The Biopsychosocial
Context 0f Psychiatric
Nursing Care
NUR 305
Mrs. Roberts
Bio context-the brain
The Cerebrum- conscious
perception, abstract
reasoning, and thinking
4 lobes:
Frontal-speech & motor
function
Temporal-auditory
processing & language
Parietal-sensory function
Occipital-visual function
The brain cont.
• The cerebellumequilibrium, muscle
tone, balance,
posture.
Limbic system
• Forms the border of
temporal lobes
• Associated with
emotional subjective
states, “fight or flight”
reactions, and
memory.
Brain cont.
• Thalamus –
influences mood and
affect
• Hypothalamustemperature
regulation, endocrine
function, feeding &
drinking behavior
Brain cont.
• Brainstem
• Pons-reflex center
• Medulla-breathing,
HR, swallowing,
• Reticular formationcore of brainsteminvolved with
consciousness & the
sleep-wake cycle.
Neurotransmission
• Process by which
neurons communicate
with each other
through electrical
impulses and
chemical
messengers.
• We all have about
100 billion brain cells.
Neurotransmitters
• Are released from the
axon into the
synapse, then
received by the
dendrite of the next
neuron.
Neurotransmitters cont.
• Serotonin-5HT ( 5
hydroxytryptophan)
derived from a dietary
amino acid. Located
only in the brainstem.
Plays a role in mood
and activities of the
CNS. Plays a role in
anxiety disorders.
Antidepressants block
its uptake.
Neuroimaging techniques
Measure activity, function,
and blood flow & allow for
visualization of the brain
CT- computed tomography
MRI- magnetic resonance
imaging
PET-positron emission
tomography
SPECT-single photon
emission computed
tomography
Biological rhythm
• Circadian rhythm- is a
network of internal clocks
in the body that work
according to a 24-hour
cycle.
• Sunlight is the time cue
from the external
environment that resets
our “clock.”
• The hypothalamus is the
“internal timekeeper.”
Sleep
• 5 stages:
• Stage 1-”falling
asleep”
• Stage 2- sleep itself
• Stages 3 & 4- “delta
sleep” or deep sleep
• Stage 5- REM sleep
occupies 25% of
sleep time
Psychoneuroimmunology
• Explores the interactions
between the CNS & the
endocrine, and immune
system.
• Research indicates
increased susceptibility to
illness following sleep
deprivation, depression,
and death of a spouse.
• Also NK (natural killer)
cells decrease in # with
increased levels of stress.
Genetics
• The search for genes that
cause mental illness has
been inconclusive but
has stimulated scientific,
political, and clinical
debate.
• Currently based on
studies based on
inheritance such as
family, twin, & adoption
studies.
Proposed uses of genetics in
psychiatry
• Developing new drugs that will target
molecular regulators of gene expressions
in brain regions shown to be abnormal in a
psychiatric illness.
• Conducting gene therapy to treat
psychiatric illness.
• Implementing studies that use cloned
genes in research procedures in
psychiatry.
Biological assessment of the
patient
• Includes:
• Screening patients for
the major signs of
physical or organic
disorders that may
complicate a patient’s
psychiatric status.
• A complete health care
history and lifestyle
review
• Physical exam & labs
Psychological context of
psychiatric nursing care
• The Mental Status
Exam-nurse’s
observation of the
patient’s current state;
not past or present
state.
Content of the mental status
exam
•
•
•
•
•
•
•
•
•
Appearance
Speech
Motor Activity
Interaction during interview
Mood- pt’s self report of emotional state
Affect-emotional tone
Perceptions
Thought processes
Memory & Judgment
Psychological tests
• 2 types;
• Evaluation of
intellectual &
cognitive ability ( i.e..
WAIS,WISC)
• Evaluation of
personality
functioning (projective
tests)
Personality tests
• Rorschach test
• Thematic
Apperception Test
• (TAT)
• Minnesota
Multiphasic
Personality Inventory
(MMPI)
Thematic Apperception Test
• Person tells a story
about a series of
pictures.
• What has led up to
the event.
• What’s happening at
the moment.
• What the characters
are feeling.
• What the outcome is.
Behavioral rating scales
• Standardized scale
• Gather a number of
measurable
behavioral indicators
of the patients
adaptive and
maladaptive
responses.
Cultural competence
• Implies cultural
awareness.
• The ability to view
each patient as a
unique individual.
Functions of culture
• Creates a perception
of reality
• Motives for behavior
• Identity
• Values
• Communication
• Emotions
Sociocultural risk factors &
protective factors
•
•
•
•
•
•
Age
Ethnicity
Gender
Education
Income
Beliefs
Gender
• Being female can
increase the risk of
depression in women.
• Being male is
associated with
increased risk of
suicide.
Age
• Depressed elderly
patients tend to
recover more quickly
than younger age
groups.
Ethnicity
• Includes a person’s racial, tribal, linguistic,
and cultural origin or background.
• Each cultural group has its own custom,
beliefs, and traditions.
• Influences the development and recovery
from psychiatric disorders.
Research on ethnicity
• Members of ethnic
groups are admitted
to psychiatric
institutions 3 times
more than the general
population (Shin
2002)
• Asians have low
admission to rates to
state hospitals.
Research cont.
• Members of minorities
have difficulty gaining
access to mental
health services.
(Hough et al.,2002,)
• Latino youths are less
likely than white
youths to use
specialty mental
health services.
Education
• Education is more important than income
in determining the use of mental health
services. Patients with less education are
less likely to seek psychiatric care and are
more at risk for dropping out of treatment.
Income
• The impact of all
other risk factors are
multiplied by poverty.
• Higher prevalence of
poverty rates are
consistently found
among women, the
elderly, and ethnic
and racial minorities.
(Alegria, 2002)
Questions to facilitate cultural
competency
“What labels am I subconsciously applying
to this patient and how did I learn them?”
“What socioeconomic status am I assuming
for the patient, and what are my
assumptions about that socioeconomic
level?”
“What other explanations might account for
the patient’s behavior.”
Sociocultural Stressors
• Disadvantagement: the lack of socioeconomic
resources that are basic to biopsychosocial
adaptation.
• Stereotype: a depersonalized conception of
individuals within in group.
• Discrimination: differential treatment of
individuals not based on actual merit.
• Racism: the belief that inherent differences
among races determine individual achievement
and than one race is superior.
Therapeutic nurse-patient
interactions
• Sociocultural differences
can be a source of
misunderstanding by the
nurse and resistance by
the patient.
• Healthy recognition of
nurse-patient
sociocultural differences
can enrich the health care
experience for both the
nurse and the patient.