NURS 6630 Week 10 Assignment 1: Psychopharmacological Approaches to Treat Psychopathology

NURS 6630 Week 10 Assignment 1: Psychopharmacological Approaches to Treat Psychopathology

NURS 6630 Week 10 Assignment 1: Psychopharmacological Approaches to Treat Psychopathology

Various conditions are usually challenging to patients across the life span. Some of them include addiction, compulsivity, and impulsivity (Tiego et al.,2019). The conditions are associated with negative behaviors, which lead to adverse outcomes among the patients. Medication-assisted treatment is usually applied in combination with behavioral and counseling therapies. Therefore, the purpose of this assignment is to explore the case and discuss the decisions made along with the pharmacological approaches and management of the patient.

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Case Overview

This case study focuses on a fifty-three-year-old Puerto Rican woman complaining of suffering from comorbidity of gambling and alcoholism. The patient has in the past sought treatment regarding alcoholism but staying near a casino combined with alcohol availability has led to relapse, and she also actively gambles regularly. The patient is experiencing depression symptoms such as lethargic and sad demeanor.

Decision #1

Naltrexone (Vivitrol) injection, 380 mg intramuscularly

Why the Decision was Selected and the Reason for Selection

Naltrexone is an effective medication used in lowering the incidences of heavy drinking and boosting abstinence. The patient has admitted to a drinking problem while a psychosocial approach has been attempted but without success; therefore, this medication should be tried. The medication is a mu-opioid receptor antagonist and can be offered as an injection (Vivitrol) or oral (Revia) (Canidate et al., 2017). It has been approved by the FDA to be used in the treatment of alcohol dependence and for the prevention of opioid dependence relapse. The medication helps by modifying the hypothalamic-pituitary-adrenal axis to help suppress alcohol use.

Why the Other two Were Not Selected

The other options were not selected due to various reasons. For example, Disulfiram was ignored due to the possible adverse impacts associated with it, such as tachycardia, metallic taste, vomiting, and nausea whenever combined with alcohol use (Sousa 2019). Therefore it is more suitable for patients who are focusing on abstinence. Acamprosate was also not selected since the available data and research evidence show that the medication should only be considered once a patient has successfully attained abstinence.

Why I was Hoping to Achieve

The main achievement targeted is the treatment of the alcohol disorder as the primary focus of the treatment plan. I was also hoping that the patient would present with improved symptoms. It was also expected that the patient would experience few side effects if at all, there would be some due to the medication.

How Ethical Consideration May Impact Treatment

The ethical consideration that may impact the treatment is nonmaleficence or not doing harm and beneficence (the duty to do good). Therefore, the prescription was done in the best interest of the patient. However, the patient’s consent has to be obtained.

Decision #2

Refer to a counselor for gambling Issues

Why the Decision was Selected and the Reason for Selection

Upon receiving the injections, four weeks later, the patient admits to being sober and indicates that she has not had any medication side effects. She complains about gambling but is also worried about anxiety and smoking. Therefore, the best choice is to see a counselor to help with a gambling problem (Chui et al., 2019). According to the American psychiatric association, gambling disorder can be treated and managed through various strategies such as family therapy, group therapy, psychodynamic therapy, and cognitive behavior therapy.

Why the Other two Were Not Selected

The patient looks concerned about smoking and is determined to stop smoking. Therefore, medication assistance could help her achieve this goal and be saved from the possible consequences resulting from smoking. However, varenicline was not selected since the provided starting dose was higher than the recommended ( 1 mg against 0.5 mg PO BID). Going for such a high dosage can lead to various adverse impacts such as agitation, vomiting, and nausea (Stahl, 2017). Even though administering diazepam (Valium) was an option, it is not a good option as it is addictive and has longer effects than other benzodiazepines. Since the patient already has a history of addiction, adding another medication with potential addictive impacts would be harmful to the patient.

Why I was Hoping to Achieve

There are various goals that were to be achieved with this option. It was hoped that the patient would willingly seek the services of a counselor who would choose the best therapy strategy for this gambling problem. It was also hoped that the patient would present with a reduced urge for gambling and a diminished urge to smoke.

How Ethical Consideration May Impact Treatment

One of the ethical considerations that would impact the treatment is patient consent. Even though the patient has to be advised to seek the services of a counselor, the patient has options to either go or refuse to go. Hence, in the event that she refuses to go, then the treatment plan would experience barriers, and other options have to be explored.

Decision #3

Explore the issue that the patient is having with the counselor and encourage her to continue attending the gamblers anonymous meetings.

Why the Decision was Selected and the Reason for Selection

When the patient visited one month later, she indicated that her anxiety was no longer there. However, she says that she does not like the therapist. On a positive note, she has joined a gambling anonymous group. It is evident that the patient is committed to ending gambling since she has decided to join a help group even though she doesn’t enjoy a good relationship with her counselor. It is worth noting that counseling is still the central pillar in addiction treatment (Stahl, 2017). As such, it is appropriate to find out why there are issues and which kinds of issues exist between the patient and the counselor. This would help in getting a better insight on how to lead the patient into the next treatment and management phase.

Why the Other two Were Not Selected

The other two options were not chosen since the patient clearly needs to manage the gambling problem. However, currently, there is no FDA-approved medication that can be used for the treatment of gambling (Stahl, 2017).  

Why I was Hoping to Achieve

It is important to also explore the smoking problem that this patient is experiencing to fully address the addiction problem. Assessment of the patient’s willingness to quit smoking is the basic step that has to be explored. In addition, gaining a deeper understanding of the patient’s perspective concerning smoking is key to the formulation of the best assistance. Among the things hoped to achieve is that the patient would stick more with the gamblers anonymous groups and attend meetings frequently to better achieve quitting gambling.

How Ethical Consideration May Impact Treatment

Various ethical considerations come into play again, which may impact the course of treatment. For example, the patient’s confidentiality and autonomy have to be taken into consideration and upheld during the medication prescription (Stahl, 2017). It is an ethical obligation to inform the patient of the disorder, potential impacts, and possible ways of management.

Conclusion

Alcohol and gambling disorders can both be devastating to a patient as they are both impacted by an individual’s reward pathways. While there are pharmacological strategies for managing alcohol addiction, the approach can vary from one patient to another, depending on the symptoms that the patient presents. However, there is no current approved medication for gambling. Therefore, it is important to use other available strategies focusing on behavioral therapy.

References

Canidate, S. S., Carnaby, G. D., Cook, C. L., & Cook, R. L. (2017). A systematic review of naltrexone for attenuating alcohol consumption in women with alcohol use disorders. Alcoholism: Clinical and Experimental Research, 41(3), 466-472. https://doi.org/10.1111/acer.13313.

Chui, W. Y., Lee, S. K., Mok, Y. L., & Tsang, C. K. (2018). The diagnostic criteria of gambling disorder of DSM-5 in Chinese culture: By confirmatory factor analysis (CFA) and item response theory (IRT). In Applied psychology readings (pp. 73-86). Springer, Singapore. Doi: 10.1007/978-981-10-8034-0_5

Sousa, A. D. (2019). Disulfiram: side effects and toxicity. In Disulfiram (pp. 59-67). Springer, Singapore.  Doi: 10.1007/978-981-32-9876-7_7

Stahl, S. M. (2017). Prescriber’s guide: Antidepressants: Stahl’s essential psychopharmacology. Cambridge University Press.

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Tiego, J., Oostermeijer, S., Prochazkova, L., Parkes, L., Dawson, A., Youssef, G., … & Yücel, M. (2019). Overlapping dimensional phenotypes of impulsivity and compulsivity explain the co-occurrence of addictive and related behaviors. CNS spectrums, 24(4), 426-440. https://doi.org/10.1017/S1092852918001244

NURS 6630: Psychopharmalogical Approaches to Treat Psychopathology
Assignment : 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.
To prepare for this Assignment:
• Review this week’s 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.
• Support your rationale with a minimum of five academic resources. You should be utilizing the primary and secondary literature.
• Utilize SafeAssign Drafts for originality report.
https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched.
Medications
• naltrexone (revia/vivitrol)
• naloxone
• acamprosate
• disulfiram

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.

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Name: NURS_6630_Week10_Assignment1_Rubric

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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.–

Levels of Achievement:

Excellent

Point range: 90–100 9 (9.00%) – 10 (10.00%)

Good

Point range: 80–89 8 (8.00%) – 8 (8.00%)

Fair

Point range: 70–79 7 (7.00%) – 7 (7.00%)

Poor

Point range: 0–69 0 (0.00%) – 6 (6.00%)

Decision #1 (1–2 pages)

• 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.–

Levels of Achievement:

Excellent

Point range: 90–100 18 (18.00%) – 20 (20.00%)

Good

Point range: 80–89 16 (16.00%) – 17 (17.00%)

Fair

Point range: 70–79 14 (14.00%) – 15 (15.00%)

Poor

Point range: 0–69 0 (0.00%) – 13 (13.00%)

Decision #2 (1–2 pages)

• 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.–

Levels of Achievement:

Excellent

Point range: 90–100 18 (18.00%) – 20 (20.00%)

Good

Point range: 80–89 16 (16.00%) – 17 (17.00%)

Fair

Point range: 70–79 14 (14.00%) – 15 (15.00%)

Poor

Point range: 0–69 0 (0.00%) – 13 (13.00%)

Decision #3 (1–2 pages)

• 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.–

Levels of Achievement:

Excellent

Point range: 90–100 18 (18.00%) – 20 (20.00%)

Good

Point range: 80–89 16 (16.00%) – 17 (17.00%)

Fair

Point range: 70–79 14 (14.00%) – 15 (15.00%)

Poor

Point range: 0–69 0 (0.00%) – 13 (13.00%)

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.–

Levels of Achievement:

Excellent

Point range: 90–100 14 (14.00%) – 15 (15.00%)

Good

Point range: 80–89 12 (12.00%) – 13 (13.00%)

Fair

Point range: 70–79 11 (11.00%) – 11 (11.00%)

Poor

Point range: 0–69 0 (0.00%) – 10 (10.00%)

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.–

Levels of Achievement:

Excellent

Point range: 90–100 5 (5.00%) – 5 (5.00%)

Good

Point range: 80–89 4 (4.00%) – 4 (4.00%)

Fair

Point range: 70–79 3.5 (3.50%) – 3.5 (3.50%)

Poor

Point range: 0–69 0 (0.00%) – 3 (3.00%)

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation–

Levels of Achievement:

Excellent

Point range: 90–100 5 (5.00%) – 5 (5.00%)

Good

Point range: 80–89 4 (4.00%) – 4 (4.00%)

Fair

Point range: 70–79 3.5 (3.50%) – 3.5 (3.50%)

Poor

Point range: 0–69 0 (0.00%) – 3 (3.00%)

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.–

Levels of Achievement:

Excellent

Point range: 90–100 5 (5.00%) – 5 (5.00%)

Good

Point range: 80–89 4 (4.00%) – 4 (4.00%)

Fair

Point range: 70–79 3.5 (3.50%) – 3.5 (3.50%)

Poor

Point range: 0–69 0 (0.00%) – 3 (3.00%)

Name:NURS_6630_Week10_Assignment1_Rubric