Posted: January 24th, 2023
NRNP 6635 Week 1: History and Theories of Psychopathology
Factors That Influence the Development of Psychopathology
In most fields of medicine, diagnosis is based on a physical assessment (signs and symptoms), lab and radiology results, and a past medical history. However, in psychiatry, a diagnosis is based on the clinician’s impression of the patient’s behavior, cross-referenced with a diagnostic or classification manual (Sadock, Sadock, & Ruiz, 2015). Unlike a medical patient that can be diagnosed with diabetes without having symptoms, a psychiatric patient cannot. For example, a patient with no symptoms cannot be diagnosed with schizophrenia (Sadock, Sadock, & Ruiz, 2015). Many contributions to the field of psychiatry and the advances in psychopathology have come from biological, psychological, and social-cultural sciences.
Biological (Genetic & Neuroscientific)
According to Sadock, Sadock, and Ruiz (2015), research has shown that 40 to 70 percent of cognition, temperament, and personality aspects (domains that are affected in mentally ill patients) can be attributed to genetic factors. The patient’s environment can also influence what genes are expressed; genetics provide the predispositions while the environment shapes what dispositions are expressed (Butcher & Kendall, 2018). The neuroscientific aspect also plays a key role in psychopathology. A table provided in one of our readings this week, showed the direct correlation between different areas of the brain, the associated function of the area, and the relevant mental health disorder. For example, the frontal cortex is involved in the control of the behavioral response; relevant mental health condition may include depression, bipolar disorder, and/or anxiety disorders (Jackson & Milberg, 2018). The limbic system, involved in sense and identity and initiating emotional response has been implicated in studies of schizophrenia and anxiety disorders (Jackson & Milberg, 2018). NRNP 6635 Week 1: History and Theories of Psychopathology
Psychological (Behavioral and Cognitive Processes, Emotional, Developmental)
Cognitive dysfunction within the context of psychopathology is common and may contribute to the high rates of functional impairment found in many psychiatric patients (Jackson & Milberg, 2018). Common areas of cognitive dysfunction include memory, attention, and executive functioning. According to Jackson and Milberg (2018), memory deficits and deficits in cognitive processing speed (executive functioning) have been associated with individuals with social phobia. Patients with Posttraumatic Stress Disorder (PTSD) commonly have deficits in executive functioning. NRNP 6635 Week 1: History and Theories of Psychopathology
Social, Cultural, and Interpersonal Factors
Mental health disparities have been well documented across socioeconomic class, race, gender, and sexual orientation. Studies have shown, individuals with less privileged social positions, unemployment, and lower income have a high association with common mental disorders (Cheung & Mak, 2018). According to Cheung and Mak (2018), a systematic review revealed that lesbian, gay, and bisexual individuals have higher risk for mental disorders, suicidal ideations, and substance abuse compared to heterosexual individuals. According to Sadock, Sadock, and Ruiz (2015), culture is a learned behavior and can play a key role in the patient’s mental health; a cultural assessment should be a part of every psychiatric assessment. When making a psychiatric diagnosis or developing a treatment plan, clinicians should take into account the behaviorism of the patient’s culture NRNP 6635 Week 1: History and Theories of Psychopathology.
Butcher, J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent psychopathology. In J. N. Butcher & P. C. Kendall (Eds.), APA handbook of psychopathology: Child and adolescent psychopathology., Vol. 2. (pp. 3–14). American Psychological Association. https://doi-org.ezp.waldenulibrary.org/10.1037/0000065-001
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 (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.
The nurse practitioner should adopt a multidimensional, integrative model of psychopathology because psychiatric diagnoses are not unidimensional. Psychopathology is exhibited by many factors, social, cultural, behavioral, cognitive, and biological (Sadock, et al., 2015). For example, obesity can be caused by genetics (biological), environmental, cultural, and social factors. According to Micanti et al. (2016), eating disorders are both pathological and psychological development. It would be important for the nurse practitioner to adopt the view of multidimensional psychopathology to accurately assess patients on a deeper level than just biological. Psychiatry is unique as psychiatric diagnoses are multidimensional; they show both biological symptoms, however, can be developed or exasperated by other factors leading to physical symptoms. Learning multidimensional psychopathology will allow me as a practitioner to understand the psychiatric patient population better and will allow me to diagnose more accurately. NRNP 6635 Week 1: History and Theories of Psychopathology
Micanti, F., Iasevoli, F., Cucciniello, C., Costabile, R., Loiarro, G., Pecoraro, G., Pasanisi, F., Rossetti, G. L., & Galletta, D. (2016). The relationship between emotional regulation and eating behaviour: a multidimensional analysis of obesity psychopathology. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 22(1), 105–115. https://doi.org/10.1007/s40519-016-0275-7
Sadock, B. J., Sadock, V. A., & Ruiz, R. P. (2015). Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (Eleventh ed.). Wolters Kluwer.
I really like the statement from Butcher & Kendall (2018) that talks about how genetics determine predispositions for mental health, whereas the environment affects what predispositions are expressed. I struggled to understand the concept of gene expression and its effect on mental health until I saw this same passage. This is why it is so important to have a multidisciplinary approach to the many facets of mental health predisposition. We as APRN’s are not going to have imaging that tells us a patient has schizophrenia. Lab work will not tell us how depressed a patient is. We must use the tools at are disposal – mainly, in-depth and accurate assessments. An accurate assessment involves being thorough and addressing all possible internal and external forces that could have led to a mental health disorder. Trauma is one of those external forces NRNP 6635 Week 1: History and Theories of Psychopathology. Mental health providers cannot treat depression without treating the trauma that led to its expression. People accessing mental health services are much more likely to have experienced violence and/or trauma in within the last year than the overall population (Sweeney et al., 2018). While also needing to consider precipitating factors, the APRN should also consider the access to care. Far too many people in the US experience a significant lack of mental health services. The APRN may provide some limited therapy and prescriptions, but how easily can the patient access other mental health services so that they can continue mental health care once they are stabilized on medications? Therefore, the APRN must be knowledgeable about community services as well. Access to appropriate mental health services in communities can be linked to reduced stigma, reduced cost, and a wider range of services, as well as promoting care adherence and improved patient outcomes (Khort et al., 2018).
Kohrt, B. A., Asher, L., Bhardwaj, A., Fazel, M., Jordans, M., Mutamba, B. B., Nadkarni, A., Pedersen, G. A., Singla, D. R., & Patel, V. (2018). The Role of communities in cental health care in low- and middle-income countries: A meta-review of components and competencies. International Journal of Environmental Research and Public Health, 15(6), 1279. Accessed December 5, 2020 from https://doi.org/10.3390/ijerph15061279
Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: relationships in trauma-informed mental health services. BJPsych Advances, 24(5), 319–333. Accessed December 5, 2020 from https://doi.org/10.1192/bja.2018.29
The history of the diagnosis of mental disorders is fraught with examples of how cultural norms and prejudices interfere with and warp a diagnosis. The result is that normal behavior and orientations have been pathologized as an illness or disease. An example of this would be the story of Alan Turing, the famous British computer scientist of the 20th century, who was instrumental in inventing modern computers and deciphering German code in World War II. He was convicted in 1952 in England of gross indecency for being gay. Turing was forced by the courts to undergo 12 months of hormone therapy and could no longer work for the British government. At the time, homosexuality was pathologized as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders and was criminalized in most Western countries. It was not until 1973 that the American Psychiatric Association (APA) finally removed homosexuality from the DSM. NRNP 6635 Week 1: History and Theories of Psychopathology
Historically, the process of rendering a diagnosis has been used to pathologize those who fell outside what was considered the cultural norm of human behavior. This process often marginalized diagnosed populations and prevented individuals from receiving appropriate care. It is of utmost importance to consider cultural issues that influence how you as a clinician interpret a client’s behavior and how cultural issues influence how a client may express behavior. This week, you explore the history of psychopathology and the evolution of theoretical perspectives in the field NRNP 6635 Week 1: History and Theories of Psychopathology.
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The PMHNP Study Support Lounge is offered throughout the course as a place of academic refuge, where you can ask questions, offer insights, and interact with your peers. Your Instructor may also weigh in to provide global feedback to the group based on trends, common problems, and common strengths in student posts.
As a peer, you are encouraged to provide constructive, helpful feedback to your peers. Advanced practice nurses always benefit from the feedback of others. Your Study Support Lounge posts may be procedural (“How do I attach a Kaltura video to a Discussion post?”), conceptual (“How does this relate to the other therapy approaches we have studied?”), or analytical (“What do these diagnostic results actually mean in the context of this specific patient case?”). Although not mandatory, this is an opportunity to interact and study together as you navigate the assignments, so you are highly encouraged to take part in this activity. Full participation in activities like these is a statistically significant predictor of success. NRNP 6635 Week 1: History and Theories of Psychopathology
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PMHNP Study Support Lounge
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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?
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
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!
To access your rubric:
Week 1 Discussion Rubric
To Participate in this Discussion:
Week 1 Discussion
In Week 2, you will be introduced to assessment and diagnosis of the psychiatric patient. You will explore elements of the psychiatric interview, history, and examination as well as psychiatric rating scales. You also will review the classification system of psychiatric disorders in the DSM-5 and the role the DSM-5 plays in diagnosis.
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In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .
For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page. NRNP 6635 Week 1: History and Theories of Psychopathology
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