BELOW IS THE CASE STUDY THAT’S BEING TALKED ABOUT:

HISTORY OF PRESENT ILLNESS:

A 35-year-old male presents to the psychiatric emergency department for psychiatric evaluation. The client was sent directly from his PCP’s office. That morning, the client and his wife presented to the PCP’s office without an appointment, with a chief complaint of “being overwhelmingly depressed.” The client has developed a plan to die by suicide, which included taking a bottle of Tylenol and drinking “as much vodka as it takes.” The internist performed a thorough evaluation, drew labs, and called 911 to bring the client to the Emergency Department.

When the PMHNP encounters the client, the client is visibly upset and clinging to his wife. The couple explains that they separated a month ago because the client “just couldn’t be a husband anymore.” Over the past four weeks, he has become isolated and has complained of decreased energy, concentration, appetite, and sleep. He lost his job as a house painter four months earlier. The client no longer enjoys taking care of the couple’s two children, ages 4 and 6—a drastic change from the role he has previously enjoyed as a father.

The PMHNP asked the client when he first began feeling down. He states, “When my mother died one and a half years ago.” He says that he has been feeling guilty over the circumstances of her death and wishing he had been closer to her in the years preceding her death. The wife notes with concern: “That was just about the time you started drinking so heavily, as well.” As you question further, you determine that the client has been drinking daily since his mother’s death. He estimates that he drinks six beers a day. He admits that drinking is a problem, and he tried to stop drinking two weeks before this visit. The client says: “My wife kicked me out of the house, I missed my kids, I didn’t have a job…I knew something was wrong.” He notes that in the days after he stopped drinking, he experienced some shakiness and felt “like there were bugs under my skin.” He added that having a beer made these symptoms subside. Last night he became distraught after calling his wife to check on the children and finding they were not home. He sat in his hotel room and thought, “I can’t go on living like this.” He called his wife at 6 a.m. the next day and said he thought he might kill himself. She immediately brought him to the internist’s office.

PAST PSYCHIATRIC HISTORY:

The client has never seen a psychiatric provider or been hospitalized for a psychiatric diagnosis. He recalls having been depressed only once earlier in his life, during his 20s, but he did not seek treatment at that time. Although the client is currently suicidal, he denies any past suicidal thinking and has never made previous suicide attempts.

PAST MEDICAL HISTORY:

Hypertension, Hypercholesteremia.

MEDICATIONS: Hydrochlorothiazide 25 mg po daily

FAMILY HISTORY:

The client’s father has a history of alcohol dependence, and his mother had hypertension and coronary artery disease before dying of myocardial infarction at age 60. The client denies any Hx of psychiatric illness in his family.

SUBSTANCE ABUSE HX:

The client has been drinking six beers/day for the past year and a half; before that, he was not drinking daily. He has a remote history of similar drinking in his 20s during his first divorce, but he was able to quit “cold turkey” and has never been to any detox facility. He experienced symptoms of withdrawal when he quit, no history of withdrawal seizures. He denies using marijuana, heroin, cocaine, or other substances. He smokes ½ pk per day of cigarettes.

SOCIAL HISTORY:

The client describes his childhood as “chaotic.” Reports his father was “unpredictable” because of his drinking. The client graduated from high school and then went to vocational school. He became a house painter and worked sporadically. He was married in his early 20s and has a 17 y/o daughter who is being raised by her mother, his first wife. He married his current wife 8 yrs. ago; the marriage was functioning well until recently.

MENTAL STATUS EXAM:

The client is a white male who appears exhausted and mildly disheveled in a sweatshirt, baseball cap, and jeans. He frequently becomes teary throughout the evaluation and has poor eye contact, although he is cooperative during the interview. His stature is slumped, even seated in the chair, and he often leans forward and hides his face in his hands. His speech is notable for increased latency and paucity of words. His affect is dysphoric, congruent with the context of the discussion, and does not brighten throughout the interview. His thought process is linear and logical, and his thought content is preoccupied with his mother’s death. The client has no overt delusions; he denies ideas of reference and paranoid ideation. He also denies hallucinations. He is experiencing suicidal ideation with intent and plan but denied homicidal ideations.

His insight and judgment are fair at this moment in that he knows he needs treatment. The cognitive exam is grossly intact.

LABS:

Alcohol level= 130; AST = 68 IU/L; ALT = 45 IU/L; GGT= 35U/L; other liver function tests are WNL.

Hemoglobin =13.4; hematocrit = 41; MCV =95; triglycerides = 200 mg/dl.

DIAGNOSIS:

Alcohol Use Disorder (F 10.20)

Major Depressive Disorder, single episode, severe without psychotic features (F32.2)

STUDENT RESPONSE TO THE ABOVE CASE STUDY TO READ:

For this case study, I would treat the patient with Naltrexone to treat the patient’s diagnosis of Alcohol use disorder and major depressive disorder.

List medication class and mechanism of action for the chosen medication.

Naltrexone is a m-opioid antagonist (Stahl et al.,2021). This medication is used to block the high of alcohol use and can shorten the withdrawal period (Stahl et al., 2021). It also limits or reduces the reinforcing properties of alcohol such as cravings or reward sensations.

Write the prescription in prescription format.

First and Last name of Patient/ DOB

Naltrexone 50mg

Take one tablet by mouth daily

Dispense #30 (Thirty)

#1 Refill

Kody Philpott, 12/6/2023

NPI: 000000000

Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.

Naltrexone is an opioid receptor antagonist that has been used in the treatment of alcohol use disorder (AUD). The rationale for using naltrexone in the management of AUD is supported by a body of evidence from clinical trials and research studies. Here are some key points that highlight the evidence-based rationale for using naltrexone for alcohol use disorder:

Reduction in Craving:

Naltrexone is thought to reduce alcohol consumption by blocking the rewarding effects of alcohol in the brain. It acts by binding to and blocking opioid receptors, which are involved in the reinforcing effects of alcohol.

Several studies have shown that individuals treated with naltrexone experience a reduction in craving for alcohol. By diminishing the rewarding effects, it may help individuals resist the urge to drink.

Reduction in Relapse Rates:

Clinical trials have demonstrated that naltrexone is associated with a reduction in relapse rates among individuals with alcohol dependence. It may be particularly effective in preventing relapse in individuals who have already achieved abstinence.

Improved Treatment Adherence:

Naltrexone is an oral medication, making it relatively easy for patients to take as prescribed. This may contribute to improved treatment adherence compared to other forms of treatment.

The ease of administration can be particularly important in improving compliance, which is a crucial factor in the success of any pharmacological intervention.

Combination with Behavioral Therapy:

Naltrexone is often used in combination with behavioral therapies, such as cognitive-behavioral therapy (CBT). This combination approach has shown synergistic effects in reducing alcohol consumption and improving treatment outcomes.

Safety and Tolerability:

Naltrexone has a favorable safety profile when used as directed. It is generally well-tolerated, with common side effects being mild and transient.

The safety and tolerability of naltrexone make it a viable option for a broad range of individuals with alcohol use disorder.

Evidence-Based Guidelines:

National and international treatment guidelines, such as those provided by organizations like the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the World Health Organization (WHO), include recommendations for the use of naltrexone in the treatment of alcohol use disorder.

Dose-Dependent Efficacy:

Some studies suggest that the efficacy of naltrexone in reducing alcohol consumption may be dose dependent. Higher doses may be more effective in some cases, although individual responses can vary. (Singh, 2023)

List any side effects or adverse effects associated with the medication.

-gastrointestinal irritation, such as diarrhea and abdominal cramps

– headache, anxiety, low energy, joint and muscle pain, nervousness, abdominal pain/cramps, difficulty sleeping, and nausea and vomiting

– loss of appetite, constipation, diarrhea, increased energy, increased thirst, feeling down, dizziness, irritability, delayed ejaculation, skin rash, and chills

– Naltrexone can precipitate a withdrawal syndrome

– are but potentially serious effects include depression and suicidality (Singh, 2023)

Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.

Liver function test (Baseline, 1 month after initiation, 3 months after initiation, 6 months after initiation and then annually)

Provide a minimum of three appropriate medication-related teaching points for the client and/or family.

Educate patient to seek help if feeling suicidal.

Monitor for signs of hepatitis such as fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain, and jaundice.

Educate on importance of adhering to medication regimen for full therapeutic potential and better patient outcomes.

You are to read the above case study response and provide a response agreeing with the use of Naltrexone

· Please respond as a nurse practitioner student when responding to the above case study response. Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.

·
Reference Citation: Use current 7th edition APA format to format citations and references and is free of errors.  Engage by asking questions, and offering new insights, applications, perspectives, information, or implications for practice. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.

Please use 2 APA references within 5 yrs. With one of the references being

Stahl, S. M. (2021).  
Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press.