Week 8: Therapy for Clients With Impulsivity, Compulsivity, and Addiction

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 clients, you must understand how these disorders differ, as well
as how their symptoms impact clients and their families.

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

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

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

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”

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

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

For insomnia

For obsessive-compulsive disorder

• Citalopram
• clomipramine
• escitalopram
• fluoxetine
• fluvoxamine
• paroxetine
• sertraline
• venlafaxine
• vilazodone

 For alcohol withdrawal

• chlordiazepoxide
• clonidine
• clorazepate
• diazepam
• lorazepam
• oxazepam

 For bulimia nervosa and binge eating

• fluoxetine
• topiramate
• zonisamide

For alcohol abstinence

• acamprosate
• disulfiram

 For alcohol dependence

• nalmefene
• naltrexone

 For opioid dependence

• buprenorphine
• naltrexone

For nicotine addiction

• bupropion
• varenicline

Book Excerpt: Substance Abuse and Mental Health Services Administration. (1999). Treatment of adolescents with substance use disorders. Treatment Improvement Protocol Series, No. 32. Retrieved from 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”

Childhood trauma linked to worse impulse control. (2016). Journal of Psychosocial Nursing & Mental Health Services, 54(4), 15.

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:http://dx.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. doi:10.1080/15504263.2012.648439

Sanches, M., Scott-Gurnell, K., Patel, A., Caetano, S. C., Zunta-Soares, G. B., Hatch, J. P., & … Soares, J. C. (2014). Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents. Comprehensive Psychiatry, 55(6), 1337-1341.

Required Media

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 week’s Assignment.

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.

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.

Submission and Grading Information

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

• Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.
• Click the Week 8 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 8 Assignment 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 “WK8Assgn+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 8 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:Submit your Week 8 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:Week 8 Assignment

Making Connections

Now that you have:

• Assessed clients presenting with impulsivity, compulsivity, and addiction
• Developed personalized plans of therapy for clients with impulsivity, compulsivity, and addiction
• Examined factors that influence pharmacokinetic and pharmacodynamic
  processes in clients requiring therapy for impulsivity, compulsivity,
  and addiction
• Explored ethical and legal implications of prescribing therapy to clients with impulsivity, compulsivity, and addiction

Next week, you will build on your assessment and treatment skills as you examine clients presenting for therapy for ADHD.
To go to the next week:Week 9

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