mpulsivity, compulsivity, and addiction are challenging disorders for patients

mpulsivity,
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.
BACKGROUND
Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.”
SUBJECTIVE
Mrs. Perez admits that she has had “problems” with alcohol since her
father died in her late teens. She reports that she has struggled with
alcohol since her 20’s and has been involved with Alcoholics Anonymous
“on and off” for the past 25 years. She states that for the past 2
years, she has been having more and more difficulty maintaining her
sobriety since the opening of the new “Rising Sun” casino near her home.
Mrs. Perez states that she and a friend went to visit the new casino
during its grand opening at which point she was “hooked.” She states
that she gets “such a high” when she is gambling. While gambling, she
“enjoys a drink or two” to help calm her during high-stakes games. She
states that this often gives way to more drinking and more reckless
gambling. She also reports that her cigarette smoking has increased over
the past 2 years and she is concerned about the negative effects of the
cigarette smoking on her health.
She states that she attempts to abstain from drinking but she
gets such a “high” from the act of gambling that she needs a few drinks
to “even out.” She also notices that when she drinks, she doesn’t smoke
“as much,” but she enjoys smoking when she is playing at the slot
machines. She also reports that she has gained weight from drinking so
much. She currently weights 122 lbs., which represents a 7 lb. weight
gain from her usual 115 lb. weight.
Mrs. Perez is quite concerned today because she borrowed over
$50,000 from her retirement account to pay off her gambling debts, and
her husband does not know.
MENTAL STATUS EXAM
The client is a 53 year old Puerto Rican female who is alert and
oriented to person, place, time, and event. She is dressed appropriately
for the weather and time of year. Her speech is clear, coherent, and
goal directed. Her eye contact is somewhat avoidant during the clinical
interview. When you make eye contact with her, she looks away or looks
down. She demonstrates no noteworthy mannerisms, gestures, or tics. Her
self-reported mood is “sad.” Affect is appropriate to content of
conversation and self-reported mood. She denies visual or auditory
hallucinations, and no delusional or paranoid thought processes are
readily appreciated. Insight and judgment are grossly intact; however,
impulse control is impaired. She is currently denying suicidal or
homicidal ideation.
Diagnosis: Gambling disorder, alcohol use disorder
Decision Point One
Select what you should do:
Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
Antabuse (disulfiram) 250 mg orally daily
Campral (acamprosate) 666 mg orally three times/day

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compulsivity, and addiction are challenging disorders for patients
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