Biopsychosocial Factors

From the video it can be seen that the patient who admitted the session is a patient of Psychosis, which is a severe mental health disorder. In this context, the etiology of the disorder will be discussed along with Its Pathophysiological Aspects thus a clear idea about the mental health disorder can be known.

Psychosis is one such mental health disorder that may occur due to a psychiatric illness primarily along with other causes such as another medical condition or neurologic condition as well as substance use or childhood traumas (Calabrese et al., 2020).

Biological: It has been seen that, there are many biological condition (that include medical condition too) that can lead the development of Psychosis in a person (nhs.uk, 2021).  It can be seen that, past family history of a patient that can be transmitted genetically is a major concern. Beside this factor, there are other medical conditions such as HIV/AIDS, hypoglycemia, Alzheimer’s disease, multiple sclerosis, brain tumor or other chronic diseases might lead to the development of psychosis (Calabrese et al., 2020).

From the aspect of the brain function and changes in brain such as changes in neurotransmitter level it can be seen that dopamine is the neurotransmitter which is responsible largely (Kesby et al., 2018). It has been seen that; dopamine largely controls many of the brain functions as dopamine pathways regulates the motor control, interest, motivation, reward as well as activities. Alteration or changes in dopamine level and impairment significantly interrupt the brain functions and the symptoms of psychosis initiates.

Psychological Factors: From aspects of psychological factor, it can be seen that, there are various mental disorder that significantly triggers the development of the psychosis. Presence of Schizophrenia (a condition where the patient experience delusions and hallucinations), presence of bipolar disorder (where the patient experience episodes of depression, low mood as well as episodes of mania or elated mood, presence of severe anxiety or stress can trigger the psychosis development (Arciniegas, 2015). In addition, lack of sleep, as well as severe depression in which the patient remains sad all the time or postnatal depression can also lead the development of psychosis.

Social Factor: Substance abuse problem has been found as one of the major causes that might lead the occurrence of this mental health issue. It has been seen that misuse of alcohol and drugs might trigger the episodes of psychosis (Gilman et al., 2018). An individual might experience a psychotic episode in case they stop consuming alcohol or taking drugs suddenly after taking it for a long period. This phenomenon also known as the withdrawal symptom. It is moreover possible to encounter psychosis if someone consume a heavy amount of alcohol or drugs (Gilman et al., 2018). In a report of UK National Health Service (2021), it was found that regular and heavy consumption of cocaine, methamphetamine (crystal meth), amphetamine (speed), cannabis, ketamine, MDMA (ecstasy), mephedrone (MCAT or Miaow), LSD (acid) and psilocybin (magic mushrooms) can significantly cause psychosis among the patients (nhs.uk, 2021).

Pathophysiology of the Disease

In this context, the patient is suffering in a mental health disorder psychosis, which is an unusual mental condition of the brain which causes extreme in difficulties among the patients in determining about the reality and they failed to distinguish which is real and not real (Gaebel & Zielasek, 2015). They start to hallucinate and experience delusion which is the major symptoms of this mental disorder. Moreover, patients might encounter other symptoms like incoherent speech and inappropriate behavior in a given or specific situation (Calabrese et al., 2020). The pathophysiology of this mental health issue is known to include an interaction between extrinsic factors such as substance misuse and intrinsic factors such as components associated with mental disorder like neurochemical dysfunction (changes in structure and function of dopamine, acetylcholine, serotonin neurotransmitters) along with structural abnormalities, deficits in visual processing, dysregulations of sleep, as well as genetics (Gaebel & Zielasek, 2015). The exact/accurate pathophysiological explanation of schizoaffective disorder or psychosis is yet not known fully, however there are many indications and researches that stated that the major cause of the disease might related to the imbalances of neurotransmitter such as dopamine, acetylcholine, serotonin in the brain that could play a role significantly in the development of this disorder (Howes et al., 2015). According to Calabrese et al. (2020), the most strongly associated pathophysiological aspect of psychosis is the neurotransmitter dopamine that largely cause this disease among most of the patients. It has been found that, the major signs of psychotic disorders mainly caused because of excess dopamine level in the mesolimbic tract (Calabrese et al., 2020). An excitatory neurotransmitter known as Glutamate is moreover implicated. Various research `has stated that a reduced function of the NMDA-glutamate receptor (N-methyl-D-aspartate glutamate) receptor in the brain also associated. The researches also have pointed that gamma-amino-butyric acid (GABA), which is a neurotransmitter that performs crucial inhibitory mechanism (Howes et al., 2015). Few scientific studies illustrated that there is major evidence of dysfunction of gamma-amino-butyric acid among the patients who were diagnosed with schizophrenia. At last, implications of psychosis point to an imbalance or dysfunction of the neurotransmitter acetylcholine (Gaebel & Zielasek, 2015). This discovery was made while studying the smoking habits of schizophrenic patients, as tobacco has been found to raise the function of acetylcholine. Observers noticed some improvements in smokers’ impairments, and investigations showed that cognitive improved as well.

The first nursing action would be carrying out the assessments to know exactly about the condition.  The nursing assessment would be: 

Nursing Action and Intervention For Psychosis

Assessing the positive symptoms:  Nurses need to assess the presence of hallucinations as well as delusions. Moreover, nurses must assess if the patient is poorly organized, fragmented, systematized, well-organized, or how much the patient is connected to the reality (Calabrese et al., 2020). Moreover, nurses must assess for pervasive suspiciousness about every person as well as their actions.

Assessing the negative symptoms: Nurses should assess the presence of negative symptoms of the psychosis as well that might help them in providing care to the patient.

Assessing the suicide or violent behaviour: It is very crucial to identify the self-harm behaviour of the patient or violent behaviour, which need to minimize immediately (SanSegundo et al., 2018).

Assessing the medical history: To know about the exact cause of the condition nurses must assess if the patient has any previous history or family background of mental disorder, or what type of medications the patient is taking, as well as adherence to therapy (Calabrese et al., 2020).

Assessing the support system: Before proceeding with the intervention nurses must determine whether the family members of the patients are well informed about the mental health condition and importance of the medication adherence.

The nursing intervention that would be helpful while treating the patient with psychosis are:

Establishing trust as well as rapport: nurses must not touch the patient without asking them or before gaining their trust. Nurses must use a short, consistent and accepting approach; repeated contacts are best till the trust has been acquired (Gaebel et al., 2014). While caring for the patient the language of the nurse must be clear as well as unambiguous. Nurses must maintain a sense of positivity for a probable improvement, as well as share this with the patient.

Maximize level of functioning: Nurses should avoid promoting or supporting the dependency of the patient by doing the things only that the patient is not capable to do for himself. Nurses can reward/appraise the positive behaviour as well as function with the patient to enhance the patient’s personal sense of responsibility in enhancing functioning.

Promoting social skills: Nurses must give support in assisting the patient in learning the social skills (Granholm & Harvey, 2018).

Ensuring safety: Nurses must maintain a calm and secure atmosphere with minimal stimulation.

Ensuring adequate nutrition:  A nurse must monitor the nutritional status of the patient as well as if the patient doubt on the food, let them fix their own food if it is possible or nurse can offer them foods in a closed container.

Involving the patient with reality: The nurse must engage the patient in activities which are reality-oriented such as human contact by arranging workshops, and inpatient training of social skills (McAllister et al., 2019).

Dealing with the hallucinations by presenting the reality: nurses should explore the subject of hallucinations and make them understand about the reality. However, they must avoid arguing about the hallucination.

Promote compliance and monitor drug therapy: This is the most important nursing intervention where the nurse must administer the prescribed drugs as well as guide the patient to adhere. They must make sure that the patient is truly taking the medicine which would help them to reduce the symptoms (Verloo et al., 2017). Nurses also need to monitor the adverse effects of the drug and minimizing them.

From the aspect of pharmacological treatment of psychosis, it can be seen that, the first choice is the antipsychotic medicines such as Benzodiazepines that greatly help the patients to reduce and control the symptoms. The antipsychotic medication functions by blocking the function of the dopamine neurotransmitter and block the transmission of signals by that neurotransmitter (Stroup & Gray, 2018). Antipsychotic medications can largely decrease the feelings of anxiety inside the few hours of the consumption; however, it might take few days to few weeks to minimize the symptoms such as delusional thoughts or hallucinations. Moreover, this drug has been found to be most efficient while treating the psychotic indications such as delirium, drug-induced psychosis, mania, the psychotic features of depression, along with the psychotic characteristics of dementia as well as other neurologic conditions (Calabrese et al., 2020).    

Another intervention can be non-pharmacological method that include psychotherapy such as involvement of family in the care process. Involvement of family can be very effective which help both the patients as well as the family members to cope up the condition. A patient might require a family support which might help them when they feel episodes of psychosis (Onwumere et al., 2018). While treating the patient family members can be very supportive from mental and emotional aspects. Hence, as an intervention nurses must educate the family members as family psycho-education is beneficial in restoring clients’ and family members’ trust and enabling them to deal with the disease together. Family is well-known as the primary caregiver, providing vital physical and mental assistance to patients (Zhang, 2016). The family would collaborate together to gain a better understanding of the disease and how they can assist in its management. This is a critical stage since families can be a valuable resource in reducing symptoms. Any special needs that the person with schizophrenia has will be discussed during the session.

Reference

Arciniegas D. B. (2015). Psychosis. Continuum (Minneapolis, Minn.), 21(3 Behavioral Neurology and Neuropsychiatry), 715–736. https://doi.org/10.1212/01.CON.0000466662.89908.e7

Calabrese, J., Al Khalili, Y., & Shaheen, K. (2020). Psychosis (Nursing). StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK546579/#article-27978.s3

Gaebel, W., & Zielasek, J. (2015). Focus on psychosis. Dialogues in clinical neuroscience, 17(1), 9–18. https://doi.org/10.31887/DCNS.2015.17.1/wgaebel

Gaebel, W., Muijen, M., Baumann, A. E., Bhugra, D., Wasserman, D., Van der Gaag, R. J., … & Zielasek, J. (2014). EPA guidance on building trust in mental health services. European Psychiatry, 29(2), 83-100. https://dx.doi.org/10.1016/j.eurpsy.2014.01.001

Gilman, J. M., Sobolewski, S. M., & Evins, A. E. (2018). Cannabis use as an independent risk factor for, or component cause of, schizophrenia and related psychotic disorders. In The complex connection between cannabis and schizophrenia (pp. 221-246). Academic Press. https://doi.org/10.1016/B978-0-12-804791-0.00010-0

Granholm, E., & Harvey, P. D. (2018). Social skills training for negative symptoms of schizophrenia. Schizophrenia bulletin, 44(3), 472-474. https://doi.org/10.1093/schbul/sbx184

Howes, O., McCutcheon, R., & Stone, J. (2015). Glutamate and dopamine in schizophrenia: an update for the 21st century. Journal of psychopharmacology (Oxford, England), 29(2), 97–115. https://doi.org/10.1177/0269881114563634

Kesby, J. P., Eyles, D. W., McGrath, J. J., & Scott, J. G. (2018). Dopamine, psychosis and schizophrenia: the widening gap between basic and clinical neuroscience. Translational psychiatry, 8(1), 1-12. https://doi.org/10.1038/s41398-017-0071-9

McAllister, S., Robert, G., Tsianakas, V., & McCrae, N. (2019). Conceptualising nurse-patient therapeutic engagement on acute mental health wards: An integrative review. International Journal of Nursing Studies, 93, 106-118. https://doi.org/10.1016/j.ijnurstu.2019.02.013

nhs.uk. (2021). Causes – Psychosis. nhs.uk. Retrieved 15 March 2022, from https://www.nhs.uk/mental-health/conditions/psychosis/causes/.

Onwumere, J., Jansen, J. E., & Kuipers, E. (2018). family interventions in psychosis change outcomes in early intervention settings–how much does the evidence support this?. Frontiers in psychology, 9, 406. https://doi.org/10.3389/fpsyg.2018.00406

SanSegundo, M. S., Ferrer-Cascales, R., Bellido, J. H., Bravo, M. P., Oltra-Cucarella, J., & Kennedy, H. G. (2018). Prediction of Violence, Suicide Behaviors and Suicide Ideation in a Sample of Institutionalized Offenders With Schizophrenia and Other Psychosis. Frontiers in psychology, 9, 1385. https://doi.org/10.3389/fpsyg.2018.01385

Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World psychiatry : official journal of the World Psychiatric Association (WPA), 17(3), 341–356. https://doi.org/10.1002/wps.20567

Verloo, H., Chiolero, A., Kiszio, B., Kampel, T., & Santschi, V. (2017). Nurse interventions to improve medication adherence among discharged older adults: a systematic review. Age and ageing, 46(5), 747-754. https://doi.org/10.1093/ageing/afx076

Zhang, C. (2016). The involvement of family members in the treatment of patients with schizophrenia. Current Treatment Options in Psychiatry, 3(2), 111-118. https://doi.org/10.1007/s40501-016-0073-x