Week 8 Assignment

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

A Puerto Rican Woman With Comorbid Addiction

Impulsivity, compulsivity, and addiction are challenging disorders for clients across the lifespan. These disorders often manifest as negative behaviors, resulting in adverse outcomes for clients. In your role as the psychiatric mental health nurse practitioner, you have the opportunity to help clients 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.

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Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 14, “Impulsivity, Compulsivity, and Addiction”

Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the Substance Use and Impulsive Disorders tab.

Chapter 10, “Disorders of Impulsivity and Compulsivity”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia

For obsessive-compulsive disorder

• Citalopram
• clomipramine
• escitalopram
• fluoxetine
• fluvoxamine
• paroxetine
• sertraline
• venlafaxineNURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
• vilazodone
• For alcohol withdrawal
• chlordiazepoxide
• clonidine
• clorazepate
• diazepam
• lorazepam
• oxazepam
• For bulimia nervosa and binge eating
• fluoxetine
• topiramate
• zonisamide
• For alcohol abstinence
• acamprosate
• disulfiram
• For alcohol dependence
• nalmefene
• naltrexone
• For opioid dependence
• buprenorphine
• naltrexone
• For nicotine addiction
• bupropion
• varenicline

Book Excerpt: S.ubstance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders. Treatment Improvement Protocol Series, No. 32. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64350/

Chapter 1, “Substance Use Among Adolescents”

Chapter 2, “Tailoring Treatment to the Adolescent’s Problem”

Chapter 7, “Youths with Distinctive Treatment Needs”

University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from https://www.sciencedaily.com/releases/2016/01/160120201324.htm

Note: Retrieved from Walden Library databases.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. doi:10.1111/j.1365-2125.2012.04457.x

Note: Retrieved from Walden Library databases.

Loreck, D., Brandt, N. J., & DiPaula, B. (2016). Managing opioid abuse in older adults: Clinical considerations and challenges. Journal of Gerontological Nursing, 42(4), 10–15. doi:10.3928/00989134-20160314-04

Note: Retrieved from Walden Library databases.

Salmon, J. M., & Forester, B. (2012). Substance abuse and co-occurring psychiatric disorders in older adults: A clinical case and review of the relevant literature. Journal of Dual Diagnosis, 8(1), 74–84. doi:10.1080/15504263.2012.648439

Note: Retrieved from Walden Library databases.

Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & … Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. doi:10.1016/j.comppsych.2014.04.018

Note: Retrieved from Walden Library databases.

Required Media

Laureate Education (2016c). Case study: A Puerto Rican woman with comorbid addiction [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction.

The Assignment

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 stop to complete the following:

A Puerto Rican Woman With Comorbid Addiction Decision #1

• Which decision did you select?NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment

A Puerto Rican Woman With Comorbid Addiction Decision #2

• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

A Puerto Rican Woman With Comorbid Addiction Decision #3

• Why did you select this decision? Support your response with evidence and references to the Learning Resources.
• What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
• Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office 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 two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their 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 two years and she is concerned about the negative effects of the cigarette smoking on her health.

She states that she attempts to abstain from drinking but that 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 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 has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.A Puerto Rican Woman With Comorbid Addiction

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert, 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. As 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 & self-reported mood. She visual or auditory hallucinations, 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.A Puerto Rican Woman With Comorbid Addiction

Diagnosis: Gambling disorder, alcohol use disorder

Decision 1: Antabuse (Disulfiram) 250mg orally daily

Decision 2: continue current dose of Antabuse and refer to counseling for ongoing gambling issues.

Decision 3: Explore the issues that Mrs. Perez is having with her counselor and encourage her to continue attending the Gambling Anonymous meeting, and discuss smoking cessation.

Resource: Laureate Education (2016a). Case study: A Caucasian man with hip pain [Interactive media file]. Baltimore, MD: Author

In summary: What needs to be in the essay.

-Introduction regarding disease state
-High-level summary of patient case
-Purpose of the essay statement

1, Decision 1
-What options were listed
-What option did you choose?
-Why did you select that option?
-Why didn’t you select the other two options?
-What was your goal of treatment
-Was the outcome what you expected? Why?

2, Decision 2
-What options were listed
-What option did you choose?
-Why did you select that option?
-Why didn’t you select the other two options?
-What was your goal of treatment
-Was the outcome what you expected? Why?

3, Decision 3
-What options were listed
-What option did you choose?
-Why did you select that option?
-Why didn’t you select the other two options?
What was your goal of treatment
-Was the outcome what you expected? Why?

-Conclusion with Ethical considerations

Resourse : Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press

SAMPLE

Excerpt from Case Study :

Puerto Rican Woman with Comorbid Addiction: A Case Study

Ms. Perez is a 53-year-old Puerto Rican female who has complained that she is suffering from co-morbid addictions of alcoholism and gambling. Ms. Perez has sought treatment for alcoholism in the past but the combination of living near a casino and the availability of alcohol has caused her to relapse as well as to engage in gambling on a regular basis. Her gambling has negatively impacted her marriage and has also caused her to borrow significant sums from her retirement account. The patient is exhibiting the symptoms of depression, including a sad and lethargic demeanor.A Puerto Rican Woman With Comorbid Addiction

Decision One

One option for the patient is prescribing Antabuse (Disulfiram), a medication which “blocks an enzyme that is involved in metabolizing alcohol intake” and “produces very unpleasant side effects when combined with alcohol in the body” (“Antabuse,” 2017). The drug is designed to interfere with the rewards drinking alcohol produces in the patient, given that alcoholism is an addiction with both physical and mental components. Antabuse has the benefit of being specifically prescribed to treat alcohol addiction, in contrast to other medications such as Naltrexone (Vivitrol), which is prescribed for both opioid and alcohol-related addictions. Naltrexone has the disadvantage of being injected versus taken orally, and the patient has a greater sense of control over the administration of this particular drug when taken orally, which may enhance long-term compliance.A Puerto Rican Woman With Comorbid Addiction

Another possible pharmaceutical intervention is Campral (acamprosate), a drug which is also exclusively prescribed to treat alcohol dependence. However, Campral can produce very unpleasant side effects in some patients, including drowsiness “that may impair your thinking or reactions,” according to its warning label, and users are instructed to “be careful if you drive or do anything that requires you to be awake and alert” (“Campral,” 2017). Although side effects are also reported with Antabuse, drowsiness is listed as a less common side effect (“Antabuse,” 2017). The hope is to reduce the patient’s reliance upon alcohol without causing effects that could act as a deterrent in her pursuit of sobriety………….A Puerto Rican Woman With Comorbid Addiction

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