Discussion: Factors That Influence the Development of Psychopathology

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In many realms of medicine, objective diagnoses can be made A clavicula is broken. An infection is present. TSH levels meet the diagnostic criteria for hypothyroidism. Psychiatry, on the other hand, deals with psychological phenomena and behaviors. Can these, too, be “defined objectively and by scientific criteria (Gergen, 1985), or are they social constructions?” (Sadock et al., 2015).

Thanks to myriad advances during recent decades, we know that psychopathology is caused by many interacting factors. Theoretical and clinical contributions to the field have come from the neural sciences, genetics, psychology, and social-cultural sciences. How do these factors impact the expression, classification, diagnosis, and prevalence of psychopathology, and why might it be important for a nurse practitioner to take a multidimensional, integrative approach?

To Prepare:

Review this week’s Learning Resources, considering the many interacting factors that contribute to the development of psychopathology.

Consider how theoretical perspective on psychopathology impacts the work of the PMHNP.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days by explaining the implications of why, as an advanced practice nurse, it is important to adopt a multidimensional, integrative model of psychopathology.

Colleague 1

Psychopathology is defined as the scientific study of mental illness or disorders. It is further subcategorized as biological, psychological; and social, cultural, and interpersonal psychopathology. Biological psychopathology involves neuronal and glial cells of the human brain. Simply put, neurons communicate with one another through chemical and electrical neurotransmission (Kaplan and Sadock, 2014). During the past 75 years, new appreciation is being given to the research of psychotropic medications, which reiterates the importance of a biological view of mental illness. In the early 1900s, Jean Piaget one of the most profound thinkers of the 20th Century, developed what we now know as developmental psychology which offers theories of how biology and experience blend to provide learned behaviors (Kaplan and Sadock, 2014).

Some mental disorders are tied to the way we respond and interact in society. Cheung and Mak (2018) state, the concept of cultural relativism proposes that the diversity in a mental disorder, the variability of symptoms presented in that disorder, or the judgement of what constitutes pathology may be explained by cultural diversity. Although the recent formation of a task force funded by the National Institute of Mental Health to develop and include materials in the Diagnostic and Statistical Manual of Mental Disorders (DSM); as well as the publication of the World Mental Health Report, culture continues to be overlooked when it comes to theory, research, training, and intervention.

To address these disparities the DSM-V has included more extensive consideration of cultural perspectives by developing the Cultural Formulation Interview for the gathering of cultural information during assessment. Cultural variables included are ethnicity, language, education, religion, gender, sexuality roles, values, socioeconomic status, among other factors. There are multiple layers of influences that may converge to form a mental health disorder. It is imperative the the provider performs a thorough evaluation to identify all contributing factors; and must also be cognizant of the fact that the psyche of each patient is unique.

Colleague 2

The nervous system is the filter through which living organisms experience life. It is a dynamic, constantly evolving unit, the components of which are in constant structural and functional change throughout life in response to every input, be it genetic or environmental, physical, or mental (Basser, 2012).

According to Beauchaine et al. (2008), the Journal of Primary Prevention explored whether a prevention science emphasizing biological or psychosocial factors would best serve those at risk for psychopathology.

Beauchaine et al. (2008) added that direct comparisons between psychology and sciences are now recognized as simplistic, given the overwhelming number of causal influences affecting human behavior. Many have argued that clinical psychology should be, first and foremost, an applied discipline that develops cognitive, behavioral, and social interventions to prevent and treat maladaptive behavior.

Beauchaine et al. (2008) report that others have advocated for a clinical science that examines genetic and neural mechanisms of vulnerability. Understanding such mechanisms will improve our ability to reduce psychiatric morbidity and mortality. For example, a large volume of research indicates that schizophrenia is about 80% heritable and is caused by genetic and neurobiological processes that give rise to compromises in the brain’s structure and function.

Biological factors are essential in developing and structuring psychological organization in various ways. Biological dispositions to temperament may determine which children are most vulnerable in each environment and at what point psychopathology may manifest. For example, infants with a low threshold for separation anxiety may be most disposed to develop anxiety disorders under circumstances of deprivation or separation (Truant, 1995).

According to Wallis et al. (2018), the ability to accurately interpret the emotional intentions of others is crucial for successful functioning in social situations. For example, there is substantial evidence that patients with clinically diagnosed eating disorders display significant deficits in emotion recognition and their ability to interpret social events. Furthermore, in the context of eating disorders, it has been argued that a reduced sensitivity in recognizing the emotional expressions of others could lead to misunderstandings during social interactions, which may undermine or inhibit the formation of meaningful social bonds. Indeed, research has shown that those who develop eating disorders are frequently shy with few friends and often experience social isolation or inadequate interpersonal relationships. As a result, it makes social interactions stressful, leading to avoidance of such interactions with others and causing difficulties in developing and maintaining personal relationships.

Wallis et al. (2018) also added that significant relationships had been observed between emotion recognition deficits and poor social functioning in patients with schizophrenia and autistic spectrum disorders.

Puerto Rican youth growing up in low-income communities in the South Bronx are exposed to many of the same risk factors for major depressive disorder, generalized anxiety disorder, and psychological distress. Puerto Ricans have been socially marginalized in the South Bronx as an ethnic minority group. A growing body of literature demonstrates the influence of neighborhood, cultural, and social factors and parental psychopathology in developing mental health problems (Alegria et al., 2022).

The study looked at the success of achieving some of the Future of Nursing workforce-related recommendations. A strong foundation exists for increasing the contributions of psychiatric-mental health nursing to overcoming shortages of mental health professionals and improving access to mental health care. More work must be done to remove regulatory barriers to promote practices to the extent of knowledge, education, and training. Overall, the psychiatric-mental health nursing workforce is primed for the future (Merwin, 2020).

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