Week 8 assignment
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 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.
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: 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.
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:
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?
Walden NURS 6630 Week 8 Sample Paper
(Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction)
Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction
Student’s Name:
Institutional Affiliation:
Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction
In the treatment of alcohol use disorder, gambling, and other addiction disorders, a PMHNP must take time to consider the effects of the chosen treatment and its effectiveness. This will be essential in ensuring that only the right medication is administered to avoid adverse effects on the patients and the chances of picking another addiction. The evaluation of pharmacokinetics and pharmacodynamics of different preferred drugs and their effects on patients is critical in making decisions of the most appropriate prescription for addiction patients. This paper explores the decisions that will be made in treating a 53-year-old Puertorican female with gambling and alcohol use disorder.
Decision #1
For the first decision, I choose to administer Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every four weeks to the patient. I selected the decision to administer Naltrexone to the patient as the drug would be effective in alleviating the alcoholism problems in the patient, which was their main challenge that fueled their gambling problems. According to Swiatek, Bosso, & Hughes (2018), Naltrexone (Vivitrol) injection is effective in treating alcoholism as it reduces the urge to drink. This helps patients to drink less or to stop drinking altogether.
I opted against the other two decisions, including administering Antabuse (Disulfiram) 250 mg orally every morning and administering Campral (acamprosate) 666 mg orally TID due to the adverse side effects that both the drugs would have on the patient and the less efficacy in resolving the patient’s alcohol abuse disorder. According to Skinner, Lahmek, Pham, & Aubin (2014), Antabuse (Disulfiram) may cause psychotic reactions among patients when it is administered in large doses. The administration of 250mg on the patient would be expected to have adverse side effects on the patients and thus was not chosen. According to Maisel, Blodgett, Wilbourne, et al. (2015), Campral (acamprosate) may have adverse side effects on patients, including fear, severe depression, and an extreme feeling of emptiness and sadness when administered in larger dosages. I ruled against the administration of Campral 666 mg orally was due to the anticipated adverse effects.
By administering Naltrexone (Vivitrol) injection, 380 mg intramuscularly, I was hoping to address the patient’s alcohol abuse disorder by reducing the amount of alcohol she took. Naltrexone (Vivitrol) injection is effective in treating alcoholism as it reduces the urge to drink among patients (Swiatek et al., 2018).
What I was hoping to achieve by administering Naltrexone (Vivitrol) injection was similar to what I achieved in that after a month, the client reported to the clinician and highlighted she had not taken alcohol in the past month and that she felt great. This showed that the naltrexone (Vivitrol) injection had worked as expected in stopping the patient from abusing alcohol.
Decision #2
For the second decision, I choose to refer the client to the counselor to address her gambling issues. According to Choi, Shin, & Kim, et al. (2017), psychotherapy is the most effective method of treating pathological gambling, such as in the case of Mrs. Perez. Referring the client to the counselor would therefore put her up to receive evidence-based therapies, including cognitive-behavioral therapy, Gambler’s Anonymous, psychodynamic therapy, behavioral therapy, and family therapy (Choi et al. 2017). These therapies would be effective in treating the client’s gambling disorders.
By making the decision to refer the client to a counselor to address her gambling issues, I was hoping to help the clients deal with her gambling addictions. I was also hoping that the anxiety side effects that the client experienced after the first month of treatment with naltrexone (Vivitrol) injection would subside with no need for treatment.
What I was hoping to achieve in making decision #2 was similar to what I achieved in that though the patient stated that she did not like her counselor, she started some session and enrolled in gamblers anonymous, where she felt supported. The patient’s anxiety also dissipated with no need for treatment, which was expected.
Decision #3
For the third decision, I choose to explore the issues Mrs. Perez was having with her counselors and encouraged her to keep attending her gamblers anonymous meetings where she was receiving a lot of support. According to Menchon, Mestre-Bach, Steward, et al. (2018), there will be no FDA approved pharmacological treatments for gambling, with counseling being the only effective option for treatment.
In making the decision to explore the issues between Mrs. Perez and her counselor and encourage her to keep attending the gamblers anonymous session, I was therefore hoping to help her kick her gambling habit through evidence-based psychotherapeutic measures. According to Ngepa Menchon et al. (2018), psychotherapeutic measures are effective in treating pathological gambling.
What is expected to achieve in encouraging Mrs. Perez to keep seeing her counselor and attending gambler anonymous decisions were similar to what I achieved in that the client reduced her gambling habit after a month of attending the sessions with a clear indication that the client would be able to quit completely after a time.
Ethical Considerations
Confidentiality and beneficence will include the two ethical considerations that would need to be included in the care of the patient. All the treatment decisions taken would, therefore, be for the benefit of the patients. The decisions would also be kept confidential and never revealed to any third parties (Stein & van Niekerk, 2015).
References
Choi, S., Shin, Y., & Kim, D. et al. (2017). Treatment modalities for patients with gambling
disorder. Ann Gen Psychiatry 16, 23. https://doi.org/10.1186/s12991-017-0146-2.
Maisel, N. C., Blodgett, J. C., Wilbourne, P. L., Humphreys, K., & Finney, J. W. (2015). Meta-
analysis of Naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful?. Addiction (Abingdon, England), 108(2), 275–293. https://doi.org/10.1111/j.1360-0443.2012.04054.x.
Menchon, J. M., Mestre-Bach, G., Steward, T., Fernández-Aranda, F., & Jiménez-Murcia, S.
(, 2018). An overview of gambling disorder: from treatment approaches to risk factors. F1000Research, 7, 434. https://doi.org/10.12688/f1000research.12784.1.
Stein, D. J., & van Niekerk, A. A. (2015). Ethics of psychopharmacology. International
perspectives in philosophy and psychiatry. The Oxford handbook of psychiatric ethics (p. 1175–1190). Oxford University Press.
Swiatek, D., Bosso, N.A., & Hughes, L.P (2018). Naltrexone for the Treatment of Alcohol Use
Disorder in the Primary Care Setting. US Pharm. 2018; 43(8)26-33.
Skinner, M. D., Lahmek, P., Pham, H., & Aubin, H. J. (2014). Disulfiram efficacy in the
treatment of alcohol dependence: a meta-analysis. PloS one, 9(2), e87366. https://doi.org/10.1371/journal.pone.0087366.
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