(Solution) NURS 6630 Week 10 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.

Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/

To prepare for this Assignment:

  • Review this week’s Learning Resources, including the 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.

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.

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents 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 2 years, she has been having more and more difficulty maintaining her sobriety since the opening of the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during its 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 2 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 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 she 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 borrowed over $50,000 from her retirement account to pay off her gambling debts, and her husband does not know.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert and 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. When 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 and self-reported mood. She denies visual or auditory hallucinations, and 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.

Diagnosis: Gambling disorder, alcohol use disorder

 

Decision Point One

Select what you should do:
Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
Antabuse (disulfiram) 250 mg orally daily
Campral (acamprosate) 666 mg orally three times/day

Comorbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female

Puerto Rican female 

Decision Point One
Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

  •  Client returns to clinic in four weeks
  •  Mrs. Perez says she feels “wonderful” as she has not “touched a drop” of alcohol since receiving the injection
  •  Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)
  •  Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also has her concerned
Decision Point Two
Refer to a counselor to address gambling issues

RESULTS OF DECISION POINT TWO

  •  Mrs. Perez returns in 4 weeks and reports that the anxiety that she had been experiencing is gone.
  •  She reports that she has met with the counselor, but she did not really like her.
  •  She also started going to a local meeting of Gamblers Anonymous. She states that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group.
Decision Point Three
Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

Guidance to Student
Although controversy exists in the literature regarding how long to maintain a client on Vivitrol, 8 weeks is probably too soon to consider discontinuation. The psychiatric mental health nurse practitioner should explore the issues that Mrs. Perez is having with her counselor. As will be covered in more depth in future courses, ruptures in the therapeutic alliance can result in clients stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (than had the client continued to receive therapy). Recall that there are no FDA-approved treatments for gambling addiction. The mainstay of treatment for this disorder is counseling. Since Mrs. Perez reports good perceived support from the Gamblers Anonymous meetings, she should be encouraged to continue her participation with this group.

You need to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

Solution:

Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Introduction

There is a correlation between impulsivity, compulsivity and addiction. Addiction is a process that involves coordination of behaviors from impulsive to compulsive(Grassi, 2020). Therefore, impulsivity takes place in the early stages of addiction when a person acts impulsively to experience the pleasure of his addiction, while compulsive addiction takes place when there are shifts that make a person not just addicted exclusively to pleasure but also take part in their addiction to experience the pleasure that comes out of it and to relieve anxiety(Grassi, 2020). Impulsivity and compulsivity are signs that reveal themselves when the brain is not able to say no to some behaviors.

The case study in this article is a female aged 53 years from Puerto Rico who comes to the clinic because of a fairly “unwelcome problem” with alcoholic addiction. She says she started using alcohol when she was twenty years old, after the death of her father. The patient reports that she has been involved with alcohol from time to time over the past 25 years and that she has been having difficulties trying to stop taking alcohol, which has deteriorated during the past two years due to her fight against gambling addiction, following the opening of a casino near her home(Grassi, 2020). The aim of this case is to show how the impact of pharmacokinetics and pharmacodynamics and the ethical and legal implications of the prescription of treatment for patients with impulsivity, compulsivity, and addiction are evaluated and developed(Grassi, 2020).

 

 

Decision One

Decision one is to inject the patient in the gluteal area every four weeks with Naltrexone (Vivitrol), with 380 mg deep inside the muscles(Serretti, 2018).

Rationale

Naltrexone is usually used for dependency on alcohol and works by decreasing alcohol consumption by altering opium systems to reduce alcohol’s rewarding effects(Blanco-Gandía, & Rodríguez-Arias, 2018). The FDA approved the development of Naltrexone injection to deal with the problem of oral naltrexone and it is done on a monthly basis instead of daily usage, which decreases patients’ chances of stopping medication (Blanco-Gandía, & Rodríguez-Arias, 2018). Naltrexone usage has some side effects, such as nausea and vomiting, sleep difficulties, abdominal discomfort and pain, fatigue, headache, and anxiety(Serretti, 2018).

Why Other Options Were Not Considered

The alternative therapy options include Antabuse (Disulfiram) 250 mg taken orally daily and Campral (Acamprosate) 666 mg taken orally three times daily are not effective for the patient at the moment(Serretti, 2018). For maintenance of alcohol abstinence, both medicines are recommended(Blanco-Gandía, & Rodríguez-Arias, 2018). If the patient uses antabuse with alcohol, she can have side effects which include alcohol toxicity, which makes it not ideal at the moment(Blanco-Gandía, & Rodríguez-Arias, 2018). Campral does not have a good dosage choice for the patient as she weighs 122 lbs. If the patient weighs less than 132 lbs, they should……Please click the icon below to purchase full answer at only $15