Clinical Pharmacology Discussion Essay

This paper explores the impulsivity, compulsivity, and addiction and its impacts on patients. The case of a 53 year old Puerto Rican female, Mrs. Perez, is used to examine the status of clients, diagnoses, treatment and ethical considerations during the pharmacological and psychological treatment therapies.Clinical Pharmacology Discussion Essay

Decision 1

Start Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

This decision was selected to help the patient manage the alcohol addictions. Naltrexone (Vivitrol) is an opiate antagonist that prevents the effects associated with addiction including pain relief and feelings of well-being (Grant, Odlaug & Schreiber, 2014). This in turn reduces the desire to take alcohol in addicted individuals. It also prevents the relapse of alcohol dependence.

Through this decision, I hoped to reduce the patient’s desires and pleasures associated with alcohol and thus resolve the alcohol dependencies and cravings. It also intended to prevent the relapse of alcohol addiction and behaviors related to its use. This is because; the medication blocks the neurotransmitters in the brain thus preventing the occurrence of alcohol cravings and pleasures (Salmon & Forester, 2012).

By the next follow up, I expected the patient to have gotten over her all her addictions completely. The alcohol addictions were successfully managed and the client reported to feel “wonderful” and not have touched alcohol within the period of treatment. However, her gambling addictions persisted contrary to what was expected. She is also anxious and is still smoking.Clinical Pharmacology Discussion Essay

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Decision 2

Refer to a counselor to address gambling issues

This decision was selected to introduce cognitive behavioral therapy in the management of addictions and anxiety. This approach promotes emotional, thought and behavioral changes and introduces positive behaviors that enable lifestyle changes (Stahl & Grady, 2012). Counselling also helps identify anxiety triggers and helps manage them as well as facilitates opening up without embarrassment and acknowledging the problem.

Counselling sought to achieve a lifestyle change that entailed not visiting the gambling den which drives the client to smoking. It also intended to eliminate anxiety through relaxation techniques and as well as help the patient cope with the life without addictions (Stahl, 2013). The decision also hoped to motivate the client in sustaining the change, gaining problem solving skills and abstinence techniques. Consequently, the intention was also meant to keep the client busy to avoid having free time to visit the gambling casino.

The counselling session was effective as the client reported eliminated anxiety after returning to the clinic after four weeks. She was able to manage her life abstinence and had joined an anonymous club of gamblers that helped share her experiences. However, the client did not like the counsellor she was assigned to which reveals a difference from the expected results. Even though, this did not affect the effectiveness of the psychological therapy.

Decision 3

Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

This decision was selected with the aim of resolving issues between the counsellor and the client to improve cooperation and collaboration among the two. Moreover, encouraging Mrs. Perez to continue attending the anonymous gambling club promoted sharing of experiences and understanding of how others were able to abstain as well as maintain and cope without gambling. Group therapy is essential in engaging clients in activities that better themselves and keep them busy and away from thinking about their addictions (Stahl, 2013).

This decision sought to med the strained relationship between the psychiatrist and Mrs. Perez in order to improve her outcomes. In addition, engagement in the gambling group sought to help the client remain busy with activities that modified her behaviors positively. It also sought to improve her problem solving and socializing skills (Loreck, Brandt & DiPaula, 2016).

The treatment intended to eliminate the addictions, impulsivity and compulsivity of the client. The difference that was observed at this stage was the persistent dislike foe the counsellor which could have been due to fear of judgment and embarrassment.

Legal and Ethical considerations

Treatment of mental disorders is guided by ethical and legal aspects. For instance, the client’s confidentiality must be maintained according to the privacy rights provided by the states and national legislations (Stahl, 2014b). In this case, the husband was not informed of the addictive behaviors of Mrs. Perez. Notably, informed consent and consent is essential during this case. As such, the patient client was informed of her illness, the treatment options available and their consequences and finally involved in decision making.  On the ethical issues, the ethical principles provide a guideline for mental disorder management. In this case, autonomy was maintained where the client’s dignity was upheld during treatment and was not judged for her behaviors. The principle of beneficence also ensured that she was given treatment that was beneficial to her.

In conclusion, addictions, impulsivity and compulsivity pose significant adverse impacts on the patient. They are difficult to manage even though psychotherapeutic and pharmacological approaches can be used to treat the symptoms and control future relapses. On the other hand, the legal and ethical issues involved during the treatment of these cases include consent, confidentiality, beneficence and autonomy.Clinical Pharmacology Discussion Essay

References

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: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

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

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

Stahl, S. M., & Grady, M. (2012). Stahl’s illustrated substance use and impulsive disorder New York, NY: Cambridge University Press.

Clinical Pharmacology Discussion Essay