Sample Answer for NURS 6630 Assignment Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction Included After Question

Background

Mrs. Maria Perez, a 53-year-old Puerto Rican woman, has presented with an issue that she finds “embarrassing.”

Subjective

Mrs. Perez has struggled with alcohol since her father’s death in her late teens. She has been in and out of Alcoholics Anonymous for the past 25 years. Recently, she has been finding it difficult to maintain her sobriety due to the opening of the “Rising Sun” casino near her home. During a visit to the casino’s grand opening, Mrs. Perez became hooked on gambling, which provides her with a sense of high.

She often drinks while gambling, which leads to reckless gambling and further drinking. She has also noticed an increase in cigarette smoking over the past two years, which worries her about its negative effects on her health. Mrs. Perez has attempted to stop drinking but finds it challenging to resist the high she experiences from gambling. She has gained seven pounds from drinking and weighs 122 lbs.

Mental Status Exam

During the clinical interview, Mrs. Perez demonstrated an alert and oriented state of mind. Her speech was clear, coherent, and goal-directed, and her eye contact was somewhat avoidant. She had no noteworthy mannerisms, gestures, or tics. Although her self-reported mood was “sad,” her affect was appropriate to the conversation and her mood. She reported no visual or auditory hallucinations, delusional or paranoid thought processes, and her insight and judgment were intact. However, her impulse control was impaired, and she denied any suicidal or homicidal ideation.

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Diagnosis

Mrs. Perez has been diagnosed with gambling disorder and alcohol use disorder.

Introduction

Compulsivity and impulsivity can manifest in various ways and often coincide with other psychiatric disorders. Individuals who act without thinking may struggle to refuse certain things, such as spending money or using illegal drugs. Some people may engage in compulsive behavior that leads to adverse consequences.

In many cases, compulsivity and impulsivity contribute to addiction-related problems. To assess and treat clients effectively, a Psychiatric Mental Health Nurse Practitioner (PMHNP) must have a clear understanding of the differences between these disorders, their symptoms, and their impact on both clients and their families (Bandelow, Michaelis, & Wedekind, 2017).

Decision #1

I have selected to begin the Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks for the patient described in the case. My decision to choose Naltrexone was based on its effectiveness in reducing alcohol consumption, craving, and relapse rates in patients with alcohol use disorder.

Studies have demonstrated the efficacy of Naltrexone in reducing alcohol use in patients with alcohol use disorder, including those with comorbid psychiatric conditions. Additionally, Naltrexone has been shown to improve overall treatment outcomes and increase the likelihood of abstinence. In the context of the patient’s case, Naltrexone could help her maintain her sobriety by blocking the pleasurable effects of alcohol and reducing her craving for alcohol (Ray et al., 2019).

A Sample Answer for The Assignment: NURS 6630 Assignment Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Title: NURS 6630 Assignment Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

I did not select Campral (Acamprosate) or Antabuse (Disulfiram) for the patient because they have different mechanisms of action and may not be as effective as Naltrexone in this particular case. Campral works by reducing cravings and withdrawal symptoms in patients who have already stopped drinking.

While it is generally well-tolerated, it has not been shown to be effective in reducing heavy drinking or promoting abstinence in patients with alcohol use disorder (Akbar et al., 2018). Antabuse, on the other hand, works by causing a psychologically unpleasant reaction if the patient drinks alcohol, which can serve as a deterrent. However, it has limited efficacy and is associated with low patient adherence due to its side effects (De Souza, 2019).

By choosing Naltrexone, I hoped to achieve a reduction in the patient’s alcohol consumption, craving, and risk of relapse. I also hoped to improve her overall treatment outcomes and increase her likelihood of abstinence. Studies such as Ray et al. (2019) have shown Naltrexone to be effective in reducing alcohol use in patients with alcohol use disorder, and I hoped to have similar results replicated in this case.

Ethical considerations play a significant role in the treatment plan and communication with patients. It is important to obtain informed consent from the patient before initiating any treatment, ensuring that they understand the risks and benefits associated with the treatment. In the case of Naltrexone, it is important to inform the patient of the potential side effects, including nausea, headache, and fatigue, and monitor them for any adverse reactions.

It is also important to involve the patient in the decision-making process and respect their autonomy by considering their preferences and values. Additionally, confidentiality and privacy must be maintained throughout the treatment process, and the patient’s dignity and respect must be upheld (Adams & Volkow, 2020).

Decision #2

I selected to refer the client to a counselor to address her gambling issues. This decision was based on the client’s primary concern being gambling disorder and the potential benefits of concurrent counseling with her current medication regimen. Research has shown that counseling and therapy are effective in treating gambling disorder, including cognitive-behavioral therapy (CBT) and motivational interviewing (MI) (Hodgins et al., 2019).

Counseling can help the client identify and address the underlying reasons for their gambling behavior, develop coping skills, and improve their self-efficacy and motivation to change. Furthermore, counseling can provide ongoing support for maintaining sobriety and reducing the risk of relapse.

I did not select the other two options provided. Adding on Chantix (varenicline) may be effective in reducing nicotine dependence, but it does not address the client’s primary concern of gambling disorder. Additionally, the client’s smoking may be a secondary issue that can be addressed through counseling or other means.

Adding on Valium (diazepam) also presents a risk for the client due to her history of alcohol and drug abuse. Valium is a benzodiazepine meaning it has potential for being abused. Mixing alcohol with Valium is also associated with side effects such as slowed breathing which can be life threatening (Powers, 2022).

By referring the client to a counselor to address gambling issues, I hope to achieve additional support for the client’s primary concern of gambling disorder. The counselor can work with the client to identify triggers and develop coping strategies to prevent relapse. Additionally, the counselor can help the client address any underlying psychological or emotional issues that may be contributing to their gambling behavior (Knaebe et al., 2019).

Ethical considerations play a significant role in the treatment plan and communication with patients. It is essential to obtain informed consent from the patient and respect their autonomy in making decisions about their treatment. The patient must understand the benefits and risks associated with counseling and be able to provide informed consent.

Confidentiality must also be maintained, and the patient’s privacy and dignity must be upheld. Additionally, the counselor must be appropriately trained and qualified to address the client’s specific needs and concerns (Adams & Volkow, 2020).

Referring the client to a counselor to address gambling issues was the appropriate decision based on the patient’s primary concern and the potential benefits of concurrent counseling with her current medication regimen. Counseling can help the client identify underlying issues and develop coping strategies to prevent relapse. Ethical considerations must be considered throughout the treatment plan to ensure the patient’s autonomy and privacy are upheld (Knaebe et al., 2019).

Decision #3

I selected to explore the issue that Mrs. Perez is having with her counselor and encourage her to continue attending the Gamblers Anonymous meetings for decision #3. This decision was based on the client’s report that she did not really like her counselor and the potential benefits of addressing this issue and continuing with Gamblers Anonymous. Research has shown that a positive therapeutic alliance between the patient and therapist is critical for successful treatment outcomes (Knaebe et al., 2019).

Patients who have a positive relationship with their therapist are more likely to engage in therapy, feel supported, and make progress towards their treatment goals. Therefore, addressing the issue that Mrs. Perez is having with her counselor is crucial for maintaining her engagement in counseling and improving her treatment outcomes.

I did not select the other two options provided in the exercise. Encouraging Mrs. Perez to continue seeing her current counselor may not be effective if she does not have a positive therapeutic alliance with her therapist. Discontinuing Vivitrol is not recommended as it has been shown to be effective in reducing alcohol consumption and preventing relapse in patients with alcohol use disorder (Ray et al., 2019).

By exploring the issue that Mrs. Perez is having with her counselor and encouraging her to continue attending the Gamblers Anonymous meetings, I hope to improve her engagement in counseling and increase her chances of successful treatment outcomes. By addressing the issue with her counselor, we can work to improve the therapeutic alliance and ensure that Mrs. Perez is receiving effective treatment. Additionally, continuing with Gamblers Anonymous provides her with additional support and resources for maintaining sobriety and preventing relapse.

Ethical considerations must be considered throughout the treatment plan and communication with patients. It is essential to respect the patient’s autonomy and preferences in their treatment. Mrs. Perez must be informed of the potential benefits and risks associated with continuing with her current counselor and encouraged to express any concerns or issues she may have. Confidentiality must also be maintained, and any communication with her counselor must be conducted with her informed consent. The goal is to provide Mrs. Perez with the best possible care while respecting her autonomy and privacy (Adams & Volkow, 2020).

Conclusion

In summary, my recommendations for the treatment of Mrs. Perez’s alcohol and gambling disorders involved a combination of pharmacological and psychosocial interventions. Treating addiction, compulsivity, and impulsivity disorders presents significant challenges to healthcare providers. These disorders are often associated with negative behaviors that can have adverse consequences for patients. It is crucial for Psychiatric Mental Health Nurse Practitioners (PMHNPs) to actively listen to clients with these disorders, evaluate their circumstances, and create a comprehensive treatment plan.

The decision to administer Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. Was based on the effectiveness of Naltrexone in reducing alcohol cravings and preventing relapse in patients with alcohol use disorder (Ray et al., 2021). The client responded well to this medication, with reduced alcohol consumption and improved sobriety.

In Mrs. Perez’s case, there are inadequate FDA-approved medications for gambling addiction. However, counseling has been shown to be an effective treatment option for this disorder. For the gambling disorder, I referred her to a counselor to address her gambling issues and encouraged her to participate in Gamblers Anonymous meetings.

This decision was based on research that supports the effectiveness of counseling and support groups combined with pharmacological intervention in treating comorbid alcohol abuse and gambling disorder (Kraus, Etuk, & Potenza, 2020). The client reported feeling supported and engaged in the Gamblers Anonymous group, and her anxiety and gambling behaviors improved.

For the third decision point, I recommended exploring the issue that Mrs. Perez was having with her counselor and encouraging her to continue attending Gamblers Anonymous meetings. This decision was based on the importance of a positive therapeutic alliance in successful treatment outcomes (Knaebe et al., 2019) and the potential benefits of addressing any concerns with the counselor and continuing with the support provided by Gamblers Anonymous.

Overall, the combination of pharmacological and psychosocial interventions was effective in treating Mrs. Perez’s alcohol and gambling disorders. Ethical considerations were also taken into account throughout the treatment plan to ensure the patient’s autonomy and privacy were respected. It is important to note that every patient is unique, and treatment plans must be tailored to their specific needs and concerns. Clinicians must consider the patient’s individual history, comorbidities, preferences, and potential risks and benefits of treatment options. Therefore, ongoing assessment and modification of the treatment plan are necessary for successful outcomes.

References

Adams, V. J. M., & Volkow, N. D. (2020). Ethical imperatives to overcome stigma against          people with substance use disorders. AMA Journal of Ethics, 22(8), 702-708. Doi:         10.1001/amajethics.2020.702.

Akbar, M., Egli, M., Cho, Y. E., Song, B. J., & Noronha, A. (2018). Medications for alcohol use disorders: An overview. Pharmacology & therapeutics, 185, 64-85.     https://doi.org/10.1016/j.pharmthera.2017.11.007

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues

De Souza, A. (2019). Disulfiram in the Management of Alcohol Dependence.             https://link.springer.com/chapter/10.1007/978-981-32-9876-7_3

            in clinical neuroscience, 19(2), 93. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow

Knaebe, B., Rodda, S. N., Hodgins, D. C., & Lubman, D. I. (2019). Behaviour change strategies endorsed by gamblers subtyped by psychological distress, risky alcohol use, and            impulsivity. Journal of Gambling Studies, 35(1), 275-292. https://doi.org/10.1007/s10899-      018-9803-x

Kraus, S. W., Etuk, R., & Potenza, M. N. (2020). Current pharmacotherapy for gambling disorder: a systematic review. Expert Opinion on Pharmacotherapy, 21(3), 287-296.             https://doi.org/10.1080/14656566.2019.1702969

Powers, H. (2022). The use of valium in alcohol withdrawal.           https://scholarworks.utep.edu/cohort_10/5/

Ray, L. A., Green, R., Roche, D. J., Magill, M., & Bujarski, S. (2019). Naltrexone effects on        subjective responses to alcohol in the human laboratory: A systematic review and meta‐        analysis. Addiction Biology, 24(6), 1138-1152. https://doi.org/10.1111/adb.12747

 

What’s Coming Up in Week 11?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will synthesize and apply your knowledge and skills of assessing and treating patients with various psychopharmacologic treatments as you prepare for your Final Exam.

Next Week

Module 3: Disorders With Behavioral Components

Mental health and substance abuse disorders can affect individuals across the life span. While these illnesses are common, recurrent, and serious, they are often treatable and many people do recover (SAMHSA, 2020). Mental disorders involve changes in thinking, mood, and/or behavior such that these changes can and do affect how individuals relate to others and how they make choices.

Behavioral disorders that give rise to impulsivity and substance abuse represent one area of expertise for which a psychiatric nurse practitioner (PNP) may prescribe pharmacologic treatments. Furthermore, understanding the underlying mechanisms that result in these behavioral disorders will be an important component of any treatment plan.

Not surprisingly, PNPs may observe the coexistence of both a mental health and a substance use disorder (SAMHSA, 2020). Such co-occurring disorders or comorbidities present additional challenges for PNPs in assessing, treating, and providing care to their patients.

As you engage with the content for this module, reflect on how you might assess, treat, and provide care for patients presenting with behavioral disorders. While some disorders may have a direct treatment plan, others may require additional assessment considerations and pharmacologic interventions.

_Reference:

Substance Abuse and Mental Health Services Administration. (2020). Mental health and substance use disorders. https://www.samhsa.gov/find-help/disorders

What’s Happening This Module?

Module 3, Disorders With Behavioral Components, is a 2-week module. During Week 10, you will continue to apply your assessment and therapy skills as you assess and treat patients suffering from impulsivity, compulsivity, and addiction. In Week 11, you will review treatment plans and concepts related to the treatment of patients with dementia/Alzheimer’s and comorbid states. You will also complete your Final Exam for the course.

Assessing and Treating Patients with Impulsivity, Compulsivity, and Addiction

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. https://doi.org/10.1016/j.ejphar.2018.08.007

Grant, J. E., & Chamberlain, S. R. (2020). Gambling and substance use: Comorbidity and treatment implications. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 99, 109852. https://doi.org/10.1016/j.pnpbp.2019.109852

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. https://doi.org/10.1016/B978-0-12-813125-1.00054-4

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. https://doi.org/10.2174/1389450119666180523092534

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. https://doi.org/10.1080/14659891.2019.1704078

Assignment 1: 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/

To prepare for this Assignment: 

• Review this week’s Learning Resources, including the Medication Resources indicated for this week.
• Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction.

The Assignment: 5 pages 

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. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting. 

 By Day 7 

Submit your Assignment.  

Submission and Grading Information 

To submit your completed Assignment for review and grading, do the following: 

• Please save your Assignment using the naming convention “WK10Assgn1+last name+first initial.(extension)” as the name. 
• Click the Week 10 Assignment 1 Rubric to review the Grading Criteria for the Assignment. 

• Click the Week 10 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area. 
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn1+last name+first initial.(extension)” and click Open. 
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. 
• Click on the Submit button to complete your submission. 

Grading Criteria 

To access your rubric: 

Week 10 Assignment 1 Rubric 

Module 3: Disorders With Behavioral Components 

Mental health and substance abuse disorders can affect individuals across the life span. While these illnesses are common, recurrent, and serious, they are often treatable and many people do recover (SAMHSA, 2020). Mental disorders involve changes in thinking, mood, and/or behavior such that these changes can and do affect how individuals relate to others and how they make choices. 

Behavioral disorders that give rise to impulsivity and substance abuse represent one area of expertise for which a psychiatric nurse practitioner (PNP) may prescribe pharmacologic treatments. Furthermore, understanding the underlying mechanisms that result in these behavioral disorders will be an important component of any treatment plan.

Not surprisingly, PNPs may observe the coexistence of both a mental health and a substance use disorder (SAMHSA, 2020). Such co-occurring disorders or comorbidities present additional challenges for PNPs in assessing, treating, and providing care to their patients. 

As you engage with the content for this module, reflect on how you might assess, treat, and provide care for patients presenting with behavioral disorders. While some disorders may have a direct treatment plan, others may require additional assessment considerations and pharmacologic interventions. 

Reference: 

Substance Abuse and Mental Health Services Administration. (2020). Mental health and substance use disorders. https://www.samhsa.gov/find-help/disorders 

What’s Happening This Module? 

Module 3, Disorders With Behavioral Components, is a 2-week module. During Week 10, you will continue to apply your assessment and therapy skills as you assess and treat patients suffering from impulsivity, compulsivity, and addiction. In Week 11, you will review treatment plans and concepts related to the treatment of patients with dementia/Alzheimer’s and comorbid states. You will also complete your Final Exam for the course.  

Week 10: Therapy for Patients With Impulsive/Substance Use Disorders (SUD)  

Impulsivity and compulsivity 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 impulsive and compulsive behaviors 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. 

This week, as you examine therapies for individuals with impulsivity, compulsivity, and addiction, you explore the assessment and treatment of patients with these disorders. You also consider ethical and legal implications of these therapies. 

Learning Objectives 

Students will: 

• Assess patient factors and history to develop personalized therapy plans for patients with impulsivity, compulsivity, and addiction 
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for impulsivity, compulsivity, and addiction 
• Synthesize knowledge of providing care to patients presenting for impulsivity, compulsivity, and addiction 
• Analyze ethical and legal implications related to prescribing therapy for patients with impulsivity, compulsivity, and addiction 

 Learning Resources 

 Required Readings (click to expand/reduce)  

 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. 

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. 

 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. 

rant, 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 

nches, 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 

Medication Resources (click to expand/reduce)  

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm 

 Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched.

If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments. 

• naltrexone (revia/vivitrol) 
• naloxone 
• acamprosate 
• disulfiram 

 Required Media (click to expand/reduce)  

 Case Study: A Puerto Rican Woman with Comorbid Addiction 
Note: This case study will serve as the foundation for this week’s Assignment. 

 Optional Resources (click to expand/reduce)  

 Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., & Di Giannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International, 2014. https://doi.org/10.1155/2014/537306 

There is a close connection between impulsivity, compulsivity, and addiction. While addiction is defined as a process coordinating the change from an impulsive to compulsive behavior, impulsivity occurs in the early stages of addiction. A person acting impulsively experiences the pleasure of their addiction, and the compulsive aspect would take control when there is a shift causing a person to stay away from their addictions. However, the compulsive behavior would compel a person to participate in their addictions to relieve themselves from the withdrawal effects.

The purpose of this paper is to show how to assess and develop a personalized treatment plan for clients with impulsivity, compulsivity, and addiction based on the decision on medications to prescribe to a client, including ethical and legal implications related to the described treatment for clients with impulsivity, compulsivity and addiction.

Introduction to the Case Study

The case in this assignment involves a 53-year-old Puerto Rican female who was administered to the clinic because of an “embarrassing problem” with alcohol addiction in her early 20s when her father passed. The client’s report on being involved in alcoholism is anonymously defined as “on and off” for the past 25 years. The patient also has difficulty in maintaining sobriety which has worsened in the last two years due to her battling with gambling addiction after a casino was opened near her home. This increased the rate of her cigarette smoking, and she is concerned about the negative effect of cigarette smoking on her health.

 Rubric Detail  

Name: NURS_6630_Week10_Assignment1_Rubric   

Name: NURS_6630_Week10_Assignment1_Rubric