Assessing and Treating Patients with Impulsivity Compulsivity and Addiction Mrs. Maria Perez, a 53-year-old Puerto Rican woman, presents to the clinic complaining of a gambling and alcohol use problem
Assessing and Treating Patients with Impulsivity Compulsivity and Addiction
Mrs. Maria Perez, a 53-year-old Puerto Rican woman, presents to the clinic complaining of a gambling and alcohol use problem. She notes that she has struggled with alcohol use from her late teenage following her father’s death. She has also been on and off with Alcoholics Anonymous for 25 years. She notes that in the last two years, her alcohol problem intensified after the “Rising Sun” casino was opened near her home. The casino triggered a compulsion for gambling, and due to the intensity and anxiety of the gambling, she drinks one or two bottles to calm her down. This only ends with her often spiraling into excessive drinking and risky gambling behavior. She also notes that she has smoked excessively in the last two years. Mrs. Perez notes that her weight has increased from 115 lbs. to 122 lbs. due to her drinking. Mrs. Perez expresses her concern as she has secretly borrowed an estimated $50,000 from her retirement account to finance her debts from gambling.
During the mental state evaluation of Mrs. Perez, she exhibited alertness, was well-oriented, was well-dressed, and spoke clearly coherently, and was goal-directed. However, she has avoidant eye contact. She also has a sad mood with a matching effect. She denies visual or auditory hallucinations, delusional and paranoid thought processes, as well as suicidal or homicidal thoughts. Her insight and judgment are grossly intact, with her impulse control impaired. Mrs. Perez is diagnosed with gambling disorder and alcohol use disorder. This diagnosis is based on a review of her health history, including alcohol use, gambling, and related factors. Her treatment plan ability will include pharmacotherapeutic and nonpharmacological options. This essay presents three decisions made by the PMHNP regarding pharmacotherapy and other issues arising during the treatment period throughout three visits and the reasons for each decision made. Our assignment writing help is at affordable prices to students of all academic levels and academic disciplines.
Decision #1
The first decision was to prescribe Antabuse (disulfiram) 250 mg for Mrs. Perez to be taken orally every morning. This decision is based on the diagnosis of the patient with alcohol use disorder and morbid gambling disorder. Antabuse (disulfiram) is one of the first-line FDA-approved medications for the management of alcohol dependence (Qian & Cantrell, 2022). Mrs. Perez is also adding weight due to her drinking. Animal-based tests of disulfiram on obese mice have shown that the drug can normalize body weight (Bernier et al., 2020). Neurological studies have also shown a relationship between the underlying functions leading to gambling and alcohol use problems (Quaglieri et al., 2020). Therefore, using disulfiram is expected to help Mrs. Perez manage her alcohol use, gambling, and her weight.
The other two medication options, Vivitrol (naltrexone) injection and Campral (acamprosate) were not selected. However, they can both be used to manage alcohol dependence, but due to the risk of side effects and addiction with long-term use, for instance, long-acting Vivitrol (naltrexone) injection has been found to only reduce craving but not AUD aversion with a risk of overstimulating opioid receptors in the brain (Mason & Heyser, 2021). Campral (acamprosate) is also effective in balancing the brain’s neurotransmitters but will only reduce alcohol cravings for a short time.
Antabuse (disulfiram) was prescribed for Mrs. Perez to reduce cravings for alcohol by associating alcohol use with subsequent discomfort. The mechanism of action of disulfiram includes interfering with the body’s metabolic process of oxidating acetaldehyde into less harmful acetic acid (Qian & Cantrell, 2022). Therefore, acetaldehyde builds up, causing undesirable hangovers that will push Mrs. Perez to reduce her alcohol consumption.
Ethical considerations during the first decision point will include appreciating Mrs. Perez’s autonomy in making well-informed decisions and privacy during communication as a person with a mental health condition. The selection of disulfiram as the drug of choice will ensure that it is beneficial to the patient in managing the alcohol use disorder with minimum risk for side effects.
Decision #2
During the second visit, the decision was to require Mrs. Maria Perez to continue with the current dose of Antabuse and refer her for counseling for the ongoing gambling issues. Sedation, fatigue, and a metallic taste are common and acceptable side effects of using disulfiram (Qian & Cantrell, 2022). Therefore, no need for alarm. On the other hand, counseling for the ongoing g