Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”

SUBJECTIVE

Mrs. Perez admits that she has had “problems” with alcohol since her father died in her late teens. She reports that she has struggled with alcohol since her 20’s and has been involved with Alcoholics Anonymous “on and off” for the past 25 years. She states that for the past 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its grand opening at which point she was “hooked.” She states that she gets “such a high” when she is gambling. While gambling, she “enjoys a drink or two” to help calm her during high-stakes games. She states that this often gives way to more drinking and more reckless gambling. She also reports that her cigarette smoking has increased over the past 2 years and she is concerned about the negative effects of the cigarette smoking on her health.

ORDER A CUSTOMIZED, PLAGIARISM-FREE Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction HERE

Good News For Our New customers . We can write this assignment for you and pay after Delivery. Our Top -rated medical writers will comprehensively review instructions , synthesis external evidence sources(Scholarly) and customize a quality assignment for you. We will also attach a copy of plagiarism report alongside and AI report. Feel free to chat Us

She states that she attempts to abstain from drinking but she gets such a “high” from the act of gambling that she needs a few drinks to “even out.” She also notices that when she drinks, she doesn’t smoke “as much,” but she enjoys smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weights 122 lbs., which represents a 7 lb. weight gain from her usual 115 lb. weight.

Mrs. Perez is quite concerned today because she borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant during the clinical interview. When you make eye contact with her, she looks away or looks down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her self-reported mood is “sad.” Affect is appropriate to content of conversation and self-reported mood. She denies visual or auditory hallucinations, and no delusional or paranoid thought processes are readily appreciated. Insight and judgment are grossly intact; however, impulse control is impaired. She is currently denying suicidal or homicidal ideation.

Diagnosis: Gambling disorder, alcohol use disorder

Impulsivity, compulsivity, and addiction are challenging disorders for patients across the life span. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences; patients often describe impulsivity as living in the present moment without regard to the future (MentalHelp.net, n.d.). Thus, these disorders often manifest as negative behaviors, resulting in adverse outcomes for patients. For example, compulsivity represents a behavior that an individual feels driven to perform to relieve anxiety (MentalHelp.net, n.d.). The presence of these behaviors often results in addiction, which represents the process of the transition from impulsive to compulsive behavior.

In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients address underlying causes of the disorders and overcome these behaviors. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with impulsivity, compulsivity, and addiction.

Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/

To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.
The Assignment: 5 pages
Examine Case Study: A Puerto Rican Woman With Comorbid Addiction. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)

Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)

Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Order Messages

A Sample Of This Assignment Written By One Of Our Top-rated Writers

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Gambling disorder and alcohol use disorder have become the common clinical diagnosis. These conditions are diagnosed in various patient populations, including youths, young adults, and elderly adults (Allami et al., 2021). Gambling disorder is characterized by being preoccupied with gambling. Individuals with this disorder tend to plan gambling activities constantly to get more money gambling. Additionally, people with this disorder have an increased urge to gamble with more money to get higher returns (Allami et al., 2021. On the other hand, alcohol use disorder is characterized by impaired ability to control or stop alcohol use despite making efforts to reduce or stop taking alcohol. Other symptoms associated with this condition are adverse social effects, impaired occupational functioning, or health issues. Pharmacological interventions are used in treating individuals who are diagnosed with gambling disorder and alcohol use disorder. In the provided case study, the client, M. R presented to the clinic with alcohol problems. The client reported that she started taking alcohol following her father’s death during her late teens. She revealed struggling with Alcoholics Anonymous for the last 25 years. The client added that remaining sober became a significant challenge following the opening of a new casino in her neighborhood. She reports getting “such a high” while gambling. She takes some beers to remain calm when gambling during high-stakes games, justifying reckless gambling and drinking more beer. M.P also reported increased cigarette smoking in the last 2 years, making her concerned about her health status.  She also reports gaining 7 lb recently. Mental healthcare providers conducted mental health status. The client is alert and oriented to places, people, events, and situations. She is goal-oriented and her speech is clear. The client denies suicidal or homicidal ideation. However, her impulse control is impaired. She is diagnosed with gambling disorder and alcohol use disorder. This paper presents pharmacological decisions for managing presented symptoms.

Decision Point 1

            The first treatment option for this client is Vivitrol (naltrexone) injection, 380 mg intramuscularly in the glueteal region every 4 weeks. This decision was selected following the effectiveness of Vivitrol in treating alcohol use disorder (AUD). According to Farhadian et al. (2020), injecting naltrexone into adults diagnosed with AUD effectively lowers alcohol craving and use. Naltrexone is an opioid receptor antagonist whose structure resembles that of morphine. Its affinity for the μ- and κ-opioid receptor active sites is relatively high. Therefore, Vivitrol (naltrexone) injection, 380 mg intramuscularly is the best treatment option for this client.

Other potential options, including Antabuse (disulfiram) 250 mg orally daily and Campral (acamprosate) 666 mg orally three times/day were rejected. Antabuse (disulfiram) 250 mg orally daily was dismissed due to severe side effects. According to Fairbanks et al. (2020), despite being an FDA-proven treatment for AUD, disulfiram increases the risk of developing serious health complications, including cardiovascular, psychiatric, and hepatic disorders. Additionally, Campral (acamprosate) 666 mg orally three times/day was rejected due to drug-related side effects. Gastrointestinal adverse events are common among acamprosate-treated patients (Burnette et al., 2022). Hence, Campral is unsafe for treating alcohol use disorder in this client.

It was expected that the client would report improvement in the presented symptoms after using Vivitrol (naltrexone) injection, 380 mg intramuscularly for four weeks. According to Farhadian et al. (2020), naltrexone effectively lowers alcohol craving and use among people with AUD. Upon returning to the clinic after 4 weeks, the client reports feeling wonderful and denies taking alcohol from the time she was injected. She has also reduced visiting the casino but gambles with a huge amount of money when she goes to the casino. She also smokes and reports being concerned about anxiety.

While developing this treatment plan, the psychiatrist considered the ethical principle of beneficence that holds that healthcare providers should aim at benefiting their patients (Bipeta, 2019). The psychiatrists benefited the client by administering the most effective medication.

Decision Point 2

            The second decision involves referring the client to a counselor to address gambling issues. This decision was selected following the effectiveness of psychotherapies in treating gambling disorders. According to Choi et al. (2017), psychosocial treatment interventions, including cognitive behavioral therapy, Gamblers Anonymous, and motivational interviewing effectively treat gambling disorders in people diagnosed with this disorder. Thus, referring the client to a counselor is the best treatment decision.

            Other options, including adding on Valium (diazepam) 5 mg orally TID/PRN/anxiety and adding on Chantix (varenicline) 1 mg orally BID were rejected. Adding on Valium (diazepam) 5 mg orally TID/PRN/anxiety was dismissed due to severe side effects, including drowsiness, muscle weakness, and fatigue (Weintraub, 2017). Additionally, adding on Chantix (varenicline) 1 mg orally BID was rejected due to drug-related side effects, including insomnia, nausea, and headaches (Cinciripini et al., 2018).

 It was anticipated that the client would report improvement in gambling habits upon returning to the clinic after four weeks. According to Choi et al. (2017), psychosocial treatments are effective in treating gambling disorders. Upon returning to the clinic after 4 weeks the client denied anxiety. She reported meeting with the counselor although she did not like her. The client also reported that she had started attending a meeting of Gamblers Anonymous within her area. She added that she spoke during the meeting the week before. She claimed that the group is supportive and it is helping her to overcome her gambling behavior.

            In developing this treatment plan, the psychiatrists adhered to the ethical principle of non-maleficence. This principle holds that healthcare providers should protect the client from potential harm (Bipeta, 2019). The psychiatrist protected the client from adverse effects associated with the rejected treatment interventions.

Decision Point 3

The third treatment decision involves exploring the issue that the client is having with her counselor and encouraging her to continue attending the Gamblers Anonymous meetings. Evaluating the differences between the client and her counselor would improve their relationship, making the client attend all counseling sessions as scheduled, and improving gambling behavior. According to Cooper‐Samonini et al. (2021), talk therapy is an effective treatment for gambling disorders. Thus, attending all counseling sessions would improve the client’s gambling behavior. Additionally, encouraging the client to continue attending the Gamblers Anonymous meetings would result in further improvement in her gambling behavior since the client reported that the group was helpful. Additionally, studies indicate that group therapies are effective interventions for treating gambling disorders (Månsson et al., 2022).

Other potential options were rejected. First, encouraging the client to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group was rejected. The client reported that she does not like the counselor; hence she would not attend all the counseling sessions if the matter was not addressed. Additionally, discontinuing Vivitrol and encouraging the client to continue seeing her counselor and continue participating in the Gamblers Anonymous group was rejected. Vivitrol was effective in improving the client’s gambling behavior; hence it should not be discontinued. The client was expected to report further improvement in presented symptoms upon returning to the clinic after 4 weeks.

            In developing this treatment plan, the client adhered to the ethical principle of confidentiality and non-disclosure. This ethical guideline holds that patients’ information should not be disclosed to third parties without the patient’s consent (Bipeta, 2019). Thus, the psychiatrist should not disclose the client’s information to other healthcare providers or family members without her consent.

Conclusion

 Three pharmacological decisions have been used in treating the client’s gambling disorder and alcohol abuse disorder. The first treatment option for this client is Vivitrol (naltrexone) injection, 380 mg intramuscularly in the glueteal region every 4 weeks. This decision was selected following the effectiveness of Vivitrol in treating alcohol use disorder (AUD). Other potential options, including Antabuse (disulfiram) 250 mg orally daily and Campral (acamprosate) 666 mg orally three times/day were rejected due to potential side effects. It was expected that the client would report improvement in the presented symptoms after using Vivitrol (naltrexone) injection, 380 mg intramuscularly for four weeks. The second decision involves referring the client to a counselor to address gambling issues. This decision was selected following the effectiveness of psychotherapies in treating gambling disorders. Other options, including adding on Valium (diazepam) 5 mg orally TID/PRN/anxiety and adding on Chantix (varenicline) 1 mg orally BID were rejected due to severe side effects. It was anticipated that the client would report improvement in gambling habits upon returning to the clinic after four weeks. The third treatment decision involves exploring the issue that the client is having with her counselor and encouraging her to continue attending the Gamblers Anonymous meetings. Evaluating the differences between the client and her counselor would improve their relationship, making the client attend all counseling sessions as scheduled, and improving gambling behavior. Other potential options were rejected. First, encouraging the client to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group was rejected. The client reported that she does not like the counselor; hence she would not attend all the counseling sessions if the matter was not addressed. Additionally, discontinuing Vivitrol and encouraging the client to continue seeing her counselor and continue participating in the Gamblers Anonymous group was rejected. Vivitrol was effective in improving the client’s gambling behavior; hence it should not be discontinued.

References

Allami, Y., Hodgins, D. C., Young, M., Brunelle, N., Currie, S., Dufour, M., … & Nadeau, L. (2021). A meta‐analysis of problem gambling risk factors in the general adult population. Addiction, 116(11), 2968-2977. https://onlinelibrary.wiley.com/doi/pdf/10.1111/add.15449

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian journal of psychological medicine, 41(2), 108-112. doi: 10.4103/IJPSYM.IJPSYM_59_19

Burnette, E. M., Nieto, S. J., Grodin, E. N., Meredith, L. R., Hurley, B., Miotto, K., … & Ray, L. A. (2022). Novel agents for the pharmacological treatment of alcohol use disorder. Drugs, 1-24. https://link.springer.com/article/10.1007/s40265-021-01670-3

Choi, S. W., Shin, Y. C., Kim, D. J., Choi, J. S., Kim, S., Kim, S. H., & Youn, H. (2017). Treatment modalities for patients with gambling disorder. Annals of general psychiatry, 16(1), 1-8. https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-017-0146-2

Cinciripini, P. M., Minnix, J. A., Green, C. E., Robinson, J. D., Engelmann, J. M., Versace, F., … & Karam‐Hage, M. (2018). An RCT with the combination of varenicline and bupropion for smoking cessation: clinical implications for front line use. Addiction, 113(9), 1673-1682.

Cooper‐Samonini, E., Delaney, Z., & Bowden‐Jones, H. (2021). Gambling disorder and NHS treatment: an overview. Trends in Urology & Men’s Health, 12(6), 15-18. https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/tre.826

Fairbanks, J., Umbreit, A., Kolla, B. P., Karpyak, V. M., Schneekloth, T. D., Loukianova, L. L., & Sinha, S. (2020, September). Evidence-based pharmacotherapies for alcohol use disorder: clinical pearls. In Mayo Clinic Proceedings (Vol. 95, No. 9, pp. 1964-1977). Elsevier. DOI:https://doi.org/10.1016/j.mayocp.2020.01.030.

Farhadian, N., Moradi, S., Zamanian, M. H., Farnia, V., Rezaeian, S., Farhadian, M., & Shahlaei, M. (2020). Effectiveness of naltrexone treatment for alcohol use disorders in HIV: a systematic review. Substance abuse treatment, prevention, and policy, 15(1), 1-7. https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-020-00266-6

https://doi.org/10.1186/s12888-021-03630-3

Månsson, V., Molander, O., Carlbring, P., Rosendahl, I., & Berman, A. H. (2022). Emotion regulation-enhanced group treatment for gambling disorder: a non-randomized pilot trial. BMC Psychiatry, 22(1), 1-13.

Weintraub, S, J. (2017). Diazepam in the Treatment of Moderate to Severe Alcohol Withdrawal. CNS Drugs; 31(2):87-95.