NRNP 6635 week 1 Discussion: Factors That Influence the Development of Psychopathology

, ,

There are many factors that have influenced the development of psychopathology. Genomic research and Psychiatric Genomics Consortium have identified hundreds of common and rare genetic variations that contribute to a range of neuropsychiatric disorders. Behavioral genetic research provides evidence for heritable influence on diagnosis such as anxiety and depressive disorders across the life span (Patterson, Mann, Grotzinger, Tackett, Tucker-Drob & Harden, 2018). Evolving conceptualizations of psychopathology and neuroscience have transitioned focus from symptom-based diagnoses to a greater emphasis on transdiagnostic commonalities (Jackson & Milberg, 2018). The important overall point of a neuroscientific perspective is that analyses of normal or abnormal function need to be informed by an understanding of the brain structures and processes that implement the function (Jackson & Milber, 2018). Different changes in the brain can be affected by treatments available. There are different treatment modalities that can occur dependent on diagnosis. Advanced research diagnostic imaging such as SPECT, PET, MRI show specific responses to different treatments. Many aspects of culture, such as cultural principles, affect the way people perceive and react (Hassim & Wagner, 2013). The emphasis on cultures in mental health is reflected in the extent to which psychiatric diagnoses and practices are based on views of mental disorders. Cultural values and perspectives derive the views of mental health, and to the extent of treatments that are provided.

 

Hassim, J., & Wagner, C. (2013). Considering the cultural context in psychopathology formulations. South African Journal of Psychiatry, 19(1), 4–10. https://doi-org.ezp.waldenulibrary.org/10.4102/sajpsychiatry.v19i1.400

Jackson, C. E., & Milberg, W. P. (2018). Examination of neurological and neuropsychological features in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and treating adult mental disorders., Vol. 1. (pp. 65–90). American Psychological Association. https://doi-org.ezp.waldenulibrary.org/10.1037/0000064-004

 

Patterson, M. W., Mann, F. D., Grotzinger, A. D., Tackett, J. L., Tucker-Drob, E. M., & Harden, K. P. (2018). Genetic and Environmental Influences on Internalizing Psychopathology across Age and Pubertal Development. Developmental Psychology, 54(10), 1928–1939.

 

response

Thank you for your post.  I enjoyed reading the information you provided.  Practicing with a multidimensional approach will be crucial because many different dynamics play into mental illness and disorders.  As you mentioned, genetics plays a huge part in who we are and what disorders or illnesses are inherited. Lebowitz and Appelbaum (2019) explained that mental disorders could be conceptualized as manifestations of genetics and neurobiological abnormalities. In addition to genetics, there are many other factors such as biological, cultural, social experience, beliefs or traits, and interpersonal factors that influence psychopathology.  As expressed by the Developmental Systems Theory, during development, individuals are emerged in many different interactions among changing systems within and outside them that shape the individual into who they are (Masten et al., 2018).  Many factors play into an individual’s mental disorder, and it is essential the advanced nurse practitioner understand and explore each factor, whether biological, developmental, social, or cultural.  Each interaction with an influencing factor may directly or indirectly shape or influence the client’s course of life.  To help clients achieve successful outcomes, the provider must acknowledge, identify, and respect the factors that have influenced the client’s life.

Lebowitz, M. S., & Appelbaum, P. S. (2019). Biomedical explanations of psychopathology and their implications for attitudes and beliefs about mental disorders. Annual Review of Clinical Psychology, 15(1), 555–577. https://doi.org/10.1146/annurev-clinpsy-050718-095416

Masten, A. S., & Kalstabakken, A. W. (2018). Developmental perspectives on psychopathology in children and adolescents. In J. N. Butcher, P. C. Kendall, J. N. Butcher (Ed), & P. C. Kendall (Ed) (Eds.), APA handbook of psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 15–36). American Psychological Association. https://doi-org.ezp.waldenulibrary.org/10.1037/0000065-002

 

Discussion: Factors That Influence the Development of PsychopathologyIn 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 3 of Week 1

Explain the biological (genetic and neuroscientific); psychological (behavioral and cognitive processes, emotional, developmental); and social, cultural, and interpersonal factors that influence the development of psychopathology.

Read a selection of your colleagues’ responses

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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

 

NRNP_6635_WK1_Discussion
 Development of Psychopathology

         The biological influence on psychopathology is extremely complicated as evidenced by the first 93 pages of our required text by Sadock, Sadock & Ruiz (2015).  I am certain I am in the minority when I disagree with one of the first remarks made in the introduction about “the human brain being clearly evolved from the brain of lower animal species”(Sadock, Sadock & Ruiz, 2015). Despite this statement the book goes on to describe the complexity of the human brain. I will concede and attempt to discuss this in a way that is acceptable for higher education since we have been denied the ability to choose belief systems on this matter throughout the entire educational process.

Neuro science and genetics have played major roles in the development of diagnosis and treatment for mental health disparities but for all the factors involved including social, cultural, psychological and interpersonal factors, to really come to a conclusion when dealing with a client, one must consider all these factors together as a unit.  I believe that neuroscience has offered the greatest way to determine the probable effectiveness of treatment using evidence-based-practice.  Being able to understand the portion of the brain that is affected, the transmitters involved in psychopathology when using medications is imperative and helps to make treatment more predictable. Most psychopathologies develop due to biological heritable weaknesses coupled with high risk environments and for this reason cognitive behavioral therapies and pharmacotherapy used together can reap the best results possible if the client is amenable (Beauchaine, Neuhaus, Brenner & Gatzke-Kopp, 2008).

Cognitive and psychological dysfunctions may work together as well in that the clients who are having difficulty psychologically may have concurrent cognitive dysfunction that prevents them from seeking or even recognizing there is any kind of dysfunction at all. Recognition of dysfunction is imperative to diagnosis, for this reason neuropsychological evaluation is not used at this time as a test for psychopathology (Jackson & Milburg, 2018).

Social stigma for those with mental health disparities is still something that many cultures do not tolerate. Diagnosing clients from different cultures requires careful translation with the help of translators who are trained in the mental health field. Unfortunately, in my experience the translators are simply not available to the degree that is needed.  Also understanding the language does not guarantee understanding the culture (Cheung & Mak, 2018). It may take years to really understand what is happening with a client. It may take more time than those providing care or those receiving care are able to provide when the translations are unavailable because of dialect and lack of social support. This is sadly a real-world practice in a State facility. Many times, when a patient has no family and has no papers, they are impossible to place and they are unable to communicate effectively so they remain lost in a system that must be improved. It is my hope that as advance practice nurses, we can make a difference and relieve some of the disparities that are present in the current system. Place some of the clients who are “not placeable” per the administrators of my facility. Have translators for the clients who just want to talk to someone and relieve some of their loneliness. It would be a great thing to be able to help the patients communicate so they can be diagnosed and treated more effectively.

References

Beauchaine, T. P., Neuhaus, E., Brenner, S. L., & Gatzke-Kopp, L. (2008). Ten good reasons to

consider biological processes in prevention and intervention research. Development and

          Psychopathology, 20(3), 745-774.

http://dx.doi.org.ezp.waldenulibrary.org/10.1017/S0954579408000369

Cheung, F. M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N. Butcher & J. M.

Hooley (Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing,

           and treating adult mental disorders., Vol. 1. (pp. 127–147). American Psychological Association.

https://doi-org.ezp.waldenulibrary.org/10.1037/0000064-006

Jackson, C. E., & Milberg, W. P. (2018). Examination of neurological and neuropsychological features in

psychopathology. In J. N. Butcher, J. M. Hooley, J. N. Butcher (Ed), & J. M. Hooley (Ed)

(Eds.), APA handbook of psychopathology: Psychopathology: Understanding, assessing, and

           treating adult mental disorders., Vol. 1. (pp. 65–90). American Psychological Association.

https://doi-org.ezp.waldenulibrary.org/10.1037/0000064-004

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th

ed.). Wolters Kluwer.

Response

 Thank you so much for your interesting discussion post this week. I was especially interested in how culture affects an individual’s personality, identity, and behavior. Sadock et al. (2015) reported that a cultural assessment should be part of every mental health assessment. I agree with this because not only does it give the provider great insight into the client and their beliefs and preferences, it also helps to build rapport and trust with the client. Knowing more about an individual’s culture allows the healthcare provider to make better judgments regarding diagnosis and treatment. 

 You touched on mental health stigmas and discrimination. I think both of these are very culturally specific and play a major role in psychopathology. Hack et al. (2020) stated that perceived discrimination has a crucial impact on how an individual seeks help and how they are involved with their treatment plan or recovery. Depending on the individual, they may be motivated for change because of the perceived discrimination or they could feel hopeless and lose any motivation they once had. Spending time with each individual and having a basic knowledge of their culture and environment is vital for the diagnosing professional. This information can lead to more appropriate questions and dialogue that will bring about how each client is dealing with all the external forces in their life. How they are dealing with these things can help a mental health provider with both a diagnosis and treatment plan the individual will be willing to follow. 

As mental health care providers and agents of change in our communities, we should be active participants of reducing stigma and discrimination related to mental health. Rossetto et al. (2020) found that those who are educated about mental health are less likely to discriminate against those who are dealing with a mental illness. I plan to do this through educating clients and their families, while also being a presence in my community. These actions will endorse receiving mental health care while improving access to care. I also agree with you about translators. Here in rural MT, we do not have the need for translators but I can see how this need would be vital in a more diverse urban community. The translator would most definitely need to be knowledgeable about the client’s culture in order to portray an accurate representation of the client to the provider. This would not be as critical in other areas of medicine where the gathering of information is more concrete. I had never thought of that before! Thank you again for the insightful post this week!

References

Hack, S. M., Muralidharan, A., Brown, C. H., Drapalski, A. L., & Lucksted, A. A. (2020). Stigma and discrimination as correlates of mental health treatment engagement among adults with serious mental illness. Psychiatric Rehabilitation Journal, 43(2), 106–110. https://doi-org.ezp.waldenulibrary.org/10.1037/prj0000385

Rossetto, A., Potts, L. C., Reavley, N. J., & Henderson, C. (2020). Perceptions of positive treatment and discrimination toward people with mental health problems: Findings from the 2017 and 2019 attitudes to mental illness surveys. Stigma and Health, 5(4), 463–471. https://doi-org.ezp.waldenulibrary.org/10.1037/sah0000216

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry(11thed.). Philadelphia, PA: Wolters Kluwer.