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 Assignment

Over the years, alcohol use has been associated with gambling among most people. Consequently, studies show that substance use disorder is greatly associated with increased risks of gambling addiction. In the United States, it is speculated that approximately 5% of adults will experience some form of gambling problems in their life. Additionally, about 20% of patients diagnosed with alcohol use disorder end up having gambling problems. The two disorders can greatly compromise the work and social life of the patient. Gambling and alcohol addiction can end up costing an individual’s job, finances, and family (Grant, & Chamberlain, 2020). This can result in even worse effects such as suicidal ideation. As such, several treatment approaches have been developed to help people suffering from the two comorbidities, comprising of both pharmacological and psychotherapeutic interventions.

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The assigned patient M.P is a 53-year-old Puerto Rican female, diagnosed with gambling disorder, alcohol use disorder. The patient has been having problems with alcohol ever since she was still a teen after the death of her father. She claims that the new casino opened in her neighborhood has contributed to her difficulties in maintaining sobriety for the past two years. Her tendency toward cigarette smoking has also increased over this period. She currently weighs 122 lbs. as she gained 7 lb. recently, as a result of excessive alcohol intake. Based on the mental status examination results, the patient has a sad mood, with impaired impulse control. She however denies suicidal or homicidal ideation. The phamokokinetic and pharmacodynamic factors which may affect the decision on which medication to use include patients age, female gender, race, weight, and diagbosis among other factors. The paper elaborates on the case of a female patient diagnosed with gambling and alcohol use disorder, and the treatment interventions utilized in managing the patient’s condition, in addition to ethical considerations encountered while treating the patient.

Decision Point One

Selected Decision

Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks.

Reason Behind the Selected Decision

Naltrexone is approved by the National Institute for Health and Care Excellence (NICE) and US Food and Drug Administration (FDA) for the management of alcohol and opioid dependence. Naltrexone is a pure opioid antagonist which treats addiction by blocking the binding of endogenous opioids (Grant, Potenza, Kraus, & Petrakis, 2017). The extended-release naltrexone, IM was developed to address poor adherence in addiction. It is long-acting, hence administered once monthly to enhance patient compliance. The safety and tolerability of the drug are quite impressive with self-limiting side effects. Studies have also related naltrexone to reduce the urge of gambling, by about 20%, as no drug has been developed for the management of gambling. The therapeutic invention has also been found to be cost-saving.

Reasons for Not Selecting the Other Two Options

            Administering Antabuse (disulfiram) was not necessary as the drug is associated with unpleasant adverse effects to discourage alcoholism. Such effects include palpitations, low blood pressure, vertigo, headache, and flushing which might compromise the patient’s life even further (Reus et al., 2018). The drug is also administered daily, hence might provoke poor patient compliance.

Campral (Acamprosate) on the other hand must be administered three times a day, which makes it easier for the patient to miss doses hence poor compliance. Consequently, the drug is associated with adverse effects such as GI problems, weight gain, and muscle/joint pain which might affect the patient life negatively (Reus et al., 2018).

Expected Outcome

            With Naltrexone, the patient is expected to report back to the clinic with reduced alcohol craving and consumption. With reduced drinking, her body weight should be back to normal. She should also be happier with improving impulse control (Grant, Potenza, Kraus, & Petrakis, 2017). Her gambling frequency should also reduce to some extent.

Ethical Consideration

            According to the nursing code of ethics, patient-centered care requires the involvement of the patient in making a decision concerning their treatment choice for a positive outcome (Grant, & Chamberlain, 2020). As such, the PMHNP needs to educate the patient on all the available treatment options, and both the positive and negative effects of each option for the patient to make a sound mind decision.

Decision Point Two

Selected Decision

Refer the patient to a counselor to address the gambling issues.

Reason Behind the Selected Decision

            From the treatment outcome, the patient seems to tolerate the drug quite remarkably. Her drinking has completely been controlled. In as much as the patient feels wonderful, she is quite concerned with her gambling and anxiety, as she still smokes. There is no FDA-approved medication for gambling, as such, it is necessary to initiate therapeutic intervention through counseling with specialists in gambling management (Choi et al., 2017). Consequently, anxiety is a common side effect of naltrexone which is self-limiting, hence expected to go away with time. Given that the patient’s smoking habits are associated with gambling, it is necessary to address the gambling first and monitor the patient’s smoking, given that she already hates it as a result of the associated health complications.

Reasons for Not Selecting the Other Two Options

            Valium is a benzodiazepine that should not be introduced among patients who already have substance use disorder due to their addictive nature. Consequently, studies show that anxiety is a common side effect of naltrexone which is self-limiting, hence should not be addressed by the addition of another medication (Reus et al., 2018).

Chantix (varenicline) on the other hand was not necessary as the drug is associated with increased adverse effects when co-administered with naltrexone such as nightmares, nervousness, nausea and vomiting, and agitations (Reus et al., 2018). Consequently, patient smoking is related to gambling, hence it is necessary for the gambling to be addressed first while looking at the patient’s smoking habits.

Expected Outcome

            Within the next one month, the patient is expected to remain sober, with reduced anxiety symptoms. With an appropriate commitment to the gambling therapy sessions, the patient’s gambling is expected to be managed completely within this time (Choi et al., 2017). With no gambling, the patient is not expected to be smoking anymore.

Ethical Consideration

            Legal and ethical guidelines require that the patient’s well-being and satisfaction be at the center of care. As such, all the patient’s concerns, such as anxiety, smoking, and gambling must be addressed to win the patient’s trust in the treatment therapy and attain utmost satisfaction (Choi et al., 2017).

Decision Point Three

Selected Decision

            Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

Reason Behind the Selected Decision

            Given that the patient’s anxiety is well managed based on the treatment outcome. The patient must continue with naltrexone for one more month. Studies have not revealed the actual duration required for naltrexone therapy, but one month is still quite limited in manage chronic alcoholism. Additionally, the patient did not like her gambling counselor, as such it is necessary to address the issues that she is having with the counselor, as a positive relationship based on trust and good communication is key in achieving therapy goals (Challet-Bouju et al., 2017). Given that she is already attending gamblers anonymous meeting, and feels that it is helping her with her gambling, it is necessary to advise the patient to continue with the sessions for a further positive outcome. the PMHNP should also talk to the patient about appropriate smoking cessation interventions for utmost control of the patient’s addiction disorders to boost her general well-being.

Reasons for Not Selecting the Other Two Options

            Ignoring the fact that the patient dislikes her gambling counselor will only lead to absenteeism and lack of commitment in the therapy sessions (Choi et al., 2017). This will prevent the patient from achieving the intended therapy goals in managing gambling disorder.

Consequently, discontinuing Vivitrol is not necessary at this point, as studies recommend the use of the medication in the management of chronic alcoholism for at least three months (Challet-Bouju et al., 2017). Additionally, the patient should only stop using the drug once all her addiction problems have been completely resolved.

Expected Outcome

            Within the next one month, the patient should have resolved the issues with her counselor and enjoyed the therapy sessions with active participation (Challet-Bouju et al., 2017). She is thus expected to have completely managed her gambling and smoking addiction within this time. Her smoking should also be reduced as it was associated with gambling which should be managed by this time.

Ethical Consideration

            Concerning ethical considerations in promoting the patient’s health and attaining their satisfaction, it is important to address the patient’s dislike for her counselor to enhance her commitment and benefits to the therapy session (Grant, & Chamberlain, 2020). Additionally, the patient has the right to make decisions concerning her own health, as such, all her concerns must be addressed for her to agree to attend the gambling sessions.

Conclusion

            Most patients diagnosed with alcohol addiction normally end up having comorbidities such as gambling disorder. As such, managing such comorbidities is normally challenging which requires an appropriate choice of the most effective intervention for a positive outcome. The patient in the provided case study was diagnosed with alcohol and gambling addiction. As such, it was necessary to administer naltrexone IM, after every four weeks, given that the drug is FDA approved for the management of alcohol addiction (Grant, Potenza, Kraus, & Petrakis, 2017). The extended-release formulation is also long-acting, with high tolerance and safety profile, hence improved patient compliance and treatment outcome.

The second intervention was introducing the patient to gambling psychotherapy. In as much as the patient encountered anxiety as a side effect, studies show that this is a common experience with naltrexone and is self-limiting (Choi et al., 2017). Additionally, there is no FDA-approved medication for gambling disorder, but with counseling, patients tend to exhibit desirable outcomes.

The last decision was based on the outcome of the second intervention. For instance, the patient started attending gamblers’ anonymous sessions which she found to be helpful, and also reported that she disliked her gambling counselor. As such, it was necessary to address the issues that the patient had with the counselor to help enhance a healthy relationship between the two (Challet-Bouju et al., 2017). Studies show that a healthy relationship between the patient and the counselor is key in exhibiting optimum benefit from psychotherapy.

Several legal and ethical considerations were encountered when caring for the patient. For instance, the patient is an adult who was entitled to making decisions concerning her health. As such, she was well informed on all the treatment alternatives available and their outcome (Choi et al., 2017). The PMHNP also ensured that the patient was satisfied with the outcome of every intervention, to promote compliance and patients trust for optimum care outcome.

Reference

Grant, J. E., & Chamberlain, S. R. (2020). Gambling and substance use: Comorbidity and treatment implications. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 99, 109852. https://doi.org/10.1016/j.pnpbp.2019.109852

Challet-Bouju, G., Bruneau, M., Victorri-Vigneau, C., Grall-Bronnec, M., Hardouin, J. B., Tessier, P., … & IGNACE Group. (2017). Cognitive remediation interventions for gambling disorder: A systematic review. Frontiers in psychology, 8, 1961. https://doi.org/10.3389/fpsyg.2017.01961

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://doi.org/10.1186/s12991-017-0146-2

Grant, J. E., Potenza, M. N., Kraus, S. W., & Petrakis, I. L. (2017). Naltrexone and disulfiram treatment response in veterans with alcohol dependence and co-occurring problem-gambling features. The Journal of clinical psychiatry, 78(9), 1299-1306. DOI: 10.4088/JCP.16m11220.

Reus, V. I., Fochtmann, L. J., Bukstein, O., Eyler, A. E., Hilty, D. M., Horvitz-Lennon, M., … & Hong, S. H. (2018). The American Psychiatric Association practice guideline for the pharmacological treatment of patients with alcohol use disorder. American Journal of Psychiatry, 175(1), 86-90. https://doi.org/10.1176/appi.ajp.2017.1750101

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Assignment 1: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction
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.

Medication resources
https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
CASE STUDY
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_08/index.html