Factors that Influence the Development of Psychopathology

Factors that Influence the Development of Psychopathology NRNP 6635

Psychopathology development is influenced by various factors recognized over time through. Neurotransmitters, neurodevelopment, and genes are the most implicated factors in psychopathology. Neurotransmitters are responsible for mood expression, emotions, reasoning, memory, and other cognitive and physical functions (Jiang et al., 2022). Their absence or presence is thus vital in explaining psychopathologies.

Factors that Influence the Development of Psychopathology

Smoller et al. (2019) show that some defective genes are essential factors in diseases such as schizophrenia, anxiety disorder, depression, and Alzheimer’s. Individuals can inherit these defective genes, and a diagnosis of psychopathologies affecting the genes in first-degree relatives translates to an increased risk for the disease. Neurodevelopment is also essential in psychopathology.

Congenital disorders in various systems lead to acromegaly, tetralogy of Fallot, and renal agenesis. Congenital disorders affecting the neurologic system (neurodevelopment problems) are also implicated in psychopathologies, such as autism, developmental language disorder, and attention deficit hyperactivity disorder. Thus, biological factors play a vital role in psychopathology.

Psychological factors implicated in psychopathology include traumatic experiences in childhood and young adulthood. Exposure to violence in younghood and young adulthood (such as work in the army) increases stress and hormone levels, fear, anxiety, and specific phobias.

Kalin (2020) shows that exposure to factors affecting individuals’ mental health, especially trauma, is implicated in many psychiatric disorders and behaviors. For example, rape and bullying tendencies are common among individuals who were bullied or sexually abused in childhood. These conditions include anxiety and depression, and post-traumatic stress disorders.

In many instances, mental disorders are associated with community and family violence and trauma, and these trends expose them to drugs and violence to escape these traumas. Psychological symptoms in psychiatric conditions include anxiety, distress, fear, irritability, low energy, and sleep disturbance.

Social and cultural factors are interrelated and greatly influence psychopathology. Cheung and Mak (2018) note that emotions and behavior depend greatly on societies. Conduct/behavior that does not align with societal conduct may count as a psychological disorder.

Molerio (2018) notes that cultural factors such as values and practices influence individuals’ interactions. For example, LGBTQ individuals report higher rates of suicide, traumatic stress, depression, and anxiety disorders due to discrimination, physical violence, and labeling in these communities. Understanding and working on these social and cultural factors, especially stereotypes, to manage psychopathologies.

Interpersonal factors are vital in the development and expression of psychiatric disorders. Brown et al. (2019) note that “Internalization, detachment, disinhibition, dominance, and compulsivity” are common in many psychiatric disorders (Brown et al., 2019).

These factors in normal individuals, such as disinhibition and detachment, can lead to developmental problems such as speech, judgment, and cognitive changes. For example, social exclusion and lack of social support for older adults can lead to depression, anxiety, and other psychiatric problems. Understanding these interpersonal factors’ presentation and their factors in earlier life stages can lead to better diagnosis and management.

Conclusion

Psychopathologies are less understood than pathophysiologic disorders, and the rising pressure of advanced nursing practice to improve their diagnosis and management is based on these premises. Biological, social, and cultural. Psychological and interpersonal factors play vital roles in psychopathology.

These factors are evident in these psychiatric disorders’ development, expression, and management. In addition, nurses must understand these factors before implementing interventions to ensure they do not interfere with the management process.

Factors that Influence the Development of Psychopathology NRNP 6635 References

  • Brown, A., Barker, E. D., & Rahman, Q. (2020). A systematic scoping review of the prevalence, etiological, psychological, and interpersonal factors associated with BDSM. The Journal of Sex Research, 57(6), 781-811. https://doi.org/10.1080/00224499.2019.1665619
  • 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
  • Jiang, Y., Zou, D., Li, Y., Gu, S., Dong, J., Ma, X., Xu, S., Wang, F., & Huang, J. H. (2022). Monoamine neurotransmitters control basic emotions and affect major depressive disorders. Pharmaceuticals, 15(10), 1203. https://doi.org/10.3390/ph15101203
  • Kalin, N. H. (2020). Early-life environmental factors impacting the development of psychopathology. American Journal of Psychiatry, 177(1), 1–3.  https://doi.org/10.1176/appi.ajp.2019.19111181
  • Molerio, C. (2018). Culture and psychopathology: New perspectives on research, practice, and clinical training in a globalized world. Front Psychiatry. https://doi.org/10.3389/fpsyt.2018.00366
  • Smoller, J. W., Andreassen, O. A., Edenberg, H. J., Faraone, S. V., Glatt, S. J., & Kendler, K. S. (2019). ” Psychiatric genetics and the structure of psychopathology”: Correction. https://doi.org/10.1038/s41380-018-0026-4

Factors that Influence the Development of Psychopathology NRNP 6635 Assignment Instructions:

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.

NRNP 6636 COMPREHENSIVE PSYCHIATRIC EVALUATION AND PATIENT CASE PRESENTATION, VIDEO CASE PRESENTATION EXAMPLE

Mental health disorders pose various threats to populations and can significantly affect their quality of life. They can be precipitated by environmental changes such as trauma or other life experiences. These disorders can be managed through extensive patient evaluation for accurate diagnosis, determining their underlying causes, and helping them accordingly.

The DSM V criteria are vital for accurate diagnosis, elimination of differentials, and patient management. Assessment and evaluation also help determine any factors contributing to the problem and allow the healthcare provider to manage it. This paper analyzes the psychiatric health of a patient going through much stress due to her husband’s drinking and evaluates differential diagnoses for the patient.

CC (chief complaint): ” I am having a lot of stress and terrible anxiety because of my husband’s drinking.”

HPI: A 40-year-old female came to the hospital. She complains of sadness, loss of interest in her hobbies, increased weight due to stress eating, problems initiating and remaining asleep, lack of energy, inattentiveness, guilt, frequent crying, frustration, and irrational fear regarding her children’s husband, work, and children’s. The symptoms have increased over the last few years.

She believes in her ability to handle the problems and has never sought medical or psychiatric help single-handedly until recently, when these symptoms overpowered her. The primary source of stress is her husband, who was diagnosed with bipolar disorder 12 years ago. They have been married for 11 years. The diagnosis led him to change jobs and miss work frequently, worsening her husband’s stress and resulting in heavy drinking. The husband is currently undergoing an intensive outpatient program, which has helped him escape heavy drinking, which the client is happy about.

Past Psychiatric History:

  •       General Statement: No history of a diagnosed psychiatric illness; it is her first psychiatric visit
  •       Caregivers (if applicable): N/A
  •       Hospitalizations: The patient has never been hospitalized
  •       Medication trials: No history of medication trial involvement
  •       Psychotherapy or Previous Psychiatric Diagnosis: No history of psychiatric/mental health illness

Substance Current Use and History: Denies any current or past substance use.

Family Psychiatric/Substance Use History: The client denies any familial diagnosis of psychiatric illnesses. The client’s husband had an alcohol drinking problem that recently stooped after IOP and the client’s request. The client is happy about that and is now stressed due to her husband’s absence from work.

Psychosocial History: Has one sibling, grew up in Media, studied in Philadelphia, and lives in Media. Her first job was at QVC and in anthropology. She currently works in transportation project development, where she has worked for fifteen years. The client expresses dissatisfaction with her current job because it is not her dream job. She keeps the job because of the flexibility and benefits. She is married to her husband of eleven years, and they have two twins who will join preschool soon. Her primary source of social support is her parents and in-laws, who live nearby.

Medical History:

  •       Current Medications: None
  •       Allergies: NKFD
  • Reproductive Hx: Sexually oriented to the opposite gender, married, has two five-year-old twin boys. Denies current or hx of STDs

ROS:

  • GENERAL: The patient reports some unconfirmed weight gain due to stress eating, weakness, and fatigue most of the time.
  • HEENT: Head: Denies any injuries, headaches, or hair loss. Eyes: Denies pain, itchiness, dryness, or visual problems. Ears: Denies pain, balance problems, drainage, or hearing problems. Throat: Denies pain swallowing, dry through, or voice changes
  • SKIN: Denies itchy skin, dryness, rashes, lesions, or discoloration
  • CARDIOVASCULAR: Denies any chest pain, pressure, palpitations, or edema
  • RESPIRATORY: Denies coughing, congestion, or SOB
  • GASTROINTESTINAL: Patient reports increased appetite and subsequent stress eating. Denies nausea or vomiting, constipation, or diarrhea
  • GENITOURINARY: Denies hx of STDs or UTIS, burning on urination, hesitancy, urgency, order, or urine coloration. She denies any changes in bowel movement.
  • NEUROLOGICAL: Denies loss of sensations or tingling sensations, headache, or
  • MUSCULOSKELETAL: Patient denies joint, muscle or back pain or stiffness and reports retained ability to perform activities of daily living.
  • HEMATOLOGIC: Denies bruising and blood clotting problems
  • LYMPHATICS: Denies lymph nodes enlargement of spleen excision
  • ENDOCRINOLOGIC: Denies heat or cold intolerance, excess thirst, or excess urination

Physical exam: BP: 135/82, P: 76, T: 98F, RR:18, Pain: N/A

Diagnostic results: N/A

Assessment

Adjustment disorder is a short-term illness precipitated by sudden stressful life changes that an individual cannot cope with (Kalauskas & Quero, 2020). These sudden stressful life changes include work-related issues such as losing a job, losing loved ones, and marriage and relationship issues, which lead to impairment. The patient expresses her concerns, which are her husband’s heavy drinking (which subsided recently after her request and beginning IOP) and frequent absence from work. 

Symptoms of the condition include anhedonia, anxiety, insomnia, headache, anger, loss or increased appetite, and suicidal thoughts (American Psychiatric Association, 2022). The patient’s presentation meets the DSM V diagnostic criteria for Chronic Adjustment disorder with mixed depression and anxiety due to the symptoms of the depressed mood and persistence for over six months. Kazlauskas and Quero (2020) note that a classic case of adjustment disorder is COVID-19, which has affected families’ integrity, people, lost jobs, and fear for individuals’ health, leading to increased global adjustment disorder prevalence. 

Adjustment disorder occurs in men and women of all ages, and treatment is brief to help realign the patient’s ability to cope with life stresses (Sadock et al., 2015). Psychotherapy and medications are the mainstay treatment. Treatment entails psychotherapy and medications. Medications can either be antidepressants or anti-anxiety medications, depending on the patient’s presenting symptoms. Treatment response is higher when psychotherapy is used alongside medications than individual treatment.

Mental Status Examination: The patient is alert, well-oriented, cooperative, and has coherent speech. The patient has a depressed mood and appears goal-directed but mildly distracted. The patient has full insight into the condition and seeks help to manage her excessive worries. The patient’s judgment is intact, and she denies any suicidal ideations or behavior. She identifies ineffective coping mechanisms because she does not seek help but believes in her ability to handle her problems. The patient reports stress eating and increased appetite. 

Differential Diagnoses:

  1. Generalized Anxiety Disorder

GAD is characterized by fear and worries without any obvious reason or specific course. The patient cannot identify a course for irrational fear. According to DSM V criteria, GAD is diagnosed when the patient has fear, nervousness, restlessness, poor concentration, irritability, muscle tension, insomnia, or worry regularly and severe in some days, without a specific course, for more than six months (American Psychiatric Association, 2022; Ströhle et al., 2018). The patient presents with a majority of these symptoms, such as poor concentration, depression, and depressive symptoms, and her fears are directed to a specific course: her husband’s diagnosis, drinking problem, and frequent absence from work., thus ruling out the diagnosis.

  1. Major Depressive Disorder

Environmental stressors related to family and work can precipitate the disorder, although in most cases, the condition is idiopathic. Patients with major depressive disorder from environmental factors have ineffective coping mechanisms resulting in depression. The patient is going through stressful events, and the diagnosis is possible for this patient. MDD is a severe mood disorder that can markedly affect the quality of life and performance of the patient’s daily living activities. 

A diagnosis of MDD is confirmed when at least five symptoms, such as consistent low mood, hopelessness, loss of appetite, insomnia, worthlessness, self-guilt, suicidal thoughts, inattentiveness, restlessness, psychomotor retardation, and anhedonia, last for more than two weeks (American Psychiatric Association, 2022). The patient reports normal functioning at home and workplace and is only stressed by her husband’s situation. Kennedy (2020) also notes that the DSM V criteria for MDD diagnosis require that these symptoms must be affecting the patient’s daily functioning at work and social life, which has not been met for this patient, thus ruling out the diagnosis.

  1. Bipolar II Disorder

Bipolar II Disorder is a common mood disorder characterized by combined major depression and hypomania. Thus, a diagnosis of major depression and a hypomania episode is necessary for the diagnosis of the disease, according to the DSM V. For this patient, she has no presentations of mania, ruling out the condition. For this client coming to the clinic for the first time, it is important to delay the diagnosis and initiate symptomatic management for at least six months to allow time for monitoring and evaluation to ensure accurate diagnosis and management of the patient.

Reflections: Comprehensive Psychiatric Assessment allows the care provider to gather extensive patient information to inform their diagnosis and management. The patient’s assessment was patient-focused, emphasizing recovery and quality of life. An extensive review of the patient’s history and current presentations increased the possibility of accurate diagnosis and subsequent management. The assessment also follows evidence-based guidelines, hence its reliability. 

I agree with the adjustment disorder assessment based on the patient’s presentation and history. Careful analysis of the symptoms and their interrelatedness with the preceptor improved my understanding and enhanced my ability to pay attention to patient presentation details. I have also appreciated the importance of understanding how the conditions present due to the significant similarities and differences in psychiatric disorders. The comprehensive psychiatric assessment has also helped me appreciate the DSM V in diagnosing mental health illnesses and their management. 

Differential diagnosis helps ensure the diagnosis selected is the most appropriate for the patient, prevents misdiagnosis, and prevents delayed treatment, which causes increased patient deterioration. When managing mental illness patients, maintaining ethical standards such as respect for autonomy and confidentiality are also essential considerations in developing a working relationship that leads to effective management (Sadocks et al., 2015).

Factors that Influence the Development of Psychopathology NRNP 6635 References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

Kazlauskas, E., & Quero, S. (2020). Adjustment and coronavirus: How to prepare for COVID-19 pandemic-related adjustment disorder worldwide? Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S22–S24. https://doi.org/10.1037/tra0000706

Kennedy, S. H. (2022). Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues in Clinical Neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/shkennedy

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Wolters Kluwer.

Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Ärzteblatt International, 115(37), 611. https://doi.org/10.3238/arztebl.2018.0611

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