NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology | Week 8

Impulsivity and compulsivity have a wide range of clinical presentations and often overlap with many other psychiatric disorders. Some individuals act without forethought and have difficulty saying “no” to certain things such as using illicit drugs or spending money, whereas other individuals engage in compulsive behaviors with undesirable consequences. In some cases, these impulsive and compulsive behaviors also fuel issues with addiction. To effectively assess and treat clients, you must understand how these disorders differ, as well as how their symptoms impact clients and their families. NURS 6630: Week 8: Case Study: A Puerto Rican Woman With Comorbid Addiction.

This week, as you examine therapies for individuals with impulsivity, compulsivity, and addiction, you explore the assessment and treatment of clients with these disorders. You also consider ethical and legal implications of these therapies.

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

Learning Objectives – NURS 6630: Week 8: Case Study: A Puerto Rican Woman With Comorbid Addiction

Students will:

• Assess client factors and history to develop personalized therapy plans for clients with impulsivity, compulsivity, and addiction
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addiction
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing therapy for clients with impulsivity, compulsivity, and addiction

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 Materialssection of your Syllabus.

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.

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: Case Study: A Puerto Rican Woman With Comorbid Addiction

For insomnia

For obsessive-compulsive disorder

• Citalopram
• clomipramine
• escitalopram
• fluoxetine
• fluvoxamine
• paroxetine
• sertraline
• venlafaxine
• 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: Substance 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

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

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

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

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

Required Media – NURS 6630: Week 8: Case Study: A Puerto Rican Woman With Comorbid Addiction

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:

• Decision #1
  • Which decision did you select?
  • 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?
• 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?
• 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?

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. NURS 6630: Week 8: Case Study: A Puerto Rican Woman With Comorbid Addiction.

ADDITIONAL INFORMATION;

Psychopharmacologic Approaches to Treatment of Psychopathology

Introduction

Psychopathology is the mental health condition that results from a disturbance in the normal functioning of the brain. The term “psychopathology” is often used to refer to the symptoms or behaviors of persons with mental disorders, but it can also be used to describe conditions such as epilepsy or diabetes that have no specific psychiatric diagnoses attached. In this article we will discuss how pharmacotherapy works in treating psychopathy and provide an overview of evidence-based treatments for specific types of psychopathology and disorders

Introduction

Psychotropic medications are used in the treatment of a variety of psychiatric disorders, including schizophrenia, bipolar disorder, depression, anxiety disorders and substance use disorders.

The exact mechanism of action for these drugs is not fully understood but it has been suggested that they act by influencing the activity of neurotransmitters such as serotonin (5-HT), norepinephrine (NE), dopamine (DA) or histamine which are involved in mood regulation and learning/memory functions.

Psychopharmacologists have developed many different types of psychotropic medications to treat different types of psychopathology; however there are some commonalities between them:

Treatment of Psychopathology

Psychopharmacologic treatment of psychopathology is the use of medications to alter the symptoms and/or course of a disorder. The term “psychopharmacology” is derived from the Greek words psychos (mind) and pharmacos (drug), which refer to medicines that work on mental processes. The first use of these terms in this context was by German psychiatrist Julius Wagner-Jauregg, who published a study on the use of succinylcholine as an anticonvulsant in 1906 [1].

In general, pharmacotherapy involves administration of drugs that have been developed specifically for treating certain disorders or symptoms associated with those disorders. There are several different types of pharmacotherapies:

• Pharmacotherapy for specific disorders such as schizophrenia or depression may involve one type only; e.g., lithium has been used primarily for treating bipolar disorder but can also be used for mood stabilization after surgery or convulsions due to epilepsy;

• Pharmacotherapy for specific symptoms such as fatigue may involve more than one type; e.,g., antidepressant agents are effective at reducing fatigue but not necessarily other symptoms associated with depression like insomnia;

• Pharmacotherapy also involves administration over longer periods than short term treatments like antidepressants do because they need time before their effects kick in so we call them slow titration products rather than fast ones like amitriptyline which works immediately upon intake!

Clinical Approach to the Patient with Psychopathology

The first step in the clinical approach to the patient with psychopathology is listening. First, listen closely and ask questions of the patient. Second, provide reassurance that you will help him or her get back on track with treatment. Third, evaluate their mental status by assessing for changes in thinking patterns or behavior patterns associated with their symptoms (e.g., confusion about names). Fourth, determine if there are any comorbid conditions that could be contributing factors such as manic episodes/mania (Bipolar Disorder), schizophrenia spectrum disorders such as schizotypal personality disorder and paranoid schizophrenia spectrum disorders such as disorganized attachment disorder (Disorders Related to Attachment Theory) which include autism spectrum disorders; substance abuse problems; eating disorders such as anorexia nervosa and bulimia nervosa

Psychiatric History

• History of presenting problem.

• History of psychiatric symptoms.

• History of medical symptoms, including physical complaints and medications taken.

• History of substance use (including drugs and alcohol). If you have a history of drug or alcohol abuse, please tell us about it here in the question section below so that we can consider this part of your history when assessing for possible drug interactions with other treatments you may be receiving here at WPCS-HELEN.

Mental Status Examination (MSE)

Mental status examination is the process by which mental health professionals evaluate a person’s state of mind, thoughts, and feelings. The MSE includes such tests as the Wechsler Adult Intelligence Scale (WAIS) vocabulary test and the Wechsler Memory Scale (WMS-III).

The purpose of any mental status assessment is to examine whether there are signs that indicate risk for developing a psychiatric disorder; this may be done by comparing results from different tests (e.g., WISC-IV IQ subtests), looking at specific behaviors that occur repeatedly over time (e.g., mania), or observing behavior in response to treatment interventions such as medication changes or psychotherapy sessions

Diagnosis and Formulation

The first step in finding the right treatment plan is defining your problem. This can be difficult because it’s easy to get lost in the details, but it’s important to break down what you’re dealing with before you start working on a solution.

• Set goals: What do you want out of life? What are some concrete steps towards achieving those goals?

• Don’t worry about other people’s goals: If they seem too high or low, don’t worry about them—they may have different priorities than yours. Try not to compare yourself with anyone else! Letting go of comparison will allow room for growth while keeping expectations realistic and manageable at any given time (a good rule of thumb).

Differential Diagnosis

Differential diagnosis is the process of determining which illness or disorder is causing a patient’s symptoms. It involves identifying possible causes, then ruling them out one by one until only one remains.

Differential diagnoses are based on characteristic signs and symptoms, so they may be helpful in making a preliminary determination about what kind of disorder you’re dealing with—but they don’t provide an exact diagnosis. In addition to these broad categories, there are many different types of disorders that have similar names; for example: borderline personality disorder (BPD), schizophrenia spectrum disorders (SSDs), bipolar I disorder and II disorder—these terms refer specifically to sets of symptoms rather than specific diseases or conditions

Treatment Plan and Goals

The treatment plan should be specific, measurable, realistic and achievable. It should also be reviewed regularly and modified accordingly.

The patient must have access to the treatment plan so they can understand what is expected of them as well as any accommodations made for their needs (i.e., medication management). In addition, it’s important that patients feel comfortable discussing any concerns or questions with their therapist or physician; this will allow for an open dialogue about how things are going so far on therapy sessions without fear of judgement or stigma from others who may not understand mental health issues as well as you do yourself!

Prioritize Treatment Targets

When prioritizing treatment targets, you should consider the following:

• The patient’s goals, preferences and values. What do they want to accomplish? What are their priorities in life? And how can we help them do so?

• The patient’s comorbidities. How is their mental health affected by other medical conditions (e.g., diabetes), environmental factors (e.g., poverty) or social circumstances (e.g., abuse)?

• The patient’s age, gender and cultural background; these factors may influence their response to certain medications or psychotherapies in different ways than others would respond differently depending on these factors alone but also play an important role when assessing the optimal course of treatment for each individual case because it will affect how much time should be spent on each component within an overall plan that includes medication management/dosing adjustments based upon monitoring blood levels/urine samples taken every week over time during regular visits with your prescribing physician before starting therapy sessions at home once you feel comfortable doing so!

Psychological Therapies in the Management of Psychopathology

Psychological therapies are the treatment of choice for many mental disorders, and they can be effective in the management of many other disorders. In fact, psychological therapies are often used as a first line of treatment for most mental disorders.

Psychological therapies can be used in combination with medication to provide better outcomes than either modality alone (Kroenke et al., 2012).

Psychopharmacologic Management of Psychopathology

Psychopharmacologic management is the use of medication to treat mental illness. Psychotropic medications are used to treat a wide range of psychiatric disorders, including depression, attention deficit hyperactivity disorder (ADHD) and schizophrenia. While they may not be as effective as psychotherapy in treating these conditions, they can be quite useful when other treatments prove ineffective or insufficiently effective.

Psychotropic medications fall into two categories: tranquilizers and antidepressants. Tranquilizers are used primarily for anxiety disorders such as panic attacks or generalized anxiety disorder; however there are some tranquilizers that also have mood altering effects if taken daily like valium or Xanax which is an anti-anxiety medication prescribed specifically for insomnia secondary to PTSD symptoms caused by traumatic events experienced during military service overseas where soldiers may serve multiple tours over several years before being redeployed back home again where they must adjust back into civilian life with all its stressors such as financial problems due moving schools etcetera…

Evidence-Based Pharmacotherapy for Specific Psychopathologies and Disorders

While medications are an important part of the treatment of a number of psychological disorders and conditions, they should not be used as a stand-alone. In most cases, psychotherapy is also required to help patients with their symptoms and provide them with skills to manage them on their own. For example, when people take antidepressants for depression they may experience some improvement in mood but not necessarily enough to make them feel better overall. This can be frustrating because it feels like something is happening but isn’t quite right yet and that’s why many people turn back toward psychotherapy after taking medication for awhile!

However there are times when we know that medication alone won’t provide sufficient relief from severe symptoms; this means we need both therapies together in order for each one’s strengths complement each other (for example: SSRI antidepressants may work well against anxiety disorders but don’t work so well against PTSD).

Conclusion

The treatment of psychopathology requires a multidisciplinary approach. Psychopharmacology is an important tool in the treatment of anxiety and mood disorders, but it is not a replacement for psychotherapy. It can be used in conjunction with a comprehensive medical evaluation to provide the patient with the best possible chance of successful treatment outcomes.