NURS 6630 Assignment Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction
NURS 6630 Assignment Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction
Psychopharmacological Approach to Treat Psychopathology
Impulsivity disorders are characterized by the inability to resist the sudden, powerful desire to do something and difficulties controlling emotions or behaviors. On the other hand, addiction is a complex mental condition characterized by compulsive substance use regardless of detrimental consequences. The purpose of this paper is to describe a patient with an addiction disorder and the treatment interventions.
Introduction to the Case
Mrs. Perez, a 53-year-old Puerto Rican woman, is portrayed in the case scenario as having alcohol drinking problems since her late adolescence. Perez has been a member of Alcoholics Anonymous on and off for the past 25 years. The patient also claims that it has become more difficult for her to stay sober in the two years since a casino opened in her neighborhood. Perez mentions getting high while gambling because she drinks while playing high-stakes gambling games. This, however, leads to increased alcohol consumption and reckless gambling. Furthermore, the client claims she has increased her smoking over the last two years and is concerned about the negative health effects.
Mrs. Perez reports that she has tried to abstain from alcohol consumption, but gambling gets her high, so she has a few drinks to compensate. She has also realized that while drinking alcohol, she smokes very little, but she enjoys smoking when gambling. The patient gained weight as a result of her excessive drinking, and she is now 122 pounds, having gained 7 pounds. The patient is concerned because she borrowed over $50,000 from her retirement account to pay off gambling debts. MSE findings of note include avoiding eye contact, a sad mood, and impaired impulse control. Mrs. Perez has a gambling disorder as well as an alcohol use disorder. Patient factors that may influence treatment decisions include age, overall health status, and comorbid mental health illnesses.
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 also fuel issues with addiction. To effectively assess and treat patients, you must understand how these disorders differ as well as how their symptoms impact patients and their families.
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Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction SAMPLE 2
The 53-year-old Puerto Rican female presents with alcohol use disorder which was diagnosed when she was in her 20s. She claims that her problems are embarrassing comprising of alcohol addiction, cigarette smoking, and gambling. About 2 years back, the patient claims that a casino was opened in the neighborhood, which made her start drinking a gain after several years of sober, as she enjoys taking alcohol and smoking when gambling. This also led to her gaining about 7lbs. Her gambling has been getting worse ever since, as she reports that she borrowed about $50,000 from her retirement account and used the money to pay gambling debts. She is afraid that when her husband finds out, he will be furious. Mental status examination results reveal that the patient is sad, and her impulse control is also impaired. The patient displayed no psychiatric symptoms, hence diagnosed with alcohol use disorder (AUD) and gambling.
In the management of the patient’s health needs, several factors will be taken into account when choosing the most effective and safest medication to prescribe. For instance, the patient history of chronic alcohol use disorder and gambling will promote the selection of the most effective medication. Her age and race will also help in selecting the medication in addition to determining the appropriate dosage and frequency. Her recent weight gain will also influence the decision on which drug to select as most psychotropic agents usually lead to weight gain. The purpose of this discussion is to select the most appropriate interventions in the management of this patient, with an illustration of the expected outcome and ethical considerations at each decision point.
Decision Point One
Selected Decision and Rationale
Administering naltrexone 380mg IM injection on the gluteal area was selected as the initial intervention. Naltrexone has been approved by the FDA and recommended by most clinical guidelines including National Institute for Health and Care Excellence (NICE) as the most effective and safest medication for treating alcohol use disorder (Martinac et al., 2019). Naltrexone had an antagonistic effect on the opioid receptors which inhibits the binding of endogenous opioids (Pakri Mohamed et al., 2018). Studies show that naltrexone also has potential effectiveness in reducing the urge of gambling among patients with comorbid gambling and alcohol addiction (Blanco-Gandía & Rodríguez-Arias, 2018). Naltrexone has been reported to mainly target the Asp40 allele with is predominant among Puerto Ricans hence promoting its effectiveness among this population (Wieczorek & Dąbrowska, 2020). The long-acting formulation was selected as it is more convenient for the patient due to its administration once a month (Renner & Ward, 2016).
The disulfiram preparation provided is short-acting, which might affect the patient’s compliance level, in addition to its increased risks of adverse events like palpitations (Pakri Mohamed et al., 2018). Acamprosate is also short-acting, with an even higher frequency of administration, which might make it hard for the patient to remain compliant with the medication (Kelly & Renner, 2016).
Expected Outcome
With the use of naltrexone for the following month, the patient’s urge to drink or gamble should reduce significantly (Grant & Chamberlain, 2020). His smoking habit is associated with gambling, hence also expected to reduce within this time (Wieczorek & Dąbrowska, 2020).
Ethical Consideration
In taking care of patients with substance use disorder, clinicians are advised to be non-judgment and not to discriminate against the patient based on their gender or race, or any other factors (Martinac et al., 2019). The PMHNP observed the ethical principle of justice in taking care of this patient (Blanco-Gandía & Rodríguez-Arias, 2018).
Decision Point Two
Selected Decision and Rationale
Referring the patient to a counselor to help with the patient’s gambling habits was selected as the second decision. The patient displayed great effectiveness with naltrexone based on the reported outcome as she claims to have never used alcohol ever since the day she received the first injection (Kelly & Renner, 2016). The only side effect that was reported was anxiety, which is common among patients on naltrexone but disappears with time itself (Grant & Chamberlain, 2020). The patient urge of gambling was also reduced but she was still concerned about the few times that she gambles as she wastes a lot of money hence the need for a specialist (Pakri Mohamed et al., 2018; Renner & Ward, 2016). Evidence demonstrates that there is no specific medication for gambling, but most patients have reported positive outcomes with the use of cognitive behavioral therapy (Wieczorek & Dąbrowska, 2020). The counselor is expected to address the patient’s gambling, which will in turn help her stop smoking.
Administering diazepam as an adjunct to naltrexone was inappropriate as the drug is addictive (Pakri Mohamed et al., 2018). Chantix is effective in smoking cessation but can only be used together with naltrexone in low doses once daily for a short period (Kelly & Renner, 2016).
Expected Outcome
With appropriate intervention implemented by the counselor and continuous use of naltrexone, the patient will continue being sober, with a reduced urge to gamble (Wieczorek & Dąbrowska, 2020). She will also be able to stop smoking (Grant & Chamberlain, 2020). The previously reported anxiety symptoms are also expected to resolve completely within this time.
Ethical Consideration
Ethically, nurses are required to treat every patient equally with no discrimination. Promoting patient-centered care is also crucial, with more focus on satisfying the needs of the patient (Martinac et al., 2019). For instance, in this decision, the patient was mainly concerned about her gambling, which can be adequately addressed by a counselor (Blanco-Gandía & Rodríguez-Arias, 2018). The PMHNP observed the ethical principle of nonmaleficence in making this decision.
Decision Point Three
Selected Decision and Rationale
Exploring the issues that the patient was having with her counselor and advising her to continue attending gamblers’ anonymous meetings was selected as the last decision. The decision was based on the reported outcome as the patient claimed to dislike her counselor (Pakri Mohamed et al., 2018). A healthy therapeutic relationship between the patient and the counselor is needed to promote positive outcomes (Wieczorek & Dąbrowska, 2020). Consequently, studies show that a patient with a negative attitude toward their psychiatrist is more likely to stop going to therapy (Grant & Chamberlain, 2020). Attending alcohol anonymous meetings is also beneficial in promoting further sobriety from alcohol (Blanco-Gandía & Rodríguez-Arias, 2018). Previous evidence also demonstrates that naltrexone can take between 8 to 12 weeks for the most patient to attain full control over not taking alcohol (Kelly & Renner, 2016).
Encouraging the patient to continue seeing the counselor and ignoring their difference will make her stop attending the therapy sessions (Martinac et al., 2019). Discontinuing the use of naltrexone is also not appropriate as the drug is more effective for long-term use, especially among patients with chronic substance use disorder (Pakri Mohamed et al., 2018).
Expected Outcome
With the resolved conflict between the patient and her counselor, she is expected to stop gambling and continue abstaining from taking alcohol (Grant & Chamberlain, 2020). She should also be able to work on her smoking habits with her counselor (Blanco-Gandía & Rodríguez-Arias, 2018).
Ethical Considerations
Psychiatrists are encouraged to invest in developing a good therapeutic relationship with their patients to promote positive outcomes (Martinac et al., 2019). When resolving differences between the patient and her counselor, it is necessary to be neutral and help the patient understand the need of working on this relationship. Ethical principles such as respect for patient autonomy and non-maleficence were also considered in making this decision (Wieczorek & Dąbrowska, 2020).
Conclusion
The 53-year-old patient reported to the clinic with a chief complaint of embarrassing problems of alcohol use disorder and gambling. Several factors were considered in deciding on the most appropriate intervention for the management of the patient’s condition, such as her age, gender, and race. From the provided options, the initial intervention was to administer naltrexone, which is FDA approved and recommended by most clinical guidelines including NICE as the first line for the management of substance use disorder (Pakri Mohamed et al., 2018). Disulfiram and Campral are short-acting, with elevated risks of adverse events hence not appropriate for the patient (Kelly & Renner, 2016). After 4 weeks, the patient reported that she has never taken alcohol ever since she received the first injection, but was still gambling and smoking (Martinac et al., 2019). It was thus necessary to refer the patient to a counselor to help with her gambling. Adding diazepam to the patient’s treatment regimen or varenicline was not appropriate as the former is addictive and the latter is only used in small doses for smoking cessation (Blanco-Gandía & Rodríguez-Arias, 2018).
During the following visit, the patient reported improved symptoms but was mainly concerned about her dislike for her counselor. It was thus decided that the issues between the patient and her counselor be examined and encouraged the patient to continue attending gambling anonymous meetings as the final decision (Grant & Chamberlain, 2020). Discontinuing the use of naltrexone and ignoring the patient’s dislike for her counselor were not appropriate decisions. The PMHNP encountered several ethical considerations at every decision point such as not discriminating against the patient and observing the right to autonomy (Wieczorek & Dąbrowska, 2020). Additional ethical principles encountered include justice and non-maleficence.
References
Blanco-Gandía, M. C., & Rodríguez-Arias, M. (2018). Pharmacological treatments for opiate and alcohol addiction: A historical perspective of the last 50 years. European journal of pharmacology, 836, 89-101.
Grant, J. E., & Chamberlain, S. R. (2020). Gambling and substance use: Comorbidity and treatment implications. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 99, 109852.
Kelly, J. E., & Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.
Martinac, M., Karlović, D., & Babić, D. (2019). Alcohol and gambling addiction. In Neuroscience of alcohol (pp. 529-535). Academic Press.
Pakri Mohamed, R. M., Kumar, J., Ahmad, S. U., & Mohamed, I. N. (2018). Novel pharmacotherapeutic approaches in the treatment of alcohol addiction. Current drug targets, 19(12), 1378-1390.
Renner, J. A., & Ward, N. (2016). Drug addiction. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.
Wieczorek, Ł., & Dąbrowska, K. (2020). Difficulties in treatment of people with comorbid gambling and substance use disorders. Journal of Substance Use, 25(4), 350-356.
| Excellent
Point range: 90–100 |
Good
Point range: 80–89 |
Fair
Point range: 70–79 |
Poor
Point range: 0–69 |
|
|---|---|---|---|---|
| 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. |
9 (9%) – 10 (10%)
The response accurately, clearly, and fully summarizes in detail the case for the Assignment. The response accurately and clearly explains in detail the specific patient factors that impact decision making when prescribing medication for this patient. |
8 (8%) – 8 (8%)
The response accurately summarizes the case for the Assignment. The response accurately explains the specific patient factors that impact decision making with prescribing medication for this patient. |
7 (7%) – 7 (7%)
The response inaccurately or vaguely summarizes the case for the Assignment. The response inaccurately or vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
0 (0%) – 6 (6%)
The response inaccurately and vaguely summarizes the case for the Assignment, or is missing. The response inaccurately and vaguely explains the specific patient factors that impact decision making with prescribing medication for this patient. |
| Decision #1 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| Decision #2 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| Decision #3 (1–2 pages)
• Which decision did you select? |
18 (18%) – 20 (20%)
The response accurately and clearly explains in detail the decision selected. The response accurately and clearly explains in detail why the decision was selected, with specific clinically relevant resources that fully support the decision selected. The response accurately and clearly explains in detail why the other two responses were not selected, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that fully support the response. The response accurately and clearly explains in detail how ethical considerations impact the treatment plan and communication with patients. Examples provided fully support the decisions and responses provided. |
16 (16%) – 17 (17%)
The response accurately explains the decision selected. The response explains why the decision was selected, with specific clinically relevant resources that support the decision selected. The response accurately explains why the other two responses were not selected, with specific clinically relevant resources that support the response. The response accurately explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that support the response. The response accurately explains how ethical considerations impact the treatment plan and communication with patients. Examples provided support the decisions and responses provided. |
14 (14%) – 15 (15%)
The response inaccurately or vaguely explains the decision selected. The response inaccurately or vaguely explains why the decision was selected, with specific clinically relevant resources that inaccurately or vaguely support the decision selected. The response inaccurately or vaguely explains why the other two responses were not selected, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that inaccurately or vaguely support the response. The response inaccurately or vaguely explains how ethical considerations impact the treatment plan and communication with patients. Examples provided may support the decisions and responses provided. |
0 (0%) – 13 (13%)
The response inaccurately and vaguely explains in detail the decision selected. The response inaccurately and vaguely explains why the decision was selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains why the other two responses were not selected, with specific clinically relevant resources that do not support the decision selected, or is missing. The response inaccurately and vaguely explains the outcome the student was hoping to achieve with the selected decision, with specific clinically relevant resources that do not support the response, or is missing. The response inaccurately and vaguely explains how ethical considerations impact the treatment plan and communication with patients, or is missing. Examples provided do not support the decisions and responses provided, or is missing. |
| 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. |
14 (14%) – 15 (15%)
The response accurately and clearly summarizes in detail the recommendations on the treatment options selected for this patient. The response accurately and clearly explains a justification for the recommendations provided, including clinically relevant resources that fully support the recommendations provided. |
12 (12%) – 13 (13%)
The response accurately summarizes the recommendations on the treatment options selected for this patient. The response accurately explains a justification for the recommendation provided, including clinically relevant resources that support the recommendations provided. |
11 (11%) – 11 (11%)
The response inaccurately or vaguely summarizes the recommendations on the treatment options selected for this patient. The response inaccurately or vaguely explains a justification for the recommendations provided, including clinically relevant resources that inaccurately or vaguely support the recommendations provided. |
0 (0%) – 10 (10%)
The response inaccurately and vaguely summarizes the recommendations on the treatment options selected for this patient, or is missing. The response inaccurately and vaguely explains a justification for the recommendations provided, including clinically relevant resources that do not support the recommendations provided, or is missing. |
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. |
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. |
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic. |
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. |
| Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
|
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
|
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
|
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
|
| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
|
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
|
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
|
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
|
| Total Points: 100 |
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