Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

Gambling disorder and alcoholism are two disorders that go hand in hand. For several individuals, the two conditions coexist and exacerbate one another. The client, a 53-year-old Puerto Rican woman, came to the facility with symptoms of a very shaming issue. She acknowledges that she had struggled with drinking after the death of her father when she was in her late adolescence. In the years afterwards, she has struggled with the problem and has attended sessions of Alcoholics Anonymous from time to time. Since the opening of the casino in her neighborhood two years ago, she has had trouble staying sober. After visiting the casino with a friend immediately after it opened, she became a regular gambler. She describes herself as ecstatic when she gambles and loves a drink to help her relax while she is playing high-stakes activities. As a result, more alcohol use and irresponsible gambling take place. During the last two years, she has also upped her cigarette use, which she believes is having a negative impact on her health. According to her, she smokes less when drinking but more while playing slot machines. She has put on weight and now weighs 122 lbs. Her husband is unaware that she has accumulated a gambling debt in the amount of $50,000 that she has repaid from her retirement fund. During her mental examination, she seems alert and oriented to her surroundings, including person, place, time, and situation. She is appropriately attired for the occasion. Her discourse is well-organized, concise, and goal-oriented. During the examination, she avoids making direct eye contact with the examiner. This woman’s mood is gloomy, and her affect is in line with that. She asserts that she has never had visual and auditory hallucinations. She does not have any delusional or paranoid thinking at all. Her way of thinking and reasoning is completely intact, and she categorically denies having had suicidal or homicidal thoughts. The ability to regulate her impulses is weakened. She was found to have gambling and alcohol use disorders Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

ORDER YOUR PAPER HERE

Decision #1: Naltrexone (Vivitrol) injection, 380 mg intramuscularly in the gluteal region every 4 weeks

Naltrexone is a mu-opioid receptor antagonist with confirmed effectiveness and is the first-line therapy for alcohol dependency disorder, which is why I made this choice. It is an approved medication for patients who are addicted to alcohol as a component of a complete therapeutic intervention with the aim of abstinence from alcoholic drinks (Stahl, 2020). Individuals who want to cut down on their alcohol consumption are also encouraged to use this medication to do so.

Antabuse was not my first choice since it is often used to maintain alcohol sobriety rather than as a first-line treatment (Yahn et al., 2013). The reason why I did not select Campral is that although it is regarded as first-line therapy, the dosage of 666 mg three times a day for patients under 60 kg is too excessive and can induce serious adverse effects like suicidal ideation (Stahl, 2020).

I made this choice in the hopes of reducing the patient’s drinking within a couple of days to 4 weeks, which is typically when Naltrexone begins to work. Individuals who drink less will visit casinos less often.

Informed consent, confidentiality, patient autonomy, nonmaleficence, and beneficence are among the ethical considerations to observe at this stage (Lupi et al., 2014). Therapy may be accepted or rejected by the patient. Her humiliation ought not to be made public, and the details she provided must remain confidential. It is necessary to provide health education and obtain informed consent. To provide optimum treatment, the risks and benefits of the medicines being given to the client must be weighed (Lupi et al., 2014) Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

Decision #2: Refer to a counselor to address gambling issues

I made this choice because the patient stated that she keeps going with her gambling habit every time she goes to the casino and that she ends up spending a significant amount of money. Because of the financial strain that the patient is bearing, she has to be referred to a counselor who can assist her manage her gambling habit.

The reason I did not select to add on Valium was that it is a benzodiazepine, and benzodiazepines are not suggested for people with alcoholism or other drug abuse problems (Stahl, 2013). Moreover, adding on Chantix 1 mg orally twice a day is not a wise choice. Chantix 1 mg orally twice daily is deemed a bigger dosage, and it has the tendency to induce severe side effects like suicidal ideation (Stahl, & Grady, 2012). In most cases, it is advised to begin with 0.5 mg/day of Chantix and gradually raise the dosage to 1 mg/day given in two doses after 3 days.

The choice I made was in the hopes of helping the patient conquer her gambling addiction. Because there are no FDA-approved therapies for gambling disorder at this time, counseling is the main therapy for gambling disorder (Grant, Odlaug, & Schreiber, 2014). Besides that, I wanted to allow the first medication to aid the patient to overcome her drinking and smoking issues.

The ethical principles of beneficence and nonmaleficence are important to observe at this point. Anxiety had been noted by the client as an adverse effect of the medication. Nevertheless, over time, it had vanished. In accordance with these ethical standards, a risk-benefit appraisal of treatment should be conducted before proceeding (Renner & Ward, 2016)Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

Decision #3: Explore the issue that Mrs Perez is having with her counselor, and encourage her to continue attending the Gamblers Anonymous meetings

My reason for making this decision would be that the client has said that she does not like her counselor, and it is thus necessary to investigate why this is the case. According to research, a negative correlation between the counselor and the client may lead to the client discontinuing treatment (Schöttke et al., 2019). Having benefitted from Gamblers Anonymous sessions, it is critical that the patient keeps attending sessions.

Due to her displeasure with her present counselor and the fact that whichever problem was triggering this has not been addressed, it would be improper for the patient to keep seeing her. As a result, it would be inappropriate to urge the client to keep consulting her present counselor since doing so may lead to her discontinuing treatment and thus failing to gain from the therapy. Since the patient had been on Naltrexone for 4 weeks, I did not decide to stop the drug on my own initiative. Despite the fact that there is no set time period for discontinuing the drug, four weeks is a very short period of time to contemplate discontinuing the prescription.

I made this choice in the hopes that after the problem between the patient and her counselor would be addressed, they will be capable of establishing a positive connection, which will aid in the improvement of the therapeutic outcome. Attending Gamblers Anonymous sessions will continue to benefit the patient.

The ethical standards to be addressed at this point are nonmaleficence and beneficence (Kelly & Renner, 2016). Rather than reducing adherence, the counseling sessions should be designed to promote adherence. As such, investigating the treatment issues was necessary to guarantee that the client receives the most value from the recommended therapy. During follow-up appointments, the medications will be re-examined to see whether there are any adverse effects. For patients to receive and comply with optimum treatment, efficient communication must be created across all avenues (Lupi et al., 2014).

BUY YOUR PAPER HERE

Conclusion

The client is a 53-year-old woman who suffers from alcoholism as well as a gambling addiction. Aside from that, she has an issue with smoking. Recently, her smoking has gotten worse, and she has admitted that she is unable to stop her behavior. She has amassed a debt of more than 50,000$ from her retirement plan, which she has used to settle her gambling debt. She is ashamed of her behaviors, and she wants to give them up. Everything seems to be fine upon assessment, with the exception of poor impulse control. She is also unable to maintain eye contact due to her embarrassment (Lupi et al., 2014) Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

As a first step in treating this client, I decided to administer Naltrexone, which was suitable since it aids in the treatment of smoke and alcohol dependence (Kelly & Renner, 2016). It helps to decrease cigarette urges as well as the quantity of tobacco used each day. I made the decision to send the client to a gambling counsellor due to the fact that drug therapy was supposed to be used to solve the other two issues. Gambling does not have a particular medical treatment plan and, as a result, does not need therapy when necessary. This decision was made in the final round of deliberations to urge the client to pursue counseling while also discussing the situation with her present therapist (Kelly & Renner, 2016). It is best practice to refer a client to another counselor who will be more pleased with if she shows dissatisfaction with the first.

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”
• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
• PMH: Asthma
• Medications: Symbicort 160/4.5mcg
• Allergies: NKDA
• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney

Diagnostics: HSV specimen obtained

Assessment: Chancre

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or why not?
• Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

Please do not write the paper in soap note format. PLEASE ANSWER ONLY THE QUESTIONS. DO NOT REWRITE THE CASE STUDY. Title page and Reference page required ( APA format ).

Sample answers to the questions

Alternatively, she may have blood tested via RPR. If immediate testing is unavailable, the

patient should begin empiric treatment with penicillin.

Vulvar Cancer –

Skin cancer occurring on the vulva presents as an ulceration like lesion which

should be considered as a likely differential diagnosis for this patient. The patient’s chief

complaint reports rough bumps noted to labia. This differing in texture is concerning for a

cancerous origin (Alkatout, et al., 2015). Biopsy of the lesion should be taken for further study.

We are unsure of the patient’s HPV vaccination status. If HPV is present in the patient her risk Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

for vulvar cancer is increased.

Genital Herpes

– Genital lesions are most often associated with Herpes Simplex Virus (HSV)

type 2 infection but may also be caused by HSV type 1 (Groves, 2016). The infection may lay

latent without symptoms for a long period of time before a patient becomes symptomatic.

Genital herpes presents as more vesicular in nature rather than a large singular chancre. These

lesions are most often described as a painful burning sensation.

Chancroid –

Is caused by a sexually transmitted bacteria called Haemophilus ducreyi and

presents first as a vesicular like lesion which quickly becomes an open chancrous like ulceration

(Copeland & Decker, 2016). These lesions are most commonly associated with pain which

decreases the likelihood of this diagnosis.

Gonorrhea –

Due to the often-simultaneous infection of chlamydia and gonorrhea, and the

patient’s past history of chlamydial infection gonorrheal infection should be ruled out. Symptoms

of gonorrhea are commonly described as a purulent vaginal discharge with inflammation of the

vulva (Ball, Dains, Flynn, Solomon, & Stewart, 2019) Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

PLAN:

This section is not r

Question

GENITALIA ASSESSMENT

Subjective:

CC: “I have bumps on my bottom that I want to have checked out.”

HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

• PMH: Asthma
• Medications: Symbicort 160/4.5mcg
• Allergies: NKDA
• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia.
• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney
• Diagnostics: HSV specimen obtained Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

Assessment:

• Chancre

1) Analyze the subjective portion of the note. List additional information that should be included in the documentation.

2) Analyze the objective portion of the note. List additional information that should be included in the documentation.

3) Is the assessment supported by subjective and objective information? Why or why not?

4) Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

5) Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

ORDER  HERE

…continue reading

Answered by Expert Tutors

1) Analyze the subjective portion of the note. List additional information that should be included in the documentation.

There are some subjective data provided that are helpful like for example the history of chlamydia and treatment and the presence of rough painless bumps which is very important since most ulcerations caused by genital infection can be classified according to pain. However, last sexual activity was not indicated which would be helpful to identify the probability of incubation period. Also the use of condoms during the previous sexual intercourse, and if the client noticed this lesion prior to her previous intercourse Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

2) Analyze the objective portion of the note. List additional information that should be included in the documentation.

The objective part lacks a lot of information such as the number of lesions, appearance of the lesion, color, diameter, decribe edges if sharply demarcated margins, depth, base, induration, presence or absence of lymphadenopathy, or if it is associated with a burning sensation during urination.

3) Is the assessment supported by subjective and objective information? Why or why not?

The assessment is partly supported by the subjective and objetive information, in that we have identified that the patient is sexually active, has a history of chlamydia, she states the presence of painless and rough bumps on genital area, and on objective it was identified to be a firm, round, small, painless ulcer on external labia. It isn’t well supported in the sense that it lacks a lot of data especially in the objective part.

4) Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

Yes, to identify the causative agent. Diagnostics include a culture and staining, or polymerase chain reaction.

• Culture and staining- isolates the caustive agent.
• Polymerase chain reaction – will detect the DNA of the virus.

5) Would you reject/accept the current diagnosis? Why or why not? 

No diagnosis was given.

But I believe the diagnosis is Syphilis with the assessment referring to a painless chancre while HSV-2 or herpes simplex virus 2 on the other hand is painful ulcer presenting.

Based on NCBI  (https://www.ncbi.nlm.nih.gov/books/NBK554427/), Herpes genitalis can be caused by the herpes simplex virus type 1 or type 2 and manifests as either a primary or recurrent infection. Genital symptoms are commonly seen in the outpatient primary care setting, despite many going without a clear diagnosis. HSV-2, in particular, may present as a primary infection with painful genital ulcers, sores, crusts, tender lymphadenopathy, and dysuria. The classical features are of macular or papular skin and mucous membrane lesions progressing to vesicles and pustules that often last for up to 3 weeks. Genital lesions can be especially painful, leading to swelling of the vulva in women, burning pain, and dysuria. The study further stressed that it is important to note that HSV-2 does not typically present with painless ulcers. Systemic symptoms can occur to include fever, headache, and malaise and are often due to concurrent viremia, which has been reported in up to 24% of patients in one study Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

SYPHILIS

Syphilis is caused by Treponema pallidum. The lesion of primary syphilis occurs at the site of initial inoculation of T pallidum. It is usually single and painless but can be multiple and painful. It tends to begin as a macule that becomes a papule, which then ulcerates. A two to three week incubation period usually occurs between the inoculation of T pallidum and development of the lesion (the range of incubation period is reported as being 9-90 days). Local, non-tender lymphadenopathy is often associated with this lesion.

Source: NCBI Syphilis By Dr. Patrick French,

DONOVANOSIS

Also known as “granuloma inguinale”. Donovanosis lesions usually start as a painless papule or subcutaneous nodule. The lesions develop the classic “beefy-red” appearance due to their high vascularity. The initial lesion takes on an ulcerative morphology after minor trauma. There is usually no regional lymphadenopathy. Developing subcutaneous granulomas known as pseudobuboes is possible. The lesions are progressive in an outward direction from the center. The borders of the lesions are sometimes described as “snake-like” in appearance. Self-inoculation is possible and may create mirror-image lesions in the same general location, usually across skin folds. Patients often delayed seeking health care for many reasons, and therefore, they usually present with a more progressed lesion. There are 4 types of lesions. Classic ulcerogranulomatous lesions are the most common with beefy-red, non-tender ulcers that bleed easily. The second type is hypertrophic or verrucous with irregular raise edges and dry texture. The third type is necrotic, offensive-smelling, deep ulceration that causes tissue destruction. The last type is sclerotic or cicatricial with fibrous and scar tissue. The genitals are affected in 90% of cases and the inguinal region in 10% of cases. The most common sites where men are affected are the prepuce, coronal sulcus, frenum, glans, and anus. The most common sites where women are affected are the labia minora, fourchette, cervix, and upper genital tract Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

Source: NCBI Granuloma Inguinale by Jenna N. Santiago-Wickey; Brianna Crosby.

LYMPHOGRANULOMA VENEREUM

LGV is caused by chlamydia trachomatis. Characteristically lymphogranuloma venereum has three stages. The primary stage begins in 3 to 12 days after exposure or sometimes it may be longer up to 30 days. The patient characteristically develops a painless genital ulcer or papules which are about 1 to 6 mm in size. Sores can also be present in the mouth or throat. An inflammatory reaction can occur at the site of inoculation. This stage often goes unnoticed due to the location of the lesions and as the lesions are usually small and there are no associated symptoms. The lesions resolve or heal spontaneously after few days. The secondary stage presents with the development of unilateral or bilateral tender inguinal and/or femoral lymphadenopathy (also called buboes), which occurs two to six weeks after the primary stage; this is called the inguinal syndrome. An anorectal syndrome also presents which is characterized by proctitis or proctocolitis-like symptoms. Pain during urination, rectal bleeding, pain during passing stools, abdominal pain, anal pain, tenesmus. Generalized symptoms like body aches, headache, and fever can occur during this stage.  This syndrome usually occurs when the transmission is via the anal route. An oral syndrome can occur in people get LGV through the oral route. Cervical lymphadenopathy can occur. The late sequelae usually occur when the disease is left untreated where necrosis and rupture of the lymph nodes are present with anogenital fibrosis, and strictures, anal fistulae and elephantiasis of the genital organs can also occur in some cases.

Source: Lymphogranuloma Venereum by Prashanth Rawla; Krishna C. Thandra; Faten Limaiem.

BUY NOW

Explanation

The case is actually quite confusing since the diagnostic indicates the presence of HSV specimen, however, the manifestation (according to subjective, objective and assessment) is different indicating that it is a painless ulcer. I would also like to indicate the lack of important objective data as I’ve stated above. Which is why diagnostics are very important to identify the causative agent for the ulcer, a PCR is ideal since it identifies the DNA/RNA of the causative agent. The problem with culture and staining is it sometimes has to be specific to the agent you want to test. For example, HSV can be cultured using Tzank smear while Syphilis cannot. And Syphilis will need dark staining. So these are some culture staining factors that needs to be considered. With this case, I feel it is incomplete with respect to the lack of diagnostic results and the lack of proper complete physical exam. It is important to note that although signs and symptoms of sexually transmitted infections may overlap, culture and/or PCR is needed to identify the specific causative agent. For the differential diagnosis, I have highlighted in bold the reason as to why I considered these diseases and mostly all of them can present with painless genital ulcer Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction.

References

Grant, J. E., Odlaug, B. L., & Schreiber, L. R. (2014). Pharmacological treatments in pathological gambling. British Journal of Clinical Pharmacology, 77(2), 375-381. https://doi.org/10.1111/j.1365-2125.2012.04457.x

Kelly, J. E., & Renner, J. A. (2016). Alcohol-Related disorders. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.),Massachusetts General Hospital Psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.

Lupi, M., Martinotti, G., Acciavatti, T., Pettorruso, M., Brunetti, M., Santacroce, R., Cinose, E., Di Iorio, G., Di Nicola, M., & DiGiannantonio, M. (2014). Pharmacological treatments in gambling disorder: A qualitative review. Biomed Research International. https://doi.org/10.1155/2014/537306

Renner, J. A., & Ward, N. (2016). Drug addiction. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital Psychopharmacology and neurotherapeutics (pp. 163–182). Elsevier.

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

Stahl, S. M. (2020). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Schöttke, H., Unrath, M., & Uhlmann, C. (2019). The effect of patient progress feedback on psychotherapy outcome. Verhaltenstherapie, 1-11. https://doi.org/10.1159/000503765

Yahn, S. L., Watterson, L. R., & Olive, M. F. (2013). Safety and efficacy of acamprosate for the treatment of alcohol dependence. Substance Abuse: Research and Treatment, 7, SART-S9345. https://doi.org/10.4137/SART.S9345 Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction

Assignment: Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction Impulsivity, compulsivity, and addiction are challenging disorders for patients across the life span. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences; patients often describe impulsivity as living in the present moment without regard to the future (MentalHelp.net, n.d.). Thus, these disorders often manifest as negative behaviors, resulting in adverse outcomes for patients. For example, compulsivity represents a behavior that an individual feels driven to perform to relieve anxiety (MentalHelp.net, n.d.). The presence of these behaviors often results in addiction, which represents the process of the transition from impulsive to compulsive behavior. In your role as the psychiatric nurse practitioner (PNP), you have the opportunity to help patients 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. Reference: MentalHelp.net. (n.d.). Impaired decision-making, impulsivity, and compulsivity: Addictions’ effect on the cerebral cortex. https://www.mentalhelp.net/addiction/impulsivity-and-compulsivity-addictions-effect-on-the-cerebral-cortex/ To prepare for this Assignment: Review this week’s Learning Resources, including the Medication Resources indicated for this week. Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients requiring therapy for impulsivity, compulsivity, and addiction. The Assignment: 5 pages Examine 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, 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. 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. Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature Assessing and Treating Clients with Impulsivity, Compulsivity, and Addiction