Assessing and Treating Patients with Impulsivity, Compulsivity, and Addition Assignment

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addition Assignment

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addition Assignment

            Compulsive, impulsive, and addiction disorders are some of the mental health problems with immense burden to patients and their significant others. Often, patients lack control over the impulsive, compulsive, and addictive behaviors. These behaviors increase in situations where patients are anxious, as they help them manage the anxiety source. Psychiatric mental health nurses play an important role in helping patients affected by these problems to achieve their optimum mental health and wellbeing. They select the appropriate pharmacological and non-pharmacological treatments to optimize treatment outcomes (Murphy IV et al., 2022). Therefore, this paper explores the treatment approaches for a patient with impulsive, compulsive, and addiction problems.

BUY A CUSTOM PAPER HERE ON; Assessing and Treating Patients with Impulsivity, Compulsivity, and Addition Assignment

            The case study is about Mrs. Perez, a Puerto Rican female that has come to the clinic with complaints of an embarrassing problem. Mrs. Perez admits experiencing alcohol problems when she was a child following her father’s death. She also reports impulsive behaviors, including gambling since a casino was established in her neighborhood two years ago. She is enrolled in Alcohol Anonymous group to help her overcome her gambling problem. She notes that her drinking habits worsen when gambling, as alcohol helps her to relax. Perez notes that she is unable to control her gambling and alcohol drinking. She has also been smoking for the last two years. The severity of her problems can be seen from her gambling debt rising to more than $50000, which she paid using borrowed money from her retirement account. Mrs. Perez’s treatment will consider some factors. They will include the safety of the treatment, tolerability, comorbidity, age, and health status. Three decisions are made, with a focus on the expected outcomes and ethical considerations that informed the selected treatments.

Decision 1

Selected Decision

            The selected decision is the administration of intramuscular injections of 380 mg Naltrexone (Vivitrol) every four weeks.

Reason for the Selection

            Naltrexone is the recommended first-line drug for alcohol use disorder. It is highly effective in antagonizing mu-opioid receptors involved in alcohol cravings and withdrawal symptoms. Its administration inhibits the effects of alcohol by modulating endogenous opioids. The recommended dosage of naltrexone in the USA is 380 mg intramuscularly every four weeks. The effectiveness of this drug has been demonstrated in studies, since it reduces heavy drinking by 25% after 24 weeks as compared to placebo. Naltrexone also has a high tolerability rate alongside being effective in reducing heavy drinking days and drinking days per month as compared to placebo (Murphy IV et al., 2022).

Why the Other Two Options were Not Selected

            I did not select starting Mrs. Perez on Antabuse (Disulfiram 250 mg every morning because it has not shown effectiveness in patients with severe end of alcohol abuse. Disulfiram also increases the risk of adverse events should the patient consume any amount of alcohol within 12-24 hours of initiating the therapy. As a result, it would be appropriate for use once Perez has achieved a sustained period of alcohol abstinence. I did not select the decision to start the patient on Campral (acamprosate) 666 mg orally because it is the second-line of drug following successful initiation of treatment. The drug is recommended for reducing relapse of alcohol abuse by suppressing alcohol cravings (Stryhn et al., 2022).

What I was Hoping to Achieve

            I was hoping that Perez will report decrease in her alcohol drinking habits, gambling, and being sober. Naltrexone not only reduces alcohol drinking by patients but also lowers potentials of patient involvement in impulsive and compulsive behaviors in times of stress or anxiety (Murphy IV et al., 2022).

Ethical Considerations

            Alcohol abuse, impulsive, and compulsive disorders treatment should aim at ensuring safety and quality outcomes. Evidence-based treatment should be adopted. Naltrexone is the recommended first-line treatment, which increases the safety and quality outcomes in the treatment (Murphy IV et al., 2022).

Decision 2

Selected Decision

            The selected decision at this step is referring the patient to a counselor and continuing with the current dose.  

Reason for the Selection

            Perez returned to the clinic reporting reduced visits to the casino and improved alcohol abstinence. Her gambling has also reduced, reflecting the effectiveness of naltrexone. As a result, an effective approach to her treatment would be focusing on helping her overcome her gambling problem. Gambling does not have an approved pharmacological treatment. However, the use of non-pharmacological interventions such as counseling and behavioral treatments have proven effective in gambling (Lee et al., 2022). Counseling will help her identify gambling triggers and effective strategies to overcome them. Addressing gambling will reduce alcohol intake and smoking since they are the accompanying impulsive behaviors when gambling.

Why the Other Two Options were Not Selected

            I did not select the decision to add valium (diazepam) 5 mg TID for anxiety. Anxiety is an expected side effect associated with naltrexone. Anxiety symptoms improve over time, as patients tolerate the treatment. As a result, initiating an anxiolytic is not recommended at this time. I did not select addition of Chantix 1 mg PO BID since its dosage is high, increasing the risk of drug toxicity. The recommended treatment is initiating patients with 0.5 mg per day and titrating up based on response (Gautam et al., 2022).

What I was Hoping to Achieve

            I made the above decision aiming to witness a reduction in patient’s involvement in gambling. I also anticipated a further reduction in drinking and smoking. I anticipated optimum outcomes because naltrexone takes at least four weeks to produce its desired effect, translating into reduced impulsive, compulsive, and alcohol abuse (Murphy IV et al., 2022).

Ethical Considerations

            Psychiatric mental health nurses should help their patients achieve independence in managing their health problems and making informed decisions. This is achieved in this case study by referring the patient to a counselor. The counselor will help Perez understand her gambling behaviors, develop effective management strategies for improved functioning. Through it, patient’s autonomy in the treatment will be enhanced (Grace & Uveges, 2022).

Decision 3

Selected Decision

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

Reason for the Selection

            Mrs. Perez has continued to demonstrate symptom improvements. She no longer experiences anxiety, implying that she has tolerated naltrexone. She has also started playing an active role in Gamblers Anonymous group. An effective therapeutic intervention at this stage would be assessing the factors contributing to her disliking the counselor. This will provide the nurse an opportunity to explore patient and provider strategies to strengthen her relationship with the counselor (Harris & Panozzo, 2019).

Why the Other Two Options were Not Selected

            I did not select the decision encourage Mrs. Perez to continue seeing her current counselor as well as continuing with the Gamblers Anonymous group since it would be non-therapeutic. Encouraging her to see her therapist without finding out why she dislikes her does not consider her views or experiences with the counselor. Non-therapeutic approaches to care may affect her participation in the counseling sessions and treatment adherence (Harris & Panozzo, 2019). I did not choose the decision to discontinue vivitrol since it has been effective in improving her symptoms. She no longer gambles, drinks alcohol, and anxious. Discontinuing vivitrol will result in symptom relapse (Gautam et al., 2022).

What I was Hoping to Achieve

            I was hoping to witness Perez’s reduction in her engagement in gambling. I was also expecting to see her continued reduction in alcohol drinking and smoking (Lee et al., 2022).

Ethical Considerations

            Therapeutic alliances between patients and their caregivers are important for the realization of optimum outcomes. Psychiatric nurses should explore issues that patients have with their caregivers. It enables the identification of effective strategies to achieve optimum care outcomes. It also safeguards patient’s autonomy in the treatment (Murphy IV et al., 2022).

Conclusion

            The use of vivitrol in treating Perez’s problems was effective in this case study. Vivitrol is the first-line of drug for treating alcohol dependence. Unlike the given options, vivitrol has high tolerability levels, which makes it suitable for the patient (Murphy IV et al., 2022). Evidence-based data supports the use of counseling in gambling disorder since there is no pharmacological agent approved for its treatment. Counseling helps patients develop knowledge and skills for managing intrusive thoughts and feelings that predispose them to gambling. The decision was effective in helping Perez reduce her visit to the casino, gambling, alcohol drinking, and smoking (Lee et al., 2022). The third decision to explore the issues Perez has with her counselor and encouraging her to continue with Gamblers Anonymous group was also appropriate. Nurses’ first role in the patient care process is assessment (Grace & Uveges, 2022). Therefore, assessing the cause of her disliking her counselor was appropriate.

            Ethics guided the provision of care to Mrs. Perez. First, I made decisions with the aim of ensuring her safety and the provision of high-quality care. Psychiatric nurses should ensure that the adopted treatments have optimal benefits and minimal harm. As a result, I selected vivitrol, a first-line drug for alcohol abuse with the aim of eliminating any potential adverse effects in managing alcohol abuse disorder (Grace & Uveges, 2022). The promotion of patient’s autonomy also guided Perez’s treatment. Accordingly, the decision to refer her to counselor aimed at helping her understand her health problems better and make informed decisions on their management. Counseling helps patients to develop effective skills for overcoming negative feelings, thoughts, or experiences that increase their intrusive, impulsive, and compulsive behaviors. The decision to explore issues Perez might have with her counselor also safeguarded her right to high quality, safe and efficient care. Therefore, ethical considerations guided the decisions made in this case study.

References

Gautam, M., Patel, S., & Zarkowski, P. (2022). Practice patterns of bupropion co-prescription with antipsychotic medications. Journal of Addictive Diseases, 40(4), 481–488. https://doi.org/10.1080/10550887.2022.2028531

Grace, P. J., & Uveges, M. K. (2022). Nursing Ethics and Professional Responsibility in Advanced Practice. Jones & Bartlett Learning.

Harris, B. A., & Panozzo, G. (2019). Therapeutic alliance, relationship building, and communication strategies-for the schizophrenia population: An integrative review. Archives of Psychiatric Nursing, 33(1), 104–111.

Lee, B. K., Ofori Dei, S. M., Brown, M. M. R., Awosoga, O. A., Shi, Y., & Greenshaw, A. J. (2022). Congruence couple therapy for alcohol use and gambling disorders with comorbidities (part I): Outcomes from a randomized controlled trial. Family Process, n/a(n/a). https://doi.org/10.1111/famp.12813

Murphy IV, C. E., Wang, R. C., Montoy, J. C., Whittaker, E., & Raven, M. (2022). Effect of extended-release naltrexone on alcohol consumption: A systematic review and meta-analysis. Addiction, 117(2), 271–281. https://doi.org/10.1111/add.15572

BUY A PLAGIARISM-FREE PAPER HERE ON; Assessing and Treating Patients with Impulsivity, Compulsivity, and Addition Assignment

The Assignment: 5 pages
Examine Case Study (REFER TO FILE “CASE STUDY”). You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’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.

OUTLINE
– Introduction to the case (1 page) // REFER TO FILE “CASE STUDY”
–> 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) // REFER TO FILE “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) // REFER TO FILE “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) // REFER TO FILE “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.