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/
Examine Case Study: Maria Perez 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.
NURS 6630: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction Sample solution
Gambling and alcohol use disorder are common conditions that psychiatric mental health nurse practitioners encounter in their practice. The presence of symptoms such as impulsive and compulsive behaviors characterizes this disorder. The affected patients become increasingly involved in the intrusive behaviors irrespective of the associated impact on their mental, social, financial, and functional wellbeing. Psychiatric mental health nurse practitioners utilize the existing best practice recommendations to implement interventions that optimize outcomes and promote recovery. Therefore, the purpose of this essay is to develop a treatment for a female client that has been diagnosed with gambling disorder and alcohol use disorder.
Introduction to the Case
The patient in the case study is Maria Perez. Perez is a 53-year-old Puerto Rican female that came to the hospital with an embarrassing problem. She reports having alcohol problems since her father died in her late teens. She has struggled with alcohol since her 20’s and has been involved with Alcohol Anonymous on and off for the last 25 years. She also has gambling problem, which started with the opening of a casino near her home. She drinks while gambling and often gives way to it leading to more reckless gambling. She also smokes for the past 2 years and spends money recklessly due to gambling. Therefore, the patient factors that will influence treatment decisions include her experience with Alcohol Anonymous group, smoking, alcohol abuse, and weight.
Decision 1
Selected Decision
Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks.
Why the Decision was Selected
I selected the decision to start the patient on naltrexone because it is blocks endogenous opioids, which play a role in alcohol addiction. The blocking reduces the urges to engage in impulsive and compulsive behaviors such as alcohol intake and gambling. Naltrexone is also effective in suppressing the desire to take alcohol. As a result, the number of alcoholic drinks and frequency decrease significantly (Anderson et al., 2021). Naltrexone has also demonstrated effectiveness in patients diagnosed with gambling disorder. Although no proven to act directly on mechanisms involved in gambling, patients diagnosed with alcohol use disorder and gambling disorder have been found to engage minimally in gambling behaviors when prescribed naltrexone(Burnette et al., 2022).
Why the Other Two Options were not selected
I did not select the decision to start the patient on Antabuse (disulfiram) 250 mg orally. This is because disulfiram is largely recommended for use if the patient expresses willingness to abstain from alcohol for at least two weeks. Its use alongside alcohol intake is associated with life threatening side effects. The rate of treatment adherence is also low, which makes disulfiram not a drug of choice for the patient. I did not select the decision to begin the patient on Campral (acamprosate) 666 mg orally three times a day. This is because acamprosate should be used in patients who have already ceased from taking alcohol (Fairbanks et al., 2020). The client in the case study has not yet withdrawn from alcohol intake, making acamprosate not the drug of choice.
What I was hoping to Achieve
I was hoping that the patient would report reduced intake of alcohol due to the blocking of opioid receptors. I was also hoping the patient would report reduced engagement in gambling behaviors (Fairbanks et al., 2020). I was also hoping the patient would report reduced alcohol cravings and drug tolerance.
Impact of Ethical Considerations
PMHNPs must ensure ethical practice in treating their patients. This includes safeguarding their right to informed care. As a result, informed consent must be obtained from Perez before initiating any treatment. This would ensure her right to autonomous care is promoted (Bloch & Green, 2021).
Decision 2
Selected Decision
Refer to counselor to address gambling issues
Why the Decision was selected
The client returned the clinic after four weeks reporting improved symptoms. The client reported that she feels wonderful. Perez has not touched a drop of alcohol since receiving the injection. However, she occasionally goes to the casino where she spends a lot of money gambling. Perez also reports smoking and some anxiety. Therefore, it is evident that she currently suffers from gambling disorder since alcohol cravings and intake have been suppressed. The existing evidence shows that the FDA has not approved any drug for use in treating gambling disorder. Psychological interventions are the mainstream treatments for the disorder. Studies have shown that treatments such as the use of cognitive behavioral therapy significantly improve outcomes in patients diagnosed with gambling disorder. This includes improvement in gambling behavior and gambling symptoms when exposure therapy is incorporated into the treatment plan (Ribeiro et al., 2021). In other studies, interventions such as motivational interviewing, couple’s therapy, and imaginal desensitization have proven effective.
Why the Other Two Options were not selected
I did not select the decision to add on valium (diazepam) 5 mg orally TID/PRN/anxiety. This is because of the side effects associated with diazepam such as drowsiness and sleepiness, which may affect her functioning. I did not select the decision to add on Chantix (varenicline) 1 mg orally BID. This was because of safety concerns, which could affect treatment adherence. Varenicline is associated with side and adverse effects such as suicidal thoughts, attempts, or plans, insomnia, and cardiovascular events (Gandhi et al., 2020).
What I was hoping to Achieve
I was hoping that Perez would report ceasing from visiting the casino and engaging in gambling. I was also hoping that she would continue to demonstrate cessation of alcohol intake. I also hoped that she would develop effective skills for overcoming pathological gambling based on the use of psychological interventions (Ribeiro et al., 2021).
Impact of Ethical Considerations
PMHNP are mandated to ensure safety and quality in their practice. They select treatment interventions based on practice recommendations from sources of evidence-based data and guidelines. The PMHNP should select the best treatment for gambling disorder with the aim of minimizing the risk of harm and optimizing on outcomes such as Perez stopping engaging in gambling behaviors (Bloch & Green, 2021).
Decision 3
Selected Decision
Explore the issue that Mrs. Perez is having with her counselor and encourage her to continue attending the Gamblers Anonymous meetings.
Why the Decision was selected
The above decision was selected because Mrs. Perez returned to the clinic with reports of more improvements in her symptoms. She reports that the anxiety she had is gone. She has also met with her counselor but she did not really like her. She has also started going to a local meeting of Gamblers Anonymous where she spoke during the meeting. She also feels supported in the group. Based on this data, an appropriate intervention would be to explore the issues she has with her counselor and encourage her to continue with the Gamblers Anonymous meetings. Exploring the issues will facilitate the identification of effective strategies to promote patient-centeredness and strengthen counselor-patient relationship (Hartley et al., 2020).
Why the Other Two Options were not selected
I did not select the decision to encourage Mrs. Perez to continue seeing her current counselor as well as continuing with Gamblers Anonymous group. This decision is inappropriate since it ignores Perez’s feelings towards her counselor. Ignoring the issues Perez could be experiencing is likely to affect her treatment adherence and outcomes. I did not select the decision to discontinue vivitrol and encourage Mrs. Perez to continue seeing her counselor and participating in the Gamblers Anonymous group. This decision would result in relapse of alcohol abuse disorder. Therefore, it is not appropriate at this time.
What I was hoping to Achieve
I was hoping to resolve the issues that Mrs. Perez has with her counselor. I was also hoping to strengthen her relationship with her counselor. I was also hoping that she would attend future gamblers anonymous meetings and her gambling problem is resolved (Hartley et al., 2020).
Impact of Ethical Considerations
Psychiatric patients have a right to data confidentiality and privacy. PMHNP should implement measures that ensure that Mrs. Perez data is protected from unauthorized access and is not shared without her consent. A breach of data privacy and confidentiality would affect Mrs. Perez’s trust on the care and lead to ethical and legal issues in psychiatric practice (Bloch & Green, 2021).
Conclusion
This case study demonstrates that naltrexone is an effective drug for treating alcohol use disorder. Naltrexone is a competitive blocker of opioid receptors, which lowers alcohol cravings and intake. The case study also demonstrates the effectiveness of counseling in treating gambling disorder. The FDA has not approved any pharmacological drug for use in treating gambling disorder. Instead, the existing evidence recommends the use of psychological interventions such as counseling and cognitive behavioral therapy in treating gambling disorder. Psychological interventions empower patients with necessary knowledge and skills needed in managing and overcoming triggers of pathological gambling. Investigating the issues Mrs. Perez had with her counselor is an appropriate intervention (Fairbanks et al., 2020; Ribeiro et al., 2021). It will enable the identification of effective strategies to enhance her relationship with the counselor.
Ethical considerations guided the treatment of Mrs. Perez. It was imperative to protect Mrs. Perez’s right to autonomous care in the first step. PMHNP was mandated to seek informed consent from her before initiating any treatments. It was also important to ensure safety and quality in the treatment process in the second step. This entailed making evidence-based decisions to promote recovery from pathological gambling (Bloch & Green, 2021). Lastly, Mrs. Perez’s right to data integrity was safeguarded in the third step, hence, the delivery of ethical psychiatric care.
References
Anderson, E. S., Chamberlin, M., Zuluaga, M., Ullal, M., Hawk, K., McCormack, R., D’Onofrio, G., & Herring, A. A. (2021). Implementation of Oral and Extended-Release Naltrexone for the Treatment of Emergency Department Patients With Moderate to Severe Alcohol Use Disorder: Feasibility and Initial Outcomes. Annals of Emergency Medicine, 78(6), 752–758. https://doi.org/10.1016/j.annemergmed.2021.05.013
Bloch, S., & Green, S. A. (2021). Psychiatric ethics. Oxford University Press.
Burnette, E. M., Nieto, S. J., Grodin, E. N., Meredith, L. R., Hurley, B., Miotto, K., Gillis, A. J., & Ray, L. A. (2022). Novel Agents for the Pharmacological Treatment of Alcohol Use Disorder. Drugs, 82(3), 251–274. https://doi.org/10.1007/s40265-021-01670-3
Fairbanks, J., Umbreit, A., Kolla, B. P., Karpyak, V. M., Schneekloth, T. D., Loukianova, L. L., & Sinha, S. (2020). Evidence-Based Pharmacotherapies for Alcohol Use Disorder: Clinical Pearls. Mayo Clinic Proceedings, 95(9), 1964–1977. https://doi.org/10.1016/j.mayocp.2020.01.030
Gandhi, K. D., Mansukhani, M. P., Karpyak, V. M., Schneekloth, T. D., Wang, Z., & Kolla, B. P. (2020). The Impact of Varenicline on Alcohol Consumption in Subjects With Alcohol Use Disorders: Systematic Review and Meta-Analyses. The Journal of Clinical Psychiatry, 81(2), 22103. https://doi.org/10.4088/JCP.19r12924
Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse–patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490. https://doi.org/10.1016/j.ijnurstu.2019.103490
Ribeiro, E. O., Afonso, N. H., & Morgado, P. (2021). Non-pharmacological treatment of gambling disorder: A systematic review of randomized controlled trials. BMC Psychiatry, 21, 105. https://doi.org/10.1186/s12888-021-03097-2
NURS_6630_Week10_Assignment1_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning Outcome 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. |
|
10 pts | ||||
| This criterion is linked to a Learning Outcome Decision #1 (1–2 pages)• 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. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome Decision #2 (1–2 pages)• 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. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome Decision #3 (1–2 pages)• 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. |
|
20 pts | ||||
| This criterion is linked to a Learning Outcome 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. |
|
15 pts | ||||
| This criterion is linked to a Learning Outcome 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 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome 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 pts | ||||
| Total Points: 100 | ||||||