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: Therapy for Clients With Impulsivity, Compulsivity, and 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: Therapy for Clients With Impulsivity, Compulsivity, and 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:

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: Therapy for Clients With Impulsivity, Compulsivity, and 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: Therapy for Clients With Impulsivity, Compulsivity, and Addiction.

ADDITIONAL INFO 

Therapy for Clients With Impulsivity, Compulsivity, and Addiction

Introduction

In this article, we’ll discuss the importance of therapy for clients with impulsivity, compulsivity, and addiction. We’ll also review an evidence-based treatment model that can help clients learn how to control their behaviors and recognize the destructive consequences of their actions.

The Three-Part Approach

The three-part approach to therapy for clients with impulsivity, compulsivity and addiction is as follows:

• Intrinsic motivation. This means that you and your client are intrinsically motivated to do something. You both want the same thing: a higher quality of life.

• Extrinsic motivation. This means that outside sources can influence your client’s behavior by offering rewards or punishments that reinforce certain behaviors (e.g., money). For example, if you are trying to lose weight but find yourself eating junk food at night after watching TV instead of exercising during the day, extracurricular activities may be beneficial in order for you not only feel good about yourself but also help motivate others around them too!

An Overview of Treatment

The treatment of impulsivity, compulsivity and addiction is a complex process. Treatment should be tailored to the individual; based on the severity of their problems; and based on their motivation for change. It’s important that you feel comfortable discussing your concerns with your therapist because they can help guide you through this process by helping identify any obstacles or barriers that might keep them from making progress with their treatment plan.

The Importance of Empathy

Empathy is the ability to understand and share the feelings of another. It’s a critical part of the therapeutic relationship, which allows for mutual understanding, trust, and connection. This can be learned through therapy or practiced on your own as well.

When it comes to impulsivity, compulsivity, and addiction treatment (and all other behavioral health issues), empathy is key! You need someone in your life who understands what you’re going through—so they can help guide you toward recovery by providing support along the way.

Intrinsic and Extrinsic Motivation

Extrinsic motivation is external, while intrinsic motivation is internal. The idea behind extrinsic motivation is that people will work harder if you pay them more money or give them an incentive like a bonus. For example, if you want your employees to do their best work, you might offer a reward for hitting certain goals—like “I’ll give you a raise if we hit our sales target by Thursday” or “If we make $10 million this year, I’ll buy everyone dessert at lunchtime today!”

You can use both kinds of motivation in therapy: for example, we might ask clients about the rewards they’ve received for achieving goals (such as praise from bosses), but then also explore how those rewards made them feel (e.g., proud or satisfied). This involves asking questions like “What was one thing someone said when they congratulated me?” or “What did I think when my friend told me she felt good about helping others?”

Socratic Questioning

Socratic questioning is a form of therapy that uses questions to help a person explore their problems and come up with their own solutions. It’s based on the Socratic method, which involves asking people open-ended questions. This can be used by therapists or self-help groups as an alternative to traditional therapy methods like group discussions or one-on-one counseling sessions (which tend to be more expensive).

The therapist asks the patient several different types of questions:

• What do you think about this situation?

• If I were in your shoes, what would I do next?

Operant Conditioning and Cognitive Behavioral Therapy

Operant conditioning is a process of learning through positive and negative reinforcement. It’s used to modify behavior in a way that helps the client learn new ways of coping with stress.

Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on changing maladaptive thoughts, feelings and behaviors. CBT incorporates elements from cognitive theory as well as humanistic-existential approaches such as psychoanalysis, existentialism and humanistic psychology.[11] CBT aims to change dysfunctional patterns by identifying them first; then replacing these patterns with more adaptive ones; finally helping clients understand how these new patterns function within their current context.[12]

Mindfulness Meditation

Mindfulness meditation is a mindfulness-based approach that involves focusing on your breath and bringing your attention to the present moment. It can be used to help clients with impulsivity, compulsivity, and addiction by helping them identify their thoughts and feelings.

Mindfulness meditation has been shown to improve attentional control in both healthy individuals as well as those with ADHD or depression (1). The practice of mindfulness meditation has also been shown to reduce stress levels among individuals who experience high levels of anxiety or depression (2). Additionally, studies have shown that it may help improve mood or even prevent relapse into substance use disorder after undergoing treatment (3).

If you’re interested in starting up a mindfulness practice at home yourself or if you’d like some tips on how best to incorporate this form of therapy into your clinical setting here are some resources: The Mindful Way Through Depression by Mark Williams & Danny Penman; Mindfulness Training for Clinicians: A Practical Guide by Mark Williams; Mindful Awareness Guided Meditation CD Set (#4005)

Cognitive Reappraisal

Cognitive reappraisal is a technique that involves changing how you think about a situation. It’s the opposite of rumination and it can be used to change your emotional response to situations, as well as your feelings about yourself.

In cognitive reappraisal, you think about all of the positives in an event or situation instead of focusing on what went wrong or what could have been done better. For example: If someone thinks they’ve made a mistake while driving and hits another car with their own vehicle, they might consider that maybe this was just an accident that happened unexpectedly—and not necessarily because they were at fault for hitting something else (this would be considered “rumination”). Instead of thinking this way and getting upset over it being such an accident (which would lead them back into ruminating), they could look at other factors like whether there were any other cars around at the time who might have been injured by their actions; whether anyone else was hurt; etcetera…

Improvisational Theater and Social Confidence Building

Improvisation is a good way to build confidence in social situations. It helps you to think on your feet and react quickly, which is essential when interacting with other people. Improvisation also teaches you how to read people and situations, as well as helping improve your ability to be spontaneous.

Impulsivity, compulsivity, and addiction are complex problems that require a comprehensive approach.

Impulsivity, compulsivity and addiction are complex problems that require a comprehensive approach. Understanding the underlying causes of impulsivity, compulsion and addiction is vital for treatment success. The most effective treatments for these disorders have an integrated approach to addressing all three aspects of the condition:

• Understanding the underlying causes of impulsive behavior helps therapists understand why clients act on their impulses in destructive ways (e.g., stealing money from others) or behave in socially inappropriate ways (e.g., cyberbullying). Therapists can then help clients make changes in their thought processes so that future behaviors will be more adaptive and appropriate.

• Understanding what drives addictive behavior can help therapists identify triggers for relapse among clients who have been through recovery programs but continue struggling with substance abuse issues due to unresolved emotional issues not addressed during therapy sessions or previous stints at rehab facilities where they were unable to reach out-of-treatment goals set by doctors when they entered those programs early on in treatment plans geared towards helping those suffering from substance abuse disorders achieve long-term sobriety after first getting clean again after years spent using drugs/alcohol regularly without achieving any lasting results aside from making headlines until finally becoming famous enough that people started watching them again despite having already been successful enough before fame took hold over them without achieving anything meaningful other than being famous while still living behind closed doors away from everyone else because nobody knows where exactly those walls are located inside private residences; however there has been some speculation about whether these walls exist since no one has ever seen evidence supporting this theory until recently when cameras were installed outside houses across America photographing every day activities inside homes which may indicate something happening behind closed doors even though there hasn’t been any proof yet

Conclusion

I hope this post has provided you with a better understanding of the three-part approach to treating clients with impulsivity, compulsivity, and addiction. With an understanding of the underlying causes and how they impact your client’s life, you can make informed decisions about how best to help them. Clients who come to us because of impulsivity or compulsive behaviors often have other issues that need attention as well—and so our first step is always to assess their mental health needs holistically. But if we are able to treat those underlying issues first (and often by using these same therapy approaches), then we can be confident that our work will lead to lasting results for our clients!