Week 8: Therapy for Clients With Impulsivity, Compulsivity, and AddictionImpulsivity 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.Photo Credit: [Apolinar B. Fonseca]/[Moment]/Getty ImagesAssignment: Assessing and Treating Clients With Impulsivity, Compulsivity, and AddictionImpulsivity, 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 ObjectivesStudents will:Assess client factors and history to develop personalized therapy plans for clients with impulsivity, compulsivity, and addictionAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for impulsivity, compulsivity, and addictionEvaluate efficacy of treatment plansAnalyze ethical and legal implications related to prescribing therapy for clients with impulsivity, compulsivity, and addictionLearning ResourcesNote: 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 ReadingsNote: 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”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 insomniaFor obsessive-compulsive disorder Citalopramclomipramineescitalopramfluoxetinefluvoxamineparoxetinesertralinevenlafaxinevilazodone For alcohol withdrawal chlordiazepoxideclonidineclorazepatediazepamlorazepamoxazepam For bulimia nervosa and binge eating fluoxetinetopiramatezonisamideFor alcohol abstinence acamprosatedisulfiram For alcohol dependence nalmefenenaltrexone For opioid dependence buprenorphinenaltrexoneFor nicotine addiction bupropionvarenicline 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”University of Michigan Health System. (2016). Childhood trauma linked to worse impulse control in adulthood, study finds. Retrieved from https://www.sciencedaily.com/releases/2016/01/1601...Note: Retrieved from Walden Library databases.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.xNote: Retrieved from Walden Library databases.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:10.3928/00989134-20160314-04Note: Retrieved from Walden Library databases.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:10.1080/15504263.2012.648439Note: Retrieved from Walden Library databases.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. doi:10.1016/j.comppsych.2014.04.018Note: Retrieved from Walden Library databases.Required MediaLaureate 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 AssignmentExamine 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 #1Which 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 #2Why 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 #3Why 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.Co-morbid Addiction (ETOH and Gambling) 53-year-old Puerto Rican FemaleBACKGROUNDMrs. Maria Perez is a 53 year old Puerto Rican female who presents to your office today due to a rather “embarrassing problem.” SUBJECTIVEMrs. 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 EXAMThe 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 disorderDecision Point OneSelect what the PMHNP should do:Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeksAntabuse (Disulfiram) 250 mg orally dailyCampral (Acamprosate) 666 mg orally three times/day

Working with Children and Adolescents Versus Adults Infant, childhood, and adolescent development are a continual interplay between nature (genetic or biologic predisposition) and nurture (environmental experiences). The nature/nurture continuum and debate will always be a part of your career as a PMHNP. Knowing common developmental milestone is important in the role as a child provider. Not only is it essential to the diagnostic process, but it is also important to the interdisciplinary interactions with other mental health professionals. The study of normal developmental processes, however, is only one tool that allows the mental health professional to understand the child being evaluated. There are many different assessment instruments and interviewing techniques that PMHNPs can have in their toolkit when working with children and adolescents. In this Discussion, you examine the differences in assessing and treating children and adolescents versus adults. You take into consideration your own clinical experiences, as well as your experiences in your clinical rotation, and the information from the readings thus far. Analyze the importance of developmental assessmentsAnalyze assessment instruments used for evaluating children and adolescentsAnalyze treatment options used for children and adolescentsAnalyze roles parents play in assessment and treatment To Prepare for the Discussion Review the Learning Resources concerning psychiatric assessments and assessment tools. Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts and cannot post anonymously. Please check your post carefully before clicking Submit! Post your answers to the following: Explain why a developmental assessment of children and adolescents is important.Describe two assessment instruments and explain why they are used for children and adolescents but not adults. Describe two treatment options for children and adolescents that may not be used when treating adults.Explain the role parents play in assessment and treatment.Support with 4 or more current evidenced based literature.

This Assessment requires submission of three (3) files. One Word document will include your written responses to Parts I–III. Save this file as MP003_Narrative_firstinitial_lastname (for example, MP003_Narrative_J_Smith). The second file is a completed “Budget” document. You will submit the budget as supporting evidence for your narrative. Save this file as MP003_Budget_firstiniital_lastname (for example, MP003_Budget_J_Smith). The third file is a completed “Labor Schedule” document. Save this file as MP003_Labor_firstinitial_lastname (for example, MP003_Labor_J_Smith). When you are ready to upload your completed Assessment, use the Assessment tab on the top navigation menu.InstructionsBefore submitting your Assessment, carefully review the rubric. This is the same rubric the assessor will use to evaluate your submission and it provides detailed criteria describing how to achieve or master the Competency. Many students find that understanding the requirements of the Assessment and the rubric criteria help them direct their focus and use their time most productively.RubricAccess the following to complete this Assessment: Budget Adult-Child Ratios Labor Schedule USDA Choose My Plate This assessment has three-parts. Click each of the items below to complete this assessment.Part I: Tuition Fees and FacilitiesGo to the “Budget” document. Find the tab “Budget for Next Year.” Locate the balance for next year (line 42).Set tuition fees for each program for the upcoming year by typing each fee into the appropriate green cell. Be sure the balance for next year exceeds the balance for this year to account for the changes that come with expanding your early childhood care center. (The balance for this year can be found on line 40 on the tab called “Budget for This Year.”)Submit 1–2 pages explaining the following: The impact of tuition changes on the program and on the families it serves How you will spend this money to manage the facilities and contribute to a safe and positive learning environment for the children enrolled at your early childhood care center Part II: Human Resource AllocationNotice the change in staff and salary in this year’s budget and next year’s budget. Using both budgets, write 2–3 paragraphs explaining the staff and salary changes that were made and infer the reasons why.You anticipate 125 children will be enrolled in the new facility.Using the “Labor Scheduling” document, develop a daily schedule of labor for the entire early childhood care center that adheres to the recommended adult-child ratios provided in the “Adult-Child Ratios” document. Note that the Monday schedules for three floaters are given. Use the following information to create the schedule: The center is open Monday through Friday from 6:30 a.m. to 6:30 p.m. Staff in full-time positions work 40 hours per week. Staff in part-time positions work as needed for the early childhood care center but no more than 30 hours per week. Floaters are not assigned to specific rooms. (They may provide support in the toddler rooms, the pre-school rooms, and the pre-K rooms as necessary.) Review the number of staff in the “Budget for Next Year” and the labor schedule you developed in Step 2.Write 2–3 paragraphs explaining any changes you would make to the staffing projections to adhere to the adult-child ratios found in the “Adult-Child Ratios” document.According to your budget, you decided to save money on custodial services by hiring a contractor instead of a full-time custodian.Write a 1-page paper describing the role and responsibilities of the custodian and explaining the advantages and disadvantages of using a contractor instead of using someone on the payroll.Part III: Nutrition ProgramUse the “USDA Choose My Plate” website to describe how you will manage the nutrition program at Sunny Skies Day Care. Your 3- to 4-page description should include the following: An explanation of your personnel needs and the responsibilities of your food service personnel A sample 1-week menu plan that includes an explanation of how it adheres to nutritional guidelines An explanation of how you will meet health regulations and accommodate special diets