Sample Nursing Case Studies Paper on A Puerto Rican Woman with Comorbid Addiction

A Puerto Rican Woman with Comorbid Addiction

In many cases, individuals with substance use addiction are at a high risk of experiencing co-occurring mental conditions, for example, mood disorders. Mental disorders are commonly comorbid in substance and alcohol use. Drug addiction is regarded to be a mental condition as it can alter brain functioning, leading to uncontrollable behavior that can compromise people’s ability to control their impulses. The current case study is about Perez, a Puerto Rican woman aged 53 years. She has comorbid addictions of alcoholism and gambling, which have made her life difficult. The patient’s efforts to seek treatment have been derailed by the fact that she stays close to a gambling club and can access alcohol at all times. Gambling has caused problems in her marriage and has made her borrow much money from the retirement account. She also enjoys smoking cigarettes and would like to stop it. Perez shows signs of depression, as well as a sad and lethargic demeanor. In this paper, I will present three decisions made regarding the drugs to prescribe to the patient. The factors that might influence the patient’s pharmacokinetic and pharmacodynamic processes were considered.

Decision #1

The first decision was offering medication on the basis of the comorbid mood disorder the patient experienced besides alcohol use and gambling problem. Since the patient often has a sad mood that occurs after smoking, drinking, and gambling, she was diagnosed with alcohol use and gambling condition that is accompanied by an unstable mood. I selected this decision since many psychiatric problems are linked to a high risk of drug abuse. However, severe symptoms of mood variations emerge after taking alcohol. Alcohol and drug abuse can affect neurotransmitters located in the brain, which play a part in psychiatric complications. Smoking and alcohol use can prompt the signs observed in this patient, for instance, sadness and mood fluctuation. Thus, the appropriate medicine for her was Lithium, which is administered with Naltrexone to enhance the mood and end the drinking addiction. Lithium is effective in women who have rapid mood cycles within a year (Parial, 2015). Therefore, the medication eliminates mood variations, sadness, and addiction.

The difference between what I expected to achieve with Decision #1 and the results of the decision is that the patient had various side effects after a while, for example, increased weight and trembling. To handle this problem, I changed her medicines to Sodium valproate along with disulfiram during bedtime. Females with rapid cycles of mood react more swiftly to Valproate compared to Lithium and Naltrexone (Yatham et al., 2018).  After taking this measure, I noted that the patient’s condition had improved due to decreased side effects.

Decision #2

I offered medication on the basis of the patient’s physical state during diagnosis. The patient reported having added weight due to drinking. Moreover, she had smoking episodes when drinking and gambling. The gambling challenge was of great concern to her since she was worried about the husband realizing her behaviors.

I selected this decision since matters of weight are a major concern when treating comorbid alcohol addiction due to the individual medication offered to a patient and the side effects of alcohol use. Many mood stabilizers and antidepressants utilized in comorbid bipolar addiction lead to weight gain (Correll, Detraux, De Lepeleire, & De Hert, 2015). Besides, alcohol consumption results in high cholesterol levels, which trigger weight gain. In this case, the patient required medications with minimal impact on her weight and those that function to reduce weight. Medicines that lead to the retention of sodium in females should be avoided as they result in increased steroid levels, resulting in weight gain.

Lamictal drugs offered orally with disulfiram/Naltrexone work fast in females with mood conditions and comorbid addiction; thus, the medications are appropriate in this case based on the patient’s weight. These medicines help in reducing weight. There was no difference between what I expected to achieve with decision #2 and the results of the decision since the patient’s alcohol craving reduced, as well as weight. The side effect was decelerated improvement, which I managed by raising the dose.

Decision #3

The third decision was offering medication on the basis of the patient’s compliance with drugs. I selected this decision since drug compliance is a crucial factor in examining the effectiveness of medicines used in comorbid addiction. Patients with comorbid addiction require medication with minimal side effects of weight gain and tremors, as well as lethargy. Such side effects occur when one takes Lithium. Thus, the patient’s non-compliance with Lithium was as a result of these side effects.

There was no difference between what I expected to attain with decision #3 and the results of the decision as the patient’s compliance with Lamictal and valproate medicines was high. Compliance is a crucial factor in selecting a mood stabilizer for alcoholic patients who have comorbid mood fluctuations (Levounis & Herron, 2014). The patient’s enhanced compliance emanated from the low risk of tremors, weight gain, and lethargy linked to Lamictal.

References

Correll, C. U., Detraux, J., De Lepeleire, J., & De Hert, M. (2015). Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry14(2), 119-136.https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20204

Levounis, P., & Herron, A. J. (Eds.). (2014). The addiction casebook. American Psychiatric Publishing.

Parial, S. (2015). Bipolar disorder in women. Indian Journal of Psychiatry57(Suppl 2), S252-S263doi:10.4103/0019-5545.161488

Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … & Alda, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders20(2), 97-170.https://onlinelibrary.wiley.com/doi/pdf/10.1111/bdi.12609