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.

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

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: Psychopharmacologic Approaches to Treatment of Psychopathology | Week 8

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

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:

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

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: Psychopharmacologic Approaches to Treatment of Psychopathology | Week 8.

ADDITIONAL INFO 

Psychopharmacologic Approaches to Treatment of Psychopathology

Introduction

Psychotropic medications are drugs that affect the mind and emotions. They’re used to treat many conditions, including depression and anxiety disorders. For some people, these medicines can have a positive impact on their symptoms, while others may experience worsening of symptoms.

A lot of people have some type of psychological disorder that can be treated with drugs.

It’s important to note that a lot of people have some type of psychological disorder that can be treated with drugs. The most common types are anxiety, depression and schizophrenia. Anxiety disorders are the most common type of mental illness in America today by far; they affect more than 18 million Americans each year (1).

When you think about it, you’re probably familiar with someone who suffers from an anxiety disorder or depression. These conditions affect everyone differently—some people may experience symptoms for years before seeking help; others get better quickly after starting medication treatment—but all share one thing in common: their ability to disrupt your life negatively by causing symptoms such as panic attacks or feelings of hopelessness when faced with stressful situations at work or school.

Different types of disorders are caused by different things and are treated differently.

There are many different types of disorders, and each type has its own specific treatment. Some disorders are caused by genetics, some by brain chemistry, some by experiences in life. Sometimes you’ll get better with drugs alone; sometimes you need both a drug and psychotherapy (or combinations of these two) to help make your symptoms go away.

There are many drugs available to treat disorders.

There are many drugs available to treat disorders. They can be used to treat the symptoms of a disorder, or they can be used to treat the cause of a disorder.

The most common way to deliver medication is orally through the mouth.

The most common way to deliver medication is orally through the mouth. Many medications are available in tablet, capsule or liquid form.

• Tablets: Tablets are coated with a substance that helps them dissolve easily in water and makes them easy to swallow. They can be taken by mouth alone or with food or liquids such as juice or soup; they do not need to be divided into equal doses before taking them (i.e., one tablet at once).

• Capsules: Capsules have an opening at one end that allows you to open each capsule individually without crushing it by hand first; this means there is less risk of swallowing air when opening capsules than there would be if you were using tablets instead of capsules—especially if someone else needs help opening up those pesky things!

It is important to prescribe the correct amount of drug.

It is important to prescribe the correct amount of drug. Drugs are not one size fits all and each individual may benefit from different dosages. Some people need more than others, while some need less. Some drugs have side effects and can interact with other medications or therapies; these are called contraindications or adverse interactions, respectively. When prescribing medications for someone with a mental illness, it is essential that you consider their overall health history and understand what kind of treatment plan might work best for them based on their specific symptoms and medical history (e.g., seizure disorders).

Conclusion

The most important thing to remember is that psychotropic drugs are not meant to take the place of therapy or counseling. They should only be used as a supplement. The best way to treat your patients is with compassionate, non-judgmental care and support.