Assessing and Treating Clients With Impulsivity, Compulsivity, and Addiction

Laureate Education (2016c). Case study: A Puerto Rican woman with comorbid addiction [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this Assignment.

https://mym.cdn.laureate-media.com/2dett4d/Walden/…

To prepare for this Assignment:

• Review this week’s Learning Resources. Consider how to assess and treat adolescent clients requiring therapy for impulsivity, compulsivity, and addiction.

ACTUAL ASSIGNMENT
PLEASE Addressed each of the following bullets with a subtopic, include references; in-text citation in each paragraph. Please use my articles and any additional one should come from USA and must be within last five years only that is from 2014 to 2018. Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations) Thanks

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 pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

• Decision #1
  • Which decision did you select?
  • 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.
  • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
• 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.
  • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
• 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.
  • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement.

BACKGROUND

Mrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office 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 two years, she has been having more and more difficulty maintaining her sobriety since they opened the new “Rising Sun” casino near her home. Mrs. Perez states that she and a friend went to visit the new casino during their 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 two 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 that 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 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 has borrowed over $50,000 from her retirement account to pay off her gambling debts. She is very concerned because her husband does not know that she has spent this much money.

MENTAL STATUS EXAM

The client is a 53 year old Puerto Rican female who is alert, 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. As 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 & self-reported mood. She visual or auditory hallucinations, 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

Decisions Made and Outcomes (Needed to formulate the paper)

Choices for Decision 1: Select what the PMHNP should do: Decision Point One

• Naltrexone (Vivitrol) 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

My decision

Decision Point One: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• Mrs. Perez said that she felt “wonderful” as she has not “touched a drop” to drink since receiving the injection
• Client reports that she has not been going to the casino, as frequently, but when she does go she “drops a bundle” (meaning, spends a lot of money gambling)
• Client She is also still smoking, which has her concerned. She is also reporting some problems with anxiety, which also have her concerned

Choices for Decision 2:

Select what the PMHNP should do next:

• Add on Valium (diazepam) 5 mg orally TID/PRN/anxiety
• Refer to a counselor to address gambling issues
• Add on Chantix (varenicline) 1 mg orally BID

My decision: Add on Valium (diazepam) 5mg orally TID/PRN/anxiety

Outcome: RESULTS OF DECISION POINT TWO: RESULTS OF DECISION POINT TWO

• Client returns to clinic in four weeks
• Mrs. Perez reports that when she first received the valium, it helped her tremendously. She states “I was like a new person- this is a miracle drug!” However, she reports that she has trouble “waiting” between drug administration times and sometimes takes her valium early
• Client is asking today for you to increase the valium dose or frequency

Choices for Decision 3:

Select what the PMHNP should do next:

• Continue current dose of Vivitrol, increase Valium to 10 mg orally TID/PRN/anxiety. Refer to counseling for her ongoing gambling issue
• Continue current dose of Vivitrol, decrease/taper Valium with the goal of discontinuation in the next 2 weeks. Refer to counseling for her ongoing gambling issue
• Continue current dose of Vivitrol and maintain current dose of valium. Refer to counseling for her ongoing gambling issue

My decision: Continue current dose of Vivitrol, decrease/taper Valium with the goal of discontinuation in the next 2 weeks. Refer to counseling for her ongoing gambling issue

Guidance to Student

Anxiety is a common side effect of Vivitrol. Mrs. Perez reports that she is doing well with this medication, and like other side effects, the anxiety associated with this medication may be transient. The psychiatric mental health nurse practitioner should never initiate benzodiazepines in a client who already has issues with alcohol, or other substance dependencies. Additionally, benzodiazepines are not to be used long-term. Problems associated with long-term benzodiazepine use include the need to increase the dose in order to achieve the same therapeutic effect. This is what we are seeing in Mrs. Perez’s case.

The most appropriate course of action in this case would be to continue the current dose of Vivitrol, while decreasing the Valium with the goal of discontinuation of the drug within the next two weeks. At this point, we need to evaluate whether or not the side effect of anxiety associated with Vivitrol persists.

Increasing the dose of Valium would not be appropriate, neither would maintaining her on the current dose of Valium. Additionally, the client should be referred for counseling to help with her gambling addiction, as there are no FDA approved medications gambling disorder.

Medication should never be added treat side effect of another medication, unless that side effect is known to be transient (for instance, benzodiazepines are sometimes prescribed to overcome the initial problem of “activation” associated with initiation of SSRI, or SNRI therapy). However, in a client with multiple addictive disorders, benzodiazepines should never be used (unless they are only being used for a limited duration of therapy such as acute alcohol detoxification to prevent seizures).

Additionally, it should be noted that Mrs. Perez continues to engage in problematic gambling, at considerable personal financial cost. Mrs. Perez needs to be referred to a counselor who specializes in the treatment of gambling disorder, and should also be encouraged to establish herself with a local chapter of gamblers anonymous.

The PMHNP needs to discuss smoking cessation options with Mrs. Perez in order to address the totality of addictions, and to enhance her overall health.

References/Resources

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

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

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter 14, “Impulsivity, Compulsivity, and Addiction”

Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the Substance Use and Impulsive Disorders tab.

• Chapter 10, “Disorders of Impulsivity and Compulsivity”

Using APA in discussion posts is very similar to using APA in a paper. And it helps to think of your discussion post as a short APA paper without a cover page. You need to cite your sources in your discussion post both in-text and in a references section. If you need help forming in-text citations, check out your in-text citation page on the APA guide

Topic 1: Travel and Transport, Inc

1. What does Travel and Transport, Inc., do?

2. Describe the complexity and the competitive nature of the business environment in whichWhat were the main business challenges?

3. List and comment on at least three main benefits of the implemented system. Can you think of other potential benefits that are not mentioned in the case?

Choose ONE ! of the following essays for your response:

1. “The Dark Knight and the Evilness of Evil” by Ashley Cocksworth

2. “The Exceptional Darkness of The Dark Knight” by Todd McGowan

3. “What do you believe in? Film scholarship and the cultural politics of the Dark Knight franchise” by Martin Fradley

Write a summary and response essay.

1. The summary section of your essay (200-300 words) should clearly and objectively present the main ideas, as well as the important sub-points, of the essay you have chosen to write about. The summary should be written almost entirely in your words; only use particularly important quotations when they are necessary to your summary. The response section of your essay (400-600 words) should include an original idea as its main thesis. While the summary is objective, the response is subjective and presents your ideas on the subject. The response can take one of the following forms:
2. (1) an explanation of your agreement or disagreement with the author’s claim (s)
   (If you choose to agree, you must go beyond simply saying you feel similarly by presenting new information or reasons that you feel the author’s position should be supported.)
3. (2) an evaluation of the author’s presentation of his or her argument. Your response should present evidence from your own knowledge and experience to support your argument. You do not need to use additional sources in this essay.

Length: 700-900 words ( 2 1⁄2 – 4 pages)

Turning in your work: Along with your final essay, turn in the annotation and the outline you have made about the article you are responding to, and any process work you have done while writing this essay. Compile all components of the essay into one Word document, and upload to BeaconLearning (directions to follow).

Select an organization and describe its history, products, and major competitors in a paragraph or two. Develop a SWOT analysis detailing the strengths, weaknesses, opportunities, and threats that may affect the organization.

You must submit a three-to four-page paper (excluding the title and reference pages) formatted according to APA style guidelines as outlined in the Ashford Writing Center. In addition to the textbook, you must use at least two scholarly sources.

Instructions 
Locate a competing organization in your local market (or region) to help develop your SWOT analysis. You can find this information on the website for the US Chamber of Commerce. Your SWOT analysis should address the Questions to Ask on Rob Berman’s blog. 

Complete the discussion after reading the Chapter on Culture and watching and/or listening to the class recording.

Give an example of a gesture within your culture that may not translate into another culture’s body language. Next, include an example of a sign and what it represents to your culture or in society.

Not including a gesture and a sign will result in points deducted.

Respond to one person’s post with thoughtful feedback. Your
feedback should be complete sentences. Be specific. Your feedback
should directly refer to the task. Be kind and supportive in your
feedback. Not including feedback on a post will result in points
deducted. (Perhaps, your culture has a different meaning of the sign or
gesture. Your response has to be more than “I agree… I disagree…”)

Click “reply” to write your response. You will not see the other posts until you respond.

EXAMPLE:
“thumbs up” sign, which expresses praise
or approval in the U.S. but may be considered obscene in South America
or Asia. Similarly, the “A-OK” sign communicates praise in the U.S. but
is not acceptable in parts of Italy.

textbook: https://openstax.org/books/introduction-sociology-…