Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

Posted: January 17th, 2023

Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

Assignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction 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 To prepare for this Assignment: 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. Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay.  pharmacokinetic and pharmacodynamic processes. (Decisions have already been made. See decision results in the attached case study) 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. I want you to answer the questions given to you (decision points one, two, and three) before you click on the option. The answers will be based on your decisions made and patient outcomes during the decision tree (see results of decision tree in the attachment doc). I am looking for an essay that is long enough to cover the topic BUT short enough to keep my interest. I do not need you to tell me the treatment options available to you – I am very familiar with the cases. Remember this is a Pharmacology class that incorporates Pharmacotherapy and not a class on diagnosing disease. I want you to tell me why you selected an option (why is it the best option- using clinically relevant and patient specific data) AND why you did not choose the other options (with clinically relevant and patient specific data). At each decision point, stop to complete the following: * Decision #1 Select what the PMHNP should do next: • You decided to start patient on Naltrexone (Vivitrol) injection, 380 mg intramuscularly every month. (see attachment for result of decision#1) • Why did you select this decision? Support your response with evidence and references to the Learning Resources. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. • Why did you not choose the option to of Antabuse (Disulfiram) 250 mg orally daily or Campral (Acamprosate) 666 mg orally three times/day? • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay. Why were they different? Decision #2 Select what the PMHNP should do next: • You decide to refer the client to refer client to a counselor to address gambling issues. (see attachment for result of decision#2) • Why did you select this decision? Support your response with evidence and references to the Learning Resources. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. • Why did you not choose the options to add Valium (Diazepam) 5 mg TID as needed for anxiety or add Chantix 1 mg twice a day. • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different? Decision #3 Select what the PMHNP should do next: • You decide to explore the issues that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings. (see attachment for result of decision#3) • Why did you select this decision? Support your response with evidence and references to the Learning Resources. • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources. • Why did you not choose the options to either discontinue Naltrexone (Vivitrol). Encourage Mrs. Perez to continue seeing her counselor and continue participating in the Gamblers Anonymous Group or encourage her to continue seeing her current counselor while still continuing attending the Gamblers Anonymous meetings. • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?  Also include how ethical considerations might impact your treatment plan and communication with clients. Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

Introduction

Impulsivity, compulsivity, and addiction impact the normal behaviors of patients causing negative effects. These disorders demand both psychotherapy and pharmacological treatment to manage the symptoms effectively. The diagnosis of these conditions is influenced by the patient’s history and personal factors. Prescription of therapy is also dependent on legal and ethical implications as demonstrated in the case study involving Mrs. Perez.

Decision One

I decided to start the patient on Naltrexone (Vivitrol) injection, 380 mg intramuscularly every month since it facilitates the treatment of alcohol dependency. This is because; the opioid receptor antagonist is intended to block the neurotransmitters in the brain of the patient thus reducing the desire and pleasurable impacts of alcohol (Loreck, Brandt &DiPaula, 2016). This was intended to result in the nullification of the psychotropic and euphoric reactions in the patient which prevents her from having alcohol cravings. This will eventually prevent the relapse of alcohol dependency as well as decrease her self-administrative behavior pattern which will consequently result in the alcohol abuse extinction. Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

The decision to administer vivitrol intended to achieve positive patient outcomes. The patient reported after four weeks feeling much better. She reported feeling “wonderful” and not having had any alcoholic drink over the treatment period. She also had no cravings for alcohol anymore. As such, I achieved the treatments objective of reducing the alcoholic urge in the patient and consequently addiction.

I did not chooseAntabuse (Disulfiram) 250 mg orally daily or Campral (Acamprosate) 666 mg orally three times/day. This is because; the recovery of the patient depended on the consistency of use of the drugs and thus, the effectiveness of the drug would be affected by the human nature which includes forgetting to take the medication at the right time and the right dose (Stahl, 2014b). The occurrence of side effects on the patient could also discourage adherence. Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

There was adifference between what I expected to achieve with this decision and the results of the decision. For instance, I intended to eliminate all the addictions of Mrs. Perez by the end of the treatment period using vivitrol. However, only the alcohol addictions were eliminated. The gambling urge was aggravated as well as smoking. She was also anxious. The difference occurred because the patient still had unrestricted access to the casino which influenced gambling. Moreover, no other therapy, outpatient meetings or drug rehabilitation was combined with vivitrol to improve the gambling, smoking and anxiety issues yet vivitrol is only a tool to facilitate successful recovery (Stahl & Grady, 2012).

Decision Two

The patient reported increased gambling, smokingas well as anxiety after four weeks of treatment with vivitro. This called for the incorporation of another intervention to manage these conditions. In his case, a mental therapy was effective for the patient since she got a platform to share her experiences and problems with other victims of addiction and receive encouragement on how to manage them. Counselling provides coping skills and abstinence techniques, problem solving skillsand as well aims at motivating the patient for sustained change and foster nonchemical development (Grant, Odlaug& Schreiber, 2014). Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

Since the patient was overly anxious, counselling sought to manage her emotions and reduce anxiety through support and guidance through setbacks and trouble spots that could result to relapse. Moreover, it sought to help Madam Perez in breaking the addictive cycle of gambling and smoking to establish a total abstinence, problem-solving and adaptive coping skills intended to achieve long-term abstinence (Salmon & Forester, 2012). Overall, the practice also aimed at preventing idleness that would provide time for the client to visit the casino as well as indulge in drug abuse.

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I did not choose the options to add Valium (Diazepam) 5 mg TIDbecause of its side effects which could affect the patient and discourage their visit to the counselling sessions. These include nausea, headaches, weaknesses and fatigue, lack of coordination, dizziness and drowsiness(Stahl, 2014b). It also has the tendency to be absorbed very fast in the system but build up overtime which could easily result to addiction of the patient. Furthermore, drug and alcohol addicted patients are cautioned against using the drug and thus, Mrs. Perez does not qualify for Valium administration. Her anxiety was also caused by gambling and thus could be controlled by the eradication of the gambling behavior. Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

I intended to achieve addiction, compulsivity and impulsivity management through problem-solving and coping skills which results to total abstinence of the patient from drug abuse, gambling and control anxiety. The counselling achieved emotional management as the patient reported lack of anxiety within the treatment period. Additionally, she was able to share with the anonymous members meaning that she felt secure and was able to open up her experiences to the group. However, she did not like the counsellor (Salmon & Forester, 2012). This could be due to the fear of being judged which was demonstrated by the avoidance of eye contact from the first hospital visit.

Decision Three

Mrs. Perez is having issues with her counselor and hence, I encourage her to proceed with the attendance of the Gamblers Anonymous meetings. This is supported by the fact that she enjoys her involvement and feels secure to share with the other members who do not know her personally. Consequently, I intend to explore the underlying issue affecting the relationship between the counsellor and the patient and thus provide a solution to it. Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

In this case, I was hoping to achieve full patient recovery results. Having issues with the counselor discourages the recovery of the patient since she is not able to open her problems effectively and honestly to receive the anticipated help. Providing a solution to the strain patient counsellor relationship will facilitate the improvement of the therapy as well as support the recommendation for a new therapist. Negative relationships would encourage Mrs. Perez to discontinue the therapy thus preventing her recovery.

I did not choose to discontinueNaltrexone (Vivitrol) because; it was too soon. This prevents relapsing of the addictive, compulsive and impulsive behaviors in Mrs. Perez which would impact her successful recover adversely (Stahl, 2014b). I will otherwise discontinue the medication after complete recovery of the patient from all the addictive, impulsive and compulsive conditions.

I encourage Mrs. Perez to continue seeing her counselor and continue participating in the Gamblers Anonymous Group. This is because, a counsellor will help her cope with the abstinence and provide guidance on problematic areas. Due To the negative relationship between the current counselor and the patient, I do not advise her to continue seeing her. Instead, I recommend a new therapist for her. The counsellor will help her too discuss the gambling and smoking issue at length and formulate an intervention based on the information obtained (Grant, Odlaug& Schreiber, 2014). Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

Moreover, the group is effective in sharing the experiences shared by people with impulsive, compulsive and addictive behaviors as well as support them mentally and physically on the best practices to indulge in as behavioral change therapy. They also account for the free time of the patient and thus, Mrs. Perez will be able to recover fast in this environment and with the help of a counsellor. She won’t also have time to visit the casino for gambling and drinking practices.

Consequently, several legal and ethical implications affect the prescription of behavioral disorder therapies. As such, the dignity and respect of Mrs. Perez are upheld and her autonomy was enabled particularly as demonstrated through the change of psychiatrist. A thorough assessment before initiating the treatment was conducted to facilitate the consistency of the treatment with the guidelines of the profession(Stahl, 2014b). Notably, her confidentiality was maintained and her addictive and money wastage behavior was not disclosed to her husband. The patient was also given consent of the type of therapy and their implications on her as a legal requirement.

In conclusion, impulsivity, compulsivity, and addiction are behavior health conditions impacting a large number of the population. The conditions are treatable through medication and mental therapies which seek to alleviate the symptoms and prevent their relapse. During treatment, confidentiality, consent, autonomy and other ethical and legal factors guide the prescription.Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay

References

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

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

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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press. Therapy for Clients With Impulsivity, Compulsivity, and Addiction Essay