, a complaint to the licensing board, and a complaint to the ethics committee of your professional association (s). While patients generally have a right to terminate at any time and for any reason, not so with therapists!
When do therapists terminate?
Therapists typically terminate when the patient can no longer pay for services, when the therapist determines that the patient’s problem is beyond the therapist’s scope of competence or scope of license, when the therapist determines that the patient is not benefiting from the treatment, when the course of treatment comes to an end because of the improvement of the patient, or when the therapist is unable or unwilling, for appropriate reasons, to continue to provide care.
What is termination and referral?
One aspect of termination and referral that I have not previously written about involves the issue of follow-through after a referral is made and communicated to the patient. Referrals are usually made after the therapist or counselor decides to terminate with the patient, which may occur for a variety of reasons.
Why do counselors terminate?
Therapists or counselors may terminate because the patient is no longer able to pay the previously agreed upon fee or because a conflict may have arisen requiring, in the judgment of the practitioner, a termination. Additionally, a termination may occur because the practitioner becomes ill or is otherwise incapacitated.
When does the duty of a therapist begin?
Generally, the duty of a therapist or counselor begins when a contract for professional services is entered into – whether in writing or orally. Likewise, I believe that the duty to the patient should end concurrently with the termination of the therapeutic relationship. This of course assumes that the termination is made in a clinically ...
Should therapists and counselors be sure to carefully and fully document the entire termination process?
Therapists and counselors should be sure to carefully and fully document the entire termination process . Doing so could prove critical. Suppose that the patient is severely depressed and that the referring professional is concerned about self-harm to the patient.
Can a counselor avoid referrals?
Unless state law or regulation dictates or specifies when the duty (to provide competent care) to the patient ends, the therapist or counselor may not be able to avoid taking some form of action after a referral is made.
Why do doctors terminate patient relationships?
However, from time-to-time, a patient’s behaviors and actions may require the physician to sever ties. Non-compliance with the treatment plan, rude, abusive behavior, repeatedly not showing up for appointments, drug-seeking behavior and non-payment of services rendered are all reasons physicians terminate their patient relationships. A good relationship/partnership between the physician and patient is essential for optimal treatment outcomes.
What to do if a physician decides to terminate care?
If the physician decides to terminate care through a letter, it should be certified with return receipt requested and regular mail. If the certified letter is returned, it should be placed in the patient’s file unopened. Scheduling staff should be told that the patient has been terminated and instructed not to schedule them should they attempt to make further appointments.
How long does a termination letter last?
Depending on the availability of physicians in the specialty needed and the patient’s ability to access care from another provider, the termination window is generally 15 to 30 days.
What is a termination letter?
In the termination letter, if the patient’s condition requires continued medical care, it is recommended that this be clearly stated with the risks of not continuing treatment/care identified. Example: “Your condition requires continued medical treatment/care.
Can a physician terminate a relationship with another physician?
According to the AMA’s Council on Ethical & Judicial Affairs, a physician may not terminate the relationship as long as further treatment is indicated without sufficient time to make other arrangements for necessary care. Additionally, in the rare situation of an acute episode of illness, the transfer of care may be physician to physician to avoid any lapse in continuity of care.
Can a physician give a patient a referral?
The physician should not provide the patient with a specific name of another physician, but provide them with a physician referral source, such as the patient’s health plan for a list of physicians, the local medical society or physician referral service.
Should scheduling staff be told that a patient has been terminated?
Scheduling staff should be told that the patient has been terminated and instructed not to schedule them should they attempt to make further appointments. It is not necessary to give the patient a reason for the termination, but by providing one often prevents the patient from reaching back out to ask why.
What is the unique patient who refuses conventional treatment?
The unique patients who refuse conventional treatment are at times self-directed, confident, and active, and have thought deeply about the meaning of life and cancer and about their cancer treatment options.
What is the survival rate of women with diseases at the same stage who did not receive chemotherapy?
It was 26%.
Is the number of patients that decline conventional cancer treatment substantial enough to warrant close attention?
The number of patients that decline conventional cancer treatment is substantial enough to warrant close attention. Effective patient-doctor communication is crucial in addressing this challenge.
Is refusal of cancer treatment a serious concern?
Although the refusal of cancer treatment is a serious concern and has been shown to reduce the effectiveness of treatment and decrease survival duration after diagnosis [1, 2], the phenomenon itself has been scarcely studied. The number of patients who make this decision is not very well-known, but the number appears substantial enough to warrant close attention [3]. Studies have reported rates of less than 1% for patients who refused all conventional treatment [4] and 3%–19% for patients who refused chemotherapy partially or completely [5–9].
