Assignment 1: assessing and treating patients with impulsivity,

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 se

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Comorbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female

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 o�” for the past 25 years. She states that for

the past 2 years, she has been having more and more di�culty 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

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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 e�ects 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 o� 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.” A�ect is appropriate to content of conversation and self-

reported mood. She denies visual or auditory hall

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Comorbid Addiction (ETOH and Gambling)
53-year-old Puerto Rican Female

Decision Point One

Vivitrol (naltrexone) 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 says she feels “wonderful” as she has not “touched
a drop” of alcohol since receiving the injection

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� 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 has her
concerned

Decision Point Two

Refer to a counselor to address gambling issues

RESULTS OF DECISION POINT TWO
� Mrs. Perez returns in 4 weeks and reports that the anxiety

that she had been experiencing is gone.

� She reports that she has met with the counselor, but she did
not really like her.

� She also started going to a local meeting of Gamblers
Anonymous. She states that last week, for the �rst time,
she spoke during the meeting. She reports feeling
supported in this group.

Decision Point Three

Explore the issue that Mrs. Perez is having with her counselor,

and encourage her to continue attending the Gamblers Anonymous

meetings

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Guidance to Student

Although controversy exists in the literature regarding how long to

maintain a client on Vivitrol, 8 weeks is probably too soon to

consider discontinuation. The psychiatric mental health nurse

practitioner should explore the issues that Mrs. Perez is having

with her counselor. As will be covered in more depth in future

courses, ruptures in the therapeutic alliance can result in clients

stopping therapy. Clearly, if the client does not continue with

therapy, the likelihood of the gambling problem spontaneously

remitting is lower (than had the client continued to receive

therapy). Recall that there are no FDA-approved treatments for

gambling addiction. The mainstay of treatment for this disorder is

counseling. Since Mrs. Perez reports good perceived support from

the Gamblers Anonymo

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