Assessing and Treating Patient With Impulsivity, Compulsivity, and Addiction
Case Study: BACKGROUND: Mrs. Maria Perez is a 53-year-old Puerto Rican female who presents today due to a rather ” embarrassing problem”. Mrs. Perez admits she 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 Alcohol Anonymous ” on and off” for the past 25 years. She states that for the past 2years, 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-stake 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 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 noticed that when she drinks, she doesn’t smoke “as much”, but she enjoys enjoy smoking when she is playing at the slot machines. She also reports that she has gained weight from drinking so much. She currently weighs 122lbs., which represents a 7lbs. weight gain from her usual 115ibs 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 events. She has dressed appropriately for the weather and time of the year. Her speech is clear, coherent, and goal-directed. Her eye contact is somewhat avoided 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 the content of the conversation and self-reported mood. She denies visual or auditory hallucination, and no delusions 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.
THE ASSIGNMENT: 5 PAGES.
You are asked to make THREE DECISIONS concerning the medication to prescribe to the patient. Consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic process.
At each decision point, evaluate all options before selecting your MEDICATION DECISION.
THE Medications are; (1) Vivitrol ( naltrexone) injection, 380 mg Intramuscular in the gluteal region every 4 weeks. (2) Antabuse ( disulfiram) 250 mg orally daily (3) Campral (acamprosate) 666 mg orally three times/day. (1) Introduction to the case (1 Page ): Briefly explain and summarize the case for this Assignment. Be sure to include the patient-specific factors that may impact your decision-making when prescribing medication for this patient.
DECISION # 1: ( 1 Page ) (a) Which Medication decision did you select?
(b) Why did you select this Medication Decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(c) Why did you not select the other Two Medications options provided in the exercise? Be specific and support tour response with clinically relevant and patient-specific resources, including the primary literature.
(d) 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).
( e) Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
DECISION #2 (1): What medication from the THREE medications above will you give or continue to give or increase/ decrease the dose or maintain at the given dose to increase the effectiveness and stability of patient treatment?
(1) Why did you select this medication? Be specific and support your response with clinically relevant and specific- patient resources, including the primary literature.
(2) Why did you not select the other Two medication options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(3) What were you hoping to achieve by making this decision? Support your response with evidence and references including the primary literature.
(4) Explain how ethical considerations may impact your treatment plan and communication with the patient. Be specific and provide examples.
DECISION # 3 ( (1 PAGE) What medication will you give either decrease/ increase or change or maintain at given doses to achieve therapeutic effectiveness? (1) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
(2) Why did you not select the other two medication options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources including the literature.
(3) What were you hoping to achieve by making this decision with this medication option? Support your response with evidence and references to the learning resources including the primary literature.
(4) Explain how ethical considerations may impact your treatment plan and communication with the patient. Be specific and provide examples.
CONCLUSION (1 Page) Summarize your recommendation on the treatment options you selected for this patient. Be sure to justify your recommendation and support your response with clinically relevant and patient-specific resources, including the primary literature. Support your rationale with a minimum of SIX academic resources by utilizing the primary and secondary literature.
