Diagnosis: Gambling Disorder, Alcohol Use Disorder
BACKGROUND Mrs. Maria Perez is a 53 year old Puerto Rican female who presents today due to a rather “embarrassing problem.” SUBJECTIVE Mrs. 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 2 years, 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-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 2 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 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 she 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 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 event. She is dressed appropriately for the weather and time of year. Diagnosis: Gambling Disorder, Alcohol Use Disorder Her speech is clear, coherent, and goal directed. Her eye contact is somewhat avoidant 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 content of conversation and self-reported mood. She denies visual or auditory hallucinations, and 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 disorder DECISION POINT ONE Select What you would do: 1-Begin Vivitrol (naltrexone) injection, 380mgnintramuscularlyin the gluteal region every 4 weeks. 2-Begin Antabuse (disulfiram) 250mg orally daily. 3- Begin Campral (acamprosate) 666mg orally three times a day. Examine this Case Study of A 53 year old Puerto Rican Woman With Comorbid Addiction(ETOH and Gambling). 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, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Questions: Introduction to the case (1 page) • Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) • Which decision did you select? • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • 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). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • 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). •
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) • Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.• Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. • 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). • Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) • Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.Diagnosis: Gambling Disorder, Alcohol Use Disorder
The purpose for this paper revolves about Mrs. Perez who is a 53-year-old Puerto Rican female currently diagnosed with gambling disorder and alcoholism. In fact, the patient condition is harmful to her health since the disorder alters individual’s mental capacity thus making it difficult to conduct normal activities. According to the patient’s report alcoholic tendances escalated immediately after losing her father during her teenage. However, her current actions escalated due to the opening of a casino in her locality making it difficult to remain sober. Additionally, the client has a persistent smoking behavior for the last two years making her concerned about her future health.
According to client’s mental examination it shows that she is alert as well as oriented to event and time. Still, she has a clear and coherent speech but loses eye contact from the interviewer during an interview session. In fact, the patient denies having auditory hallucinations and paranoic thoughts. Currently, she denies having suicidal thoughts as well as homicidal thoughts. Lastly, the paper will cover evaluation and clinical assessment based probable decision chosen for treatment and the reason why such decision is employed.
Decision point 1: Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks
Based on the presented case study my first decision will include Vivitrol (naltrexone) injection, 380 mg intramuscularly in the gluteal region every 4 weeks. This decision is motivated by patient current trends of smoking cigarettes, taking alcohol, and gambling. Rationale to this decision comes as a result of naltrexone drug is capable of inhibiting alcoholism receptors thus lowering intake to the patient (Knox et al., 2019). This decision was reached as a result of eliminating other probable solution such as Antabuse (disulfiram) 250 mg and Campral (acamprosate) 666 mg orally TID.
Administration of Antabuse (Disulfiram) 250 mg orally daily was not a recommendable option since it could develop negative impacts to the client’s recovery phase such as headache, coma, and seizure. On the other hand, Campral (acamprosate) 666 mg orally TID decision would not fit since it is used in form of combination including psychological and social treatment for clients with alcoholic problems.
The selected decision to the patient were primarily aiming at reducing the patient’s tendency of gambling as well as halt alcoholic cravings. By so doing, the recommended drug is approved in reducing alcohol intake to an individual as well as managing gambling disorders. Still, by giving this patient naltrexone it will not expose her to adverse side effects and other risk factors. However, comparing the expected and actual outcome their similar expectation since the patient reveals to have a positive outcome. In fact, the patient stopped drinking and reduced frequent movement to casino. Contrary, the patient reported having anxiety feeling although it is a common side effects from Naltrexone drug.
Beneficence, non-maleficence, autonomy, and informed consent are ethical consideration that influenced the above decision. For instance, a medical profession attending a patient should ensure the client fully understand the reason for selecting a certain drug as well as the associated risk and side effects. By so doing, this will allow the client to accept the idea from the doctor without objection. Secondly, when treating a patient medical issues and diagnosis should be made primarily aiming at improving and managing the health condition (Spruit, & Lytras, 2018). This mode of approach instill client’s with confidence with assurance of no harm while taking the prescribed dosage. Lastly, patient should not be given drug without their will or get lured to take a certain type of medication.
The client returns to the clinic after four weeks after injection and reveals she has been sober since getting injection. Also, she denies having side effects from the treatment. But this time the chief complaint is gambling issue and more concerned about cigarette smoking and anxiety.Diagnosis: Gambling Disorder, Alcohol Use Disorder
Decision point 2: Refer to a counselor to address gambling issues
The patient condition in the second phase of treatment will involve referring her to a counselor to address gambling issues. In this case the professional will offer the patient with different therapies probable in treating continued gambling disorder. Such therapies will include cognitive, psychodynamic, and group therapies. According to Gadde, Apolzan, & Berthoud (2018) currently there are no set remedies for gambling disorders approved by FDA. However, such aid to the patient will include employment of pharmacotherapies to such a patient with comorbid psychiatric disorder linked with substance abuse and compulsive disorder.
This decision was critically arrived by disqualifying other probable solutions to the patient such as addition of Chantix (varenicline) 1 mg orally BID and disqualifying addition on Valium (diazepam) 5mg orally TID/PRN/anxiety. For instance, varenicline option was not recommendable since the starting dosage was higher than patient’s condition. Still, this medication would create negative impacts to patient’s condition. On the other hand, Diazepam was not applicable since valium react as an addictive benzodiazepine with severe side effects.
The expected and an actual outcome resembled with similarities since the client returned to the clinic with minimal anxiety experiences. Although, the patient reports she is not happy with the type of therapies subscribed to her but she is happy joining gambling anonymous groups.
Patient confidentiality is a vital aspect ruling medics during treatment process (Gioia & Salducci, 2019). However, this rule does not allow medical professionals to unfold health records to an authorized individual without owner’s consent. In this case the patient medical information remains intact without any individual alteration. Consequently, patient voluntary participation overrules the decision since they freely collaborate with the treatment plan.
Decision point 3: Explore the issue that Mrs. Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings
My third decision to attend the patient is explore issue with the patient raised after interacting with counselor as well as encouraging her to uphold attending group meetings. This decision comes in after the patient develops a negative experience from professional assistance. However, this point my decision is mainly aiming at completely fighting with gambling addiction as part of recovery. More so, counseling remedy remain significant since it will offer effective outcome. Then, the patient will be in a position to easily stop taking cigarettes after getting away from gambling areas.
In this decision, the anticipated results yielded with close similarities since after the patient’s visit to a counselor she upholds need to stop gambling as well as smoking by self. In fact, this came practical as she joined anonymous gambling groups as an exit idea. At this time, the difference that erupted to the client’s case is that she started cooperating easily contrary to neglecting the idea as anticipated.Diagnosis: Gambling Disorder, Alcohol Use Disorder
In the third decision, patient confidentiality and autonomy remains paramount before prescribing medications to the patient. This keeps patient with confidence since nobody knows their health condition. Still, professional patient approach allows medics to approach clients with care as well as prescribing exact medication aimed at managing and treating a certain condition (Yousef & Yousef, 2017).
The patient presented in the case study is approached with critically defined decision that eventually controls and manage the patient condition. For instance, naltrexone drug is an effective remedy to control alcohol addiction. Still, while fighting with gambling difficulties the patient is advised to seek counselor’s assistance that makes Mrs. Perez get the need to quit smoking as well as gambling actions. All decision employed to the patient are equally productive since she is able to stop ill health behaviors.
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Gioia, G., & Salducci, M. (2019). Medical and legal aspects of telemedicine in ophthalmology. Romanian journal of ophthalmology, 63(3), 197.
Knox, J., Hasin, D. S., Larson, F. R., & Kranzler, H. R. (2019). Prevention, screening, and treatment for heavy drinking and alcohol use disorder. The Lancet Psychiatry, 6(12), 1054-1067.
Moore, W., & Frye, S. (2019). Review of HIPAA, part 1: history, protected health information, and privacy and security rules. Journal of nuclear medicine technology, 47(4), 269-272.
Spruit, M., & Lytras, M. (2018). Applied data science in patient-centric healthcare: Adaptive analytic systems for empowering physicians and patients.
Yousef, N., & Yousef, F. (2017). Using total quality management approach to improve patient safety by preventing medication error incidences. BMC health services research, 17(1), 1-16. Diagnosis: Gambling Disorder, Alcohol Use Disorder