Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

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 Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper:
• Decision #1
o Which decision did you select?
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• Decision #2
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper
• Decision #3
o Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o 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.
NOTE 2
Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.
NOTE 3
NOTE

BUY A PLAGIARISM-FREE PAPER HERE

1. SEE ATTACHED DECISIONS ANSWERS A, B, OR C FOR POINT ONE, TWO AND THREE TO REACH A BETTER GOAL.
FYI: THE ANSWER C OPTION IS THE BEST- USE THAT ONE
2. INCLUDE THE TWO TEXT BOOK BY STAHL BUT NOT COUNTED AS YOUR 3 ACADEMIC RESOURCES.
3. ALL REFERENCES 5 YEARS OR LESS
4. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

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

 

Decision Point One

 

Antabuse (Disulfiram)Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper 250 mg orally every morning

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Mrs. Perez reports to your office complaining of sedation, fatigue and a “metallic taste” in her mouth, which “seems to be going away.” She also reports that she had just one drink about 5 days after starting the drug and thought that she would “die.” She reports that her face was red, and she felt that her heart would “pound right out of my chest.”
  • Mrs. Perez also reports that she continues to visit the casino, but has not been spending as much money when she does go. She has noticed that her cigarette smoking is increasing

Decision Point Two

 

Continue current dose of Antabuse and refer to counseling for ongoing gambling issues

 

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Mrs. Perez returns to your office in four weeks and reports that she has met with the counselor, but did not really like her. She did start going to a local meeting gamblers anonymous
  • Client stated that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group.Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper. She also reports that she is still smoking quite a bit

Decision Point Three

 

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings, and discuss smoking cessation options

 

Guidance to Student

Sedation/fatigue is a common complaint of people who take Antabuse, the best approach would be for the PMHNP to change the administration time to the evening. The “metallic” taste in Mrs. Perez’s mouth is also another side effect that lessens and may fully go away with the passage of time. When a person taking disulfiram ingests alcohol, they will most likely experience “flushing,” tachycardia, nausea, and vomiting.

Although controversy exists in the literature regarding how long to maintain a client on disulfiram, eight 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 you will learn in future courses, ruptures in the therapeutic alliance can result in the client stopping therapy. Clearly, if the client does not continue with therapy, the likelihood of the gambling problem spontaneously remitting is lower (as opposed to the client who receives therapy)Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper. Recall that there are no FDA approved treatments for gambling addiction, and 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.

  // Comorbid Addiction (ETOH and Gambling)

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

 

Decision Point One

 

Campral (acamprosate) 666 mg orally TID

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Mrs. Perez states that she has noticed that she has been having suicidal ideation over the past week, and it seems to be getting worse
  • Clientis She is also reporting that she is having “out of control” anxiety

Decision Point Two

 

Discontinue Campral and begin Antabuse (disulfiram) 250 mg orally daily

 

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Mrs. Perez states that the suicidal thoughts have abated, but reports that she has been feeling tired for several hours after taking the drug
  • reports that she has not been going to the casino, because she is afraid that she may be tempted to drink, and noticed that the last time she drank, she felt nauseous, and began to vomit, she also reported that it felt like her heart would “pound right out” of her chest. She does report that she is smoking more, however

Decision Point Three

Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

Continue Antabuse in the morning and discuss smoking cessation options

 

Guidance to Student

Sedation occurs in many people taking disulfiram. Mrs. Perez is experiencing adverse effects when she consumes alcohol with this drug- which is the expected/intended therapeutic effect. As a “side effect”- she is avoiding the casino which is also helping. At this point, it is not appropriate to discontinue disulfiram. Despite the fact that controversy exists regarding how long someone should remain on this medication, she has only been on this drug for 4 weeks. Additional time on the medication would be prudent.

In order to treat the side effect of sedation, the drug should be changed to bedtime to minimize this side effect.

In all cases, the PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

Additionally, it should be noted that although Mrs. Perez reports that she has been avoiding the casino secondary to her fear that she will drink, this “fear” has not actually treated her gambling addiction. This particular addiction has resulted in considerable personal financial cost to Ms. Perez. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

  // Comorbid Addiction (ETOH and Gambling)

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

 

Decision Point One

 

Naltrexone (Vivitrol) 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 said that she felt “wonderful” as she has not “touched a drop” to drink 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 have her concerned

Decision Point Two

 

Refer to a counselor to address gambling issues

 

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client reports that the anxiety that she had been experiencing is gone
  • Client reports that she has met with the counselor, but did not really like her. She did start going to a local meeting gamblers anonymous. She stated that last week, for the first time, she spoke during the meeting. She reports feeling supported in this group

Decision Point Three

Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

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, four 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 you will learn in future courses, ruptures and 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, and 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.

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

Assignment-Assessing and Treating Clients With Impulsivity Compulsivity  and Addiction-WK863N

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

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.Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

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.Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

  • 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.

Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

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/Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

  • 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.Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper

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.

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Assessing and Treating Clients With Impulsivity Compulsivity and Addiction Paper