The Main Aspect of a Patient's Life - Biopsychosocial Assessment - Coursework Example

Title: First Episode Psychosis Name: University The aim of this assignment is to understand the importance of thorough biopsychosocial assessment to reliably identity factors that will lead t diagnosis of mental health issue and appropriate nursing care management. Psychosis (schizophrenia) primarily begins in young adulthood and its effects may last throughout one’s life. It is good to start by noting that the onset of psychosis is preceded by duration of non-psychotic characteristics referred to as prodromal symptoms. It is after this duration that full-blown psychosis manifests. The actual symptoms of full-blown psychosis are: emotional withdrawal, hallucinations, disordered thinking and delusions (Bruns & Disorbio, 2012). Early interventions among people with first episode psychosis is aimed at two main objective i.e.: to prevent the onset of psychosis among people with manifestation of prodromal symptoms; the second point is offering appropriate nursing care to those with full-blown psychotic disorder (Bruns & Disorbio,2012). Biosychosocial model is therefore an approach that will entail the biological, (genealogy and other biological traits); psychological (entails thoughts, behaviors and emotions); and social (cultural, social-economical and social-environmental) factors, all of which might be contributing factors towards the onset of first episode psychosis (Dobkin and Morrow, 2014). It is through exploring these factors that correct lead to diagnosis of certain diseases will be established. Thereafter, proper medical and nursing interventions can then be considered. In the medical arena, some scholars have viewed the psychosocial approach from a perspective of causation (McLaren , 2012). In this respect, the biopsychosocial assessment seeks clear understanding the manner in which the cause of the illness impacts of the individuals body functioning. In this model therefore, the biological component of the assessment seeks to outline on how the cause of illness (psychosis in this case), might be from the biological aspect of one’s body (Engel, 2010). The biological aspect in this case may entail: sex, age, genetics, and general body health amongst others. When it comes to the psychological assessment of a person in respect to psychosis, potential psychological causes of the illness for instance: emotional turmoil, self-control, temperament, negative thinking, attitudes, fears and so on should be put into consideration (McLaren , 2012). Thirdly, the social aspect of psychosocial assessment seeks understanding of how culture poverty, social-economic status, religion and so on can be the causative agent of psychosis (Engel, 2010). In realia, biopsychosocial model should be viewed from a social cognitive theory whereby, the psychological assessment in illness (psychosis) treatment calls for the health practitioners to adder the social, psychological and biological influences upon the well functioning of the patient (Engel, 2010). Taking an example of biological factors as said earlier on in this paper, genetics is one of the factors that are always in interplay with others when it comes to psychosis. Researchers have indicated that there is a 50% chance of the second identical twin developing psychosis after the first one. It has also been found that individuals with genetic mutation 22q11 deletion syndrome have high likelihood of developing psychosis for instance schizophrenia. Head injury and brain illnesses for instance Parkinson’s disease, rain cysts or tumors, dementia among other brain-illnesses are also biological-causative agents of psychosis. Syphilis, HIV, stroke, some types of epilepsy is also causes of psychotic disorders. Other biological aspect that ought to be considered during the biopsychosocial assessment of a case of first episode psychosis is the Intelligence quotient (IQ). People with high IQ have been found to be t a higher risk of suffering from first episode psychosis as opposed to those with low IQ. Age is also another biological factor that should be factored in during the biopsychosocial assessment f first episode psychosis bearing in mind that even though people of all ages have been found to suffer from psychosis, young adults (adolescents or slightly older) are at a high risk of being diagnosed of psychosis than any other group within a particular population (Fischer, 2012). Finally on the biological aspect of psychosocial assessment of first episode psychosis is sex. In this respect, sex is biological the aspect of being male or female. Pregnancy absence/presence is also supposed to be factored in since pregnancy has been pointed by some studies as a causative factor of some source of psychosis. During biopsychosocial assessment for individuals with first episode psychosis, the above biological factors are key and hence of great importance (Bruns, & Disorbio, 2012). Their importance is tailored on two main purposes i.e., to find out the causative agent of the illness and secondly to offer valuable leads on the best approach and form of medical and nursing interventions to be carried out (Bruns & Disorbio, 2012). Psychological aspect deals with the state of mind of the person being assessed of psychosis. Here, the assessment should entail the actual feeling of the patient at hand, the duration of which the patient has been feeling the same, the intensity of the feeling in the patient from time to time and during the time of the assessment; the level of which the feeling of the illness is affecting the patients normal functioning should also be assessed. Under psychological bit of assessment, the patient should also be assessed on the occurrence and recurrence of the following symptoms within the previous thirty days. These symptoms are: sadness, insomnia, feeling hungry, sense of isolation from one’s social circles, hopelessness, indifference, solitude nervousness, suspicious, fast talking, irritability, suicidal thoughts, fearfulness, too much sleep, impulsiveness, nightmares and their recurrence, feeling of guilt, fatigue, restlessness/ lack of concentration, panic attacks, feeling of special powers, feeling of worthlessness, too much energy/lack of energy, easily startled, fear of association, loss of memory among others (Bruns, & Disorbio, 2012). This is the part of the assessment that carries greater weight in diagnosis of psychosis since most of the symptoms lies in this spectrum. Worth noting is the fact that people suffering from psychosis are characterized by: depressed moods, too much less sleep, difficulties in concentration, withdrawal from friends and family, suspicion ad recurrence of unusual beliefs and thoughts for the Early stages. In later stages of psychosis the symptoms are: hallucinations, delusions, random speech (erratic change of topics), anxiety, depression, difficult in functioning and suicidal thoughts. From this, t is worth noting that if the biopsychosocial assessment is well carried out, the section described above will capture all the symptoms of psychosis to the patient at hand. These, together with other sections of assessment plus other diagnostic measures will confirm presence of first episode psychosis and consequently point of the correct nursing interventions to be carried to remedy the same (Bruns, & Disorbio, 2012). On the social aspect, the assessment should capture the following information: Drug and substance abuse; this should entail alcohol, tobacco, narcotics and other commonly abused drug or substances (McLaren, 2010). The assessment should capture the history and current drug usage/ abuse by the user, withdrawals, the form in which he/she took/takes the substance, the frequency and quantity in which he/she takes or used to take and so on. Family, friendships and relations: this section also falls under the social aspect. The assessment should capture the people making up the patients family (brother, parents, sisters, children etcetera); the closest relation the patient in the previous few months, relations of the patient with his/her family/ friends, presence or absence of disputes in the family presently or in past, presence/absence of problems within family support systems, marital status, problems or lack of them within the marriage set up, relations with friends, close friends, colleagues and neighbors and so on. Education is another aspect within the social spectrum of the assessment (Bruns, & Disorbio, 2012). Information to do with the level of education of the patient, school experience and current school/ training program? if the patient is undergoing any are some of the aspect that should be captured within the assessment. The legal aspect is also crucial aspect that should be capture under the social bit. Has the patient been arrested/ incarcerated at any particular time? If so, for how long? What is the frequency? Which crime was committed? Parole/ probation? The last aspect of the social aspect of the assessment is socio-economical bit (work, income and the needs); this section should capture the following info: Does the patient have a job? How long does the patient work? How long has he/she worked? What is the kind of the work? Has the patient retired? Does he work in military? What is the source of income of the patient? Is the patient in any financial crisis? Can the patient afford basic needs? Is the patient homeless or not? What is the condition of patient’s neighborhood? How often does the patient groom (bathe, comb, change cloths etcetera) (McLaren, 2010). At this juncture, it is worth acknowledging that if a biopsychosocial assessment will have captured all the details in three of the facets described and discussed above in this paper, then the diagnostic aspect of first episode psychosis will have been completed and the leads for appropriate nursing care management strategies unearthed (Bruns, & Disorbio, 2012). After diagnosis from the biopsychosocial assessment, a professional nurse will be at a position to set achievable targets with the patient at hand; set the desired results for the patient with psychosis and finally craft a criteria for the family members of the patient at hand (Holmes, Kennedy & Perron, 2014). In this section, we will outline, analyze and discuss the probable nursing interventions that can be formulated from a well executed biopsychosocial assessment (Fischer, 2012). In case of a client exhibiting withdrawal/ isolation, it is advisable to: employ therapeutics; create simple one-on-one activities; offer trainings on social skills; carry out a number of activities to boost self-esteem; create a consistence and honest interactions with the client and finally in a friendly-manner encourage the client to interact with peers (Holmes, Kennedy & Perron, 2014). In case of a patient exhibiting erratic/ regressive behavior, a nursing professional will; look for a manner to approach the strange behavior; monitor the mannerisms of the patient and offer assistance where necessary; treat the client as an adult even if in regression; avoid touch contacts with the patient might interpret as threats; craft regular Rota of activities with the patient and also include simple choices of two items in case of a patience with ambivalence (Johansen, 2014). In case of rude or suspicious clients, the nursing professional should: Foster a professional relationship with the patient; offer more control and freedom to the client within therapeutic circles; inculcate sense of mutual care, trust and communication in the professional relations; avoid strength and focus on delusional and suspicious character of the patient; describe ay therapy (medication, tests and treatment) before the onset of the session; find out and respond to any emotional concern of delusion or suspicion and also avoid any mannerism that might be misinterpreted by the patient(Gatchel & Oordt, 2013) In case of a patient with disorderly communication patters, a nursing professional should: keep the communication elaborate and straight-to-the point; foster consistent verbal and non-verbal communication with the client; and lastly clarify any aspect of communication that might be ambiguous to the patient (Ghaemi, 2011). In case of a patient exhibiting hallucinations/ delusions, a nursing professional should: Ignore the hallucinatory aspect and engage the patient with direct interaction on reality as a cover-up; tell the client softly that you disagree with their hallucinatory-perspective but acknowledge to them that you understand that he/she is really experiencing the hallucinations; avoid argument with the patient over the hallucinations; engage the client to task-based, real and structured activity; promptly respond to patient’s feelings on delusion once he/she communicates; avoid quick/ stimulating movements towards the client; start counseling sessions once the client stops having hallucinations; make the patient understand that the delusions and hallucinations are indicators of a psychiatric condition; introduce anxiety stimulus to evoke the hallucinations; assist the patient to handle hallucinations through taking prescribed medication and engaging in reality. In case of persistence in delusions, they should be ignored and more focus should be turned on remedial measure; finally, one should teach the patient a number of cognitive measures like soliloquy and blockage of one’s mind from delusional thoughts (Fischer, 2012). During the nursing management interventions in case of first episode psychosis, a number of ethical issues and considerations ought to be put into focus (Fischer, 2012). There are three ethical issues that commonly occur in psychiatric nursing, these are; the ethical issue of balancing patent’s freedom alongside the requirement of conserving unit control; balancing the need of fostering professional relationship and the requirement to distance oneself from the desire; and balance the quest ‘to do right’ while maintaining cordial relations with the colleagues. These three are mainly the ethical issues that impact on nursing management interventions in psychotic patients (Fischer, 2012). To conclude this paper, it has been found that a thorough biopsychosocial assessment entails three main aspect of patient’s life that includes; the biological aspects; psychological aspect and finally the social aspect. The biological aspect entails age, sex, genetics and medical history; the psychological aspects entail the feeling of one’s mind for instance temperament, feeling of isolation, suspicion among other. On the other hand, the social aspects include ones: marital status, friends, relation with the family, socio-economic aspects and so on. A thorough biopsychosocial assessment will help a nursing professional in pinpointing the causing factors, diagnosing and coming up with appropriate nursing management and intervention measures that will remedy the psychotic patient’s condition while putting into consideration of all safety and ethical issues that may be encountered in the course of the therapy (McLaren , 2012). References Bruns, D., & Disorbio, J. (2012). Assessment of biopsychosocial risk factors for medical treatment: A collaborative approach. J Clin Psychol Med Settigs, 18(2), 127-47. Retrieved September 29, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/1920585/ Bruns D. & Disorbio J., (2010 eds) Chronic Pain and Biopsychosocial Disorders. Practical Pain Management, volume 9, issue 2 Dobkin, P & Morrow R., (2014) Biopsychosocial assessment of cancer patients. American journal of Psychiatry 189 (7): 120-27 Engel L. (2010 ed). The clinical application of the biopsychosocial model. American Journal of Psychiatry 137 (5): 535–544. Fischer, A. (2012) The influence of biopsychosocial assessment on the degree of doctor-patients empathy. Sch Ing Nurs Pract; 9 (2): 193-208 retrieved on 30th september 2015 from: http://www.ncbi.nlm.nih.gov/pubmed/7667570 Gatchel, J. & Oordt, S. (2013 ed.) Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration. American Psychological Association: Washington, D.C. Ghaemi N. (2011) The Biopsychosocial Model in Psychiatry: A Critique. Existenz 6(1). Holmes, D., Kennedy, L., & Perron, A. (2014). The mentally ill and social exclusion: A critical examination of the use of seclusion from the patient's perspective. Issues Ment Health Nurs., 6, 559-78. Retrieved September 30, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/15371143 Johansen B.(2014) The social aspect of biopsychosocial assessment. J Can Acad Child Adolesc Psychiatry, 18(4), 344–347. Retrieved September 30th , 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765389/ Marshall, M., & Lockwood, A. (2012 ed). Early Intervention for psychosis. The Cochrane Database of Systematic Reviews (Protocol). McLaren N (2012). The myth of the biopsychosocial model. Australian and New Zealand Journal of Psychiatry 36 (5): 701–703. McLaren, N. (2010). Humanizing Psychiatry. Australian and New Zealand Journal of Psychiatry 36 (5): 603–714.. 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