Assignment; Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Assignment; Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

Addictive, impulsive, and compulsive disorders are common mental health disorders that psychiatric mental health nurse practitioners (PMHNP) experience in their practice regularly. Patients suffering from these conditions experience challenges in managing their intrusive and impulsive behaviors. PMHNP utilize evidence-based interventions to optimize the treatment outcomes among the affected populations. Often, they weigh the benefits and risks of the different pharmacological and non-pharmacological interventions that can be adopted to help clients to overcome their problems. Care practices such as interprofessional collaboration, patient-centeredness, and care coordination help PMHNP achieve their desired outcomes in the treatment process.

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Therefore, the purpose of this research paper is to explore treatment options for a patient who has been diagnosed with gabling disorder and alcohol use disorder. The patient is a Mrs. Perez, a 53-year-old, who came to the clinic with an embarrassing problem. She reports problems with alcohol since the death of her father when she was a teenager. She has been involved on and off basis with Alcoholics Anonymous for the past 25 years. She also reports difficulties in maintaining her sobriety since the opening of a casino near her home. She engages in gambling and drinks a lot to help her calm down during high-stakes games. She gives aware to reckless gambling and drinking. She also reports increased cigarette smoking over the past 2 years. She has gained 7 lb weight, which is above her usual 115 lb weight. He husband is not aware that she also borrowed $50000 from her retirement account to repay gambling debts. Her mental status examination was unremarkable except the patient avoiding eye contact during the assessment. The factors that will influence Mrs. Perez’s treatment decisions include her current substance use and abuse, uncontrolled gambling, experience with Alcohol Anonymous group, and weight changes.

Decision 1

Selected Decision

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

Why the Decision was selected

The Food and Drug Administration (FDA) has approved the use of naltrexone as the primary drug of choice for the treatment of alcohol abuse disorder. Naltrexone works by inhibiting receptor binding of endogenous opioids. Alcohol use disorder and gambling disorder stimulate the endogenous opioid system, which makes opioid antagonists such as naltrexone the most effective treatments for these problems. Naltrexone is also effective against compulsive and impulsive behaviors such as stealing and stealing behavior, which translate into its potential effectiveness in gambling disorder (Avery, 2022).

Why the Other Two Options were not selected

I did not select the decision to start the patient on Antabuse (disulfiram) 250 mg daily because it is a second-line treatment for alcohol use disorder. The FDA has approved its use after patients have been started on acamprosate and naltrexone. Disulfiram was also not selected because of its associated adverse effects to the patients. They include sleepiness, headache, halitosis, tiredness, hepatotoxicity, psychosis, peripheral neuropathy, optic neuritis, and exfoliative psoriasis among others (Stokes & Abdijadid, 2023). I did not select the decision to begin the patient on Campral (acamprosate) 66 mg orally three times a day because it is a maintenance treatment for patients who have been initiated on other treatments for alcohol use dependence. The patient should already be abstinent for her to be started on acamprosate (Kumar et al., 2020).

What I was Hoping to Achieve

I made the above decision with the aim of reducing gambling and alcohol abuse by the patient. Naltrexone blocks alcohol receptors, reducing alcohol use and engaging in gambling. I also expected the patient to tolerate naltrexone since it has high safety efficacy level (Avery, 2022).

Ethical Considerations

PMHNP should promote safety and quality in their practice. This includes adopting evidence-based interventions in treating psychiatric conditions. The need for safety and quality influenced the decision to select naltrexone because of its efficacy over the other options. Through it, the client’s right to safe, efficient, and quality care was safeguarded (Butts & Rich, 2022).

Decision 2

Selected Decision

Refer to a counselor to address gambling issues

Why the Decision was selected

I selected the above decision because vivitrol was effective in managing problems associated with alcohol use disorder. The client returned to the clinic after four weeks. She reports that she feels wonderful since she has not touched a drop of alcohol since receiving vivitrol injection. She also reports that she has not been going to the casino as frequently. However, she spends a lot of money gambling whenever she goes. She is also still smoking, which concerns her. She also has anxiety. The client’s data shows that she currently suffers from gambling problems. Gambling has not pharmacological treatment. Instead, psychological interventions are the mainstream approaches for its treatment. This includes the use of interventions such as psychotherapy, counseling, and motivational interviewing (Ginley et al., 2019). Psychological interventions will help her developing effective coping strategies against triggers of impulsive and compulsive gambling behaviors.

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 was because the initial dose of vivitrol was effective, eliminating the need for augmenting the treatment. Diazepam also has severe side effects such as drowsiness, tremors, and confusion, which may affect treatment outcomes (Stokes & Abdijadid, 2023). I did not select the decision to add Chantix (varenicline) 1 mg orally BID because of safety concerns. The dosage is higher than the recommended, which increases the risk of adverse reactions from the patient.

What I was Hoping to Achieve

I was hoping counseling would help the patient develop effective coping strategies against gambling behaviors. I was also hoping that she would reduce in her engagement in gambling activities. I also hoped that the counselor would help her manage her anxiety (Bodor et al., 2021).

Ethical Considerations

Patients have a right to access, accept, and decline care given to them in healthcare settings. Healthcare providers are mandated to respect patient’s decisions in the treatment process to ensure the protection of their right to autonomous care. PMHNP must educate the patients about the indications for the treatments, benefits, and risks. Similarly, they respect their decisions on the adopted interventions (Butts & Rich, 2022). Therefore, Mrs. Perez’s decision to decline the available treatment would affect the decisions that the PMHNP make.

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 patient returned to the clinic after 4 weeks with further improvement in her symptoms. She reports that the anxiety she had been experiencing is gone. She also reports meeting the counselor but did not really like her. She has also started going to a local meeting of Gamblers Anonymous. She spoke during the meeting for the first time last week and feels supported. The client’s experience with psychological interventions is positive. As a result, an effective intervention at time would be aiming at strengthening the relationship she has with her counselor. It would be appropriate to find out any issues she has with her counselor and explore interventions that can be adopted to address it (Butts & Rich, 2022). This would enhance the treatment outcomes.

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 the Gamblers Anonymous group since it is non-therapeutic. PMHNP should not ignore issues in the treatment process, as it would affect the treatment 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. Discontinuing vivitrol after eight weeks is too early and could lead to relapse in alcohol abuse problem (Avery, 2022). The patient may also develop negative side effects from the sudden cessation of treatment.

What I was Hoping to Achieve

I was hoping to find out and resolve the issues between the patient and counselor. I was also hoping to strengthen counselor-patient relationship. I was also hoping to achieve sustained improvement in the patient’s non-engagement in gambling activities (Ginley et al., 2019).

Ethical Considerations

The promotion of data privacy and confidentiality is important in psychiatric practice. PMHNP must adopt measures that prevent access to patient’s data by unauthorized parties. In addition, they must not share patient’s data with other parties without seeking informed consent from their patients. Violation of the patient’s right to confidentiality and privacy would affect the realization of the desired treatment outcomes in this study (Butts & Rich, 2022). Mrs. Perez will also lose trust and confidence on the care given in the institution.

Conclusion

The case study showed that the initiation of the patient on Vivitrol was effective. Practice guidelines and evidence-based data informed the decision to initiate the patient on Vivitrol. Vivitrol is an effective competitor for alcohol receptors. It has also been shown to have some effect on compulsive, impulsive, and obsessive behaviors such as gambling. I did not select the decisions to start the patient on acamprosate or antabuse because of safety concerns. Acamprosate is indicated for clients that have achieved abstinence from alcohol abuse while antabuse is second-line drug of choice for alcohol abuse (Avery, 2022; Kumar et al., 2020). The second decision to refer the patient for a counselor’s support was effective. This was because there is no drug that has been approved for use in treating gambling disorder. Lastly, the decision to explore the issues between Mrs. Perez and her counselor was also appropriate. It would strength counselor-patient relationship and patient’s empowerment, satisfaction, and compliance with the treatment (Butts & Rich, 2022).

Ethical considerations informed the client’s treatment decisions. First, the need for the promotion of safety and quality in the treatment informed the initial decision in the treatment process. The PMHNP weighed the benefits and risks of the treatment alternatives before settling on naltrexone. Naltrexone has high safety profile and practice recommendations as compared to the other options. The other ethical consideration that would influence the treatment is protection of the patient’s autonomy. PMNPs must seek informed consent and respect decisions made by their patients in the treatment process. Lastly, it is imperative for PMHNP to ensure the protection of data privacy and confidentiality (Abbasinia et al., 2020). Mrs. Perez information should not be accessed or shared without seeking her informed consent.

References

Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2020). Patient advocacy in nursing: A concept analysis. Nursing Ethics, 27(1), 141–151.

Avery, J. (2022). Naltrexone and Alcohol Use. American Journal of Psychiatry, 179(12), 886–887. https://doi.org/10.1176/appi.ajp.20220821

Bodor, D., Ricijaš, N., & Filipčić, I. (2021). Treatment of gambling disorder: Review of evidence-based aspects for best practice. Current Opinion in Psychiatry, 34(5), 508. https://doi.org/10.1097/YCO.0000000000000728

Butts, J. B., & Rich, K. L. (2022). Nursing Ethics: Across the Curriculum and Into Practice. Jones & Bartlett Learning.

Ginley, M. K., Rash, C. J., & Petry, N. M. (2019). Psychological Interventions in Gambling Disorder. In A. Heinz, N. Romanczuk-Seiferth, & M. N. Potenza (Eds.), Gambling Disorder (pp. 181–194). Springer International Publishing. https://doi.org/10.1007/978-3-030-03060-5_9

Kumar, A., Sharma, A., Bansal, P. D., Bahetra, M., Gill, H. K., & Kumar, R. (2020). A comparative study on the safety and efficacy of naltrexone versus baclofen versus acamprosate in the management of alcohol dependence. Indian Journal of Psychiatry, 62(6), 650. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_201_19

Stokes, M., & Abdijadid, S. (2023). Disulfiram. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK459340/

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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: 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.

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

Resources:

• Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
  • Chapter 13, “Impulsivity, Compulsivity, and Addiction” (pp. 538-578)

• Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders: Treatment improvement protocol series, no. 32. 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. Journal of Psychosocial Nursing & Mental Health Services, 54(4), 15.
• Grant, J. E., Odlaug, B. L., & Schreiber, L. N. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375–381. https://doi.org/10.1111/j.1365-2125.2012.04457.x
• Hulvershorn, L. A., Schroeder, K. M., Wink, L. K., Erickson, C. A., & McDougle, C. J. (2015). Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Human Psychopharmacology, 30(3), 164–172. https://doi.org/10.1002/hup.2467
• 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. https://doi.org/10.3928/00989134-20160314-04
• 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. https://doi.org/10.1080/15504263.2012.648439
• Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., Olvera, R., Swann, A. C., & Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337–1341. https://doi.org/10.1016/j.comppsych.2014.04.018