Bipolar Disorder Prescribing for Children and Adolescents essay

Bipolar Disorder Prescribing for Children and Adolescents essay

Prescribing for Children and Adolescents

Off-label prescribing involves the use of medications in a manner not specified in the Food and Drug Administration’s (FDA) approved packaging label, such as for an unapproved age group, dosage, or form of administration (Rusz et al., 2021). It is common in children and adolescents for the management of bipolar disorder because the FDA has approved only a limited number of medications for pediatric use. This scarcity of approved treatments drives clinicians to rely on off-label prescribing to manage symptoms and improve the quality of life for young patients, despite the need for careful consideration of efficacy and safety.

FDA-Approved Drug: Aripiprazole

Aripiprazole is an atypical antipsychotic that has been approved by the FDA for the management of bipolar disorder in children and adolescents between the ages of 10 and 17 years. It has been used in the treatment of bipolar affective disorder for its mood-stabilizing effects and for the management of mania and mixed episodes. The advantages of the use of aripiprazole are the lower risks of developing weight gain, metabolic syndrome, and other unfavorable side effects compared to other antipsychotics (Yee et al., 2019). However, it retains the risk factors like extrapyramidal syndromes (tremor, rigidity), akathisia (restlessness), and, in rare instances, tardive dyskinesia (involuntary movements.

Off-Label Drug: Lamotrigine

Lamotrigine is used off-label to treat bipolar disorder in children and adolescents as a maintenance therapy. It is particularly useful in preventing episodes of depression. The main advantage of lamotrigine is its anti-depressive effect without affecting weight or metabolic parameters. However, the drug poses the danger of a very serious form of skin reaction called Stevens-Johnson syndrome which may be fatal (Hashimoto et al., 2020). To manage this side effect, initiation of lamotrigine is done at a low dose with a gradual increase of dosages. Other possible side effects include dizziness, headache, and double vision. Despite these risks, lamotrigine is preferred due to its low rates of depressive episodes and its safety profile compared to other mood stabilizers.

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Nonpharmacological Intervention: Cognitive-behavioral therapy (CBT)

Cognitive Behavioral Therapy (CBT) is one of the notable non-pharmacological approaches to tackling bipolar disorder in children and adolescents. CBT involves the alteration of negative patterns of thinking and behavior, the improvement of coping strategies, and the management of emotions. The advantages of CBT include the absence of side effects from medications and the acquisition of skills that may be helpful in the future even after the completion of the treatment sessions (Nakao et al., 2021). However, it may not be effective if administered infrequently or by a therapist with minimal exposure to pediatric bipolar disorder.

Risk Assessment and Clinical Practice Guidelines

Comprehensive medication risk assessment is based on factors such as the intensity and frequency of mood episodes experienced, the age of the child, other existing or coexisting medical conditions, possible side effects, and the family’s compliance ability with the regimes. For aripiprazole, the advantages include approval in treating acute manic and mixed episodes and demonstrated effectiveness compared to the risks of developing metabolic changes and extrapyramidal side effects. Lamotrigine has efficacy in the prevention of depressive episodes and boasts a lower risk of inducing metabolic side effects but risks severe rash if the patient is not properly titrated Bipolar Disorder Prescribing for Children and Adolescents essay.

Clinical practice guidelines for bipolar disorder in children and adolescents, such as those from the American Academy of Child and Adolescent Psychiatry (AACAP), support the use of FDA-approved medications like aripiprazole and the consideration of off-label options like lamotrigine when first-line treatments are inadequate (Gautam et al. 2019). These guidelines emphasize the importance of combining pharmacotherapy with psychotherapy, such as CBT, to achieve optimal outcomes. In the absence of specific guidelines, clinicians should rely on the latest evidence-based research, clinical expertise, and patient and family preferences to guide treatment decisions.

References

Gautam, S., Jain, A., Gautam, M., Gautam, A., & Jagawat, T. (2019). Clinical practice guidelines for bipolar affective disorder (BPAD) in children and adolescents. Indian Journal of Psychiatry, 61(8), 294. https://doi.org/10.4103/psychiatry.indianjpsychiatry_570_18

Hashimoto, Y., Kotake, K., Watanabe, N., Fujiwara, T., & Sakamoto, S. (2020). Lamotrigine in the maintenance treatment of bipolar disorder. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd013575

Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1), 1–4. https://doi.org/10.1186/s13030-021-00219-w

Rusz, C.-M., Ősz, B.-E., Jîtcă, G., Miklos, A., Bătrînu, M.-G., & Imre, S. (2021). Off-label medication: From a simple concept to complex practical aspects. International Journal of Environmental Research and Public Health, 18(19), 10447. https://doi.org/10.3390/ijerph181910447

Yee, C. S., Hawken, E. R., Baldessarini, R. J., & Vázquez, G. H. (2019). Maintenance pharmacological treatment of juvenile bipolar disorder: Review and meta-analyses. International Journal of Neuropsychopharmacology, 22(8), 531–540. https://doi.org/10.1093/ijnp/pyz034 Bipolar Disorder Prescribing for Children and Adolescents essay

Assessing, Diagnosing, and Treating Adults with Mood Disorders

Assessing, Diagnosing, and Treating Adults with Mood Disorders

 Subjective:

CC (chief complaint): “I have a history of taking medications and then stopping them. I don’t think I need them. I really feel like the medication squashes who I am.”

HPI: P.P. is a 29-year-old Caucasian Female patient seeking mental examination regarding her ongoing mental health concerns and medication adherence issues. She has taken medications before but stopped because it is suppressing the real her. She has not been taking any medications currently. This patient was referred by her primary care physician, who expressed concern about the inconsistencies in this patient’s use of prescribed psychiatric medications and their possible effects on her mental health and overall functioning. The individual in question claims she has been hospitalized four times for behavioral difficulties. The patient states that her mom admitted her to a medical facility as a young woman after she went for four to five days with no sleep. In 2017, the individual in question went to the hospital for a suicide attempt after overdosing on Benadryl, during which she experienced hearing voices. The person in question went to the hospital when cops discovered her dancing in a field while wearing a night gown and playing guitar. She believes her mom fabricated this narrative to get her to return to her lover.

The person in question previously received diagnoses for anxiety, depression, and bipolar illness. Previously on Zoloft, she experienced a “high” sensation and difficulty sleeping due to racing emotions. Risperdal and Seroquel caused her to acquire bodyweight, which she disliked. She reported that Klonopin slowed her down, which she didn’t enjoy. The client experiences bouts of exhaustion, lack of drive, lack of fascination, and feelings of worthlessness four to five times per year.

She is not currently betrothed and had no kids of her own. She working a part-time at the aunt’s bookstore but misses job because of despair. She is presently studying cosmetics at an educational institution and aspires to work as a makeup professional for celebrities. She adores composing her entire history and aims to publicize it. She also paints like Picasso and hopes to market her work to famous actors.

History of Mental Illness

 Hospitalizations – 4 times, with the most current one occurring in 2020 springtime.

 Overdosing on Benadryl during a 2017 attempt to commit suicide

 Diagnosed with bipolar illness, depression and anxiety.

Trials of Medication

 Zoloft: “Gave me a very euphoric feeling. My thoughts were speeding up and I was having trouble falling asleep”.

 Risperidone and Seroquel resulted in a notable increase in bodyweight.

 Klonopin: “I feel like I’m slowing down.”

 “I abruptly discontinued a prescription that started with the letter “L,” which assisted but it stifled my imagination.

Family History: Mom of the individual in question tried and failed to end her life. She believes that her mom was given a bipolar disorder diagnosis. Dad served time in jail for narcotics offenses. The individual in question claims that she hasn’t seen her father in nearly a decade. The client states that although his brother has behavioral problems, he has never asked for help or received a diagnosis.

Substance Current Use: She smokes one pack of cigarettes daily. She denied current or past use of any illicit substances, claims to have tried marijuana one time, but she didn’t enjoy it because it made her anxious. disputes consuming alcohol; last sip was at age 19.

Medical History: Hypothyroidism and polycystic ovarian syndrome.

• Current Medications: The patient is currently birth control pill and a medication for her thyroid problem but cannot remember the name.
• Allergies: The patient reports no known allergy. There is no documentation of food allergies.
• Reproductive Hx: None reported

ROS:

• GENERAL: Disputes weakness, cold, a high temperature, decrease in weight, or exhaustion.
• HEENT: Denies migraines, or injuries to the head. Disputes visual changes, double vision, or eye pain. Denies hearing loss, ear pain, nasal congestion, or sore throat.
• SKIN: Denies any irritation or blemishes.
• CARDIOVASCULAR: Denies any heart rate fluctuations, chest discomfort, or swelling in the legs.
• RESPIRATORY: Denies breathing difficulties or dyspnea.
• GASTROINTESTINAL: Disputes stomach pain, bloating, loose stool or vomiting.
• GENITOURINARY: Denies dysuria, pressure, frequency, or hematuria.
• NEUROLOGICAL: Denies experiencing any tingling, shifts in coordination, convulsions, fainting, convulsions, or paralysis.
• MUSCULOSKELETAL: Denies Absence of edema, muscular weakness, or tenderness in the joints.
• HEMATOLOGIC: Disputes history of hemorrhage, bruising, or shortage of blood.
• LYMPHATICS: Denies enlarged lymph lobes or history of lymphatic disorders.
• ENDOCRINOLOGIC: The patient’s thyroid-stimulating hormone (TSH) level was elevated at 6.3. The prolactin level was normal at 8. Further, the CBC, CMP, and lipid panel showed no abnormalities indicative of endocrine disorders such as diabetes or dyslipidemia.

Objective:

ROS:

• GENERAL: The individual in question is tidy, polished, and properly dressed. The state of mind and attitude are suitable and compatible.
• HEENT: The head is normal in shape and shows no signs of trauma or malformation.
• SKIN: Lack of moisture warm, and free of visible wounds, irritation, or blemishes.
• CARDIOVASCULAR: No chest pain nor palpitation noted. Assessing, Diagnosing, and Treating Adults with Mood Disorders
• RESPIRATORY: There are no noticeable wheezes or loss of breath.
• NEUROLOGICAL: The individual in question is friendly, accommodating, and four times as focused as usual.
• MUSCULOSKELETAL: Capable of effortlessly moving all limbs.

Vital Signs: Temp. 98.2, Pulse 90, RR 18, BP 138/88, O2 Sat 98%, Weight 166lbs., Height 5ft 7”.

Diagnostic results: For this patient, diagnostic testing would include thyroid function tests that may explain her elevated TSH to contribute to mood instability similar to the symptoms of bipolar disorder. Such tests may help in distinguishing primary mood disorders from underlying medical conditions such as hypothyroidism and allow for complete management based on needs. The structured interviews for the psychiatric evaluation would be necessary for the establishment and refining of the diagnosis of bipolar disorder since she reported manic episodes characterized by symptoms of impulsivity and depressive episodes characterized by suicidal ideation. These tests will arrive at a proper diagnosis and adequately plan for treatment, stressing that it is necessary to couple medical and psychiatric assessments in the management of complex mood disorders.

Assessment:

Mental Status Examination: PP is well-groomed and appropriately dressed. She sits calmly, with steady eye contact throughout the interview. Her motor behaviour does not show any abnormalities. During the interview, she was cooperative and engaged. She expresses an entire spectrum of feelings—from sadness while describing recent depressive episodes to optimism when talking about more stable periods in her life. Her affect is generally congruent to her mood, appropriately variable, tearful while describing distressing events, and brightening when describing her supportive relationships and future goals. PP’s speech is fluent and coherent, with no evidence of pressured speech or tangentiality. The rate, volume, and rhythm were within normal limits. She is logical and goal-directed in thought processes, reflecting deeply on the triggers and patterns of mood episodes; there is no evidence of delusions or disorganized thinking. The content of thought is well-focused, principally preoccupied with concerns about future mood swings and their consequences in her private and professional life.

She denies suicidal or homicidal ideation and paranoid thoughts or perceptual disturbances such as hallucinations or illusions. Cognitive functions seem grossly intact;. She appears to be aware of the moment, the place, and the individuals. There is excellent devote and focus, and recollection is unharmed. She has good insight regarding her illness, realizing how it had been impairing her functioning and expressing willingness to comply with treatment recommendations. The assessment indicates that there are no safety concerns regarding self-harm or harm to others at this moment, as Petunia denies any current suicidal intent or risk. Assessing, Diagnosing, and Treating Adults with Mood Disorders

Diagnostic Impression: Bipolar II Disorder, Hypomanic Episode

PP came with a joyful mood, increased energy, pressure of speech, grandiosity, and decreased need for sleep—some hallmarks of a hypomanic episode. The diagnosis that best fits these symptoms is Bipolar II Disorder because hypomania is less severe than full-blown mania but significantly impacts functioning (McIntyre et al., 2020). A lack of current psychotic symptoms, such as hallucinations or delusions in conjunction with a history of prior depressive episodes, more likely confirms this diagnosis over other mood disorders or psychotic disorders.

Differential Diagnosis

Major Depressive Disorder (MDD): Considered in the differential diagnoses initially given PP’s history of depressive episodes (Abdoli et al., 2022). Still, the current presentation with an elevation of mood, increase in energy, and grandiosity is more suggestive of a hypomanic rather than a depressive episode.

Generalized Anxiety Disorder: Is characterized by too much stress, agitation, nervousness, and difficulty sleeping lasting at least a half-year. The above signs might cause anguish and negatively impact interpersonal and vocational performance. The person in question experiences significant difficulties with sleep, including trouble sleeping and excessive sleepiness.

Substance-Induced Mood Disorder: Ruled out due to insufficient evidence of recent substance use that could explain the current symptoms.

Schizoaffective Disorder: Although grandiosity and forced speech are also hallmarks of bipolar disorder and schizoaffective disorder, no psychotic symptom was elicited upon assessment for PP; therefore, the probability of schizoaffective disease is considerably reduced (Dennison et al., 2021).

Reflections:

The PP case has, in some measure, enlightened the understanding of the complexities involved in diagnosing and treating Bipolar II Disorder. The differentials at the beginning, when she had been feeling low and could not concentrate, were multiple major depressive illnesses or adjustment disorders. This diagnosis of bipolar II disorder, however, was made in the light of a clear clinical history provided by PP with hypomanic episodes marked with high energy and goal-directed conduct. This, therefore, emphasizes the critical role of good assessment in arriving at a correct diagnosis by carefully evoking variations in mood and functional impairment during many phases of this illness.

Cultural sensitivity in healthcare was a core ethical responsibility above informed consent and confidentiality protections. Confidentiality words have to be defined because this is  professionals’ ethical and legal obligations. The individual in question deserves to be aware of her medical plan alternatives before making a selection. Maintaining the patient’s autonomy is critical in the treatment bond involving physician and patient. It is important that the patient completely knows all possible therapies to choose from the potential hazards and benefits of each therapy choice, and the sort of surveillance that might be required for certain therapeutic alternatives. Establishing trust and respect for PP’s ethnic background and beliefs significantly improved communication and the working relationship (Stubbe, 2020). Two of the more pertinent barriers to PP’s treatment plan include minimizing the stigma associated with mental illness within her culture and educating her about Bipolar II Disorder. Furthermore, the identified social determinants of health—socioeconomic class and access to healthcare services—implored the necessity of care planning. Health promotion strategies include lifestyle modifications and stress management techniques that would help improve the overall well-being of PP and prevent relapses.

Case Formulation and Treatment Plan:

For this reason, my plan for PP’s psychotherapy is the integration of cognitive behavioural therapy as a primary modality. CBT can be beneficial in the management of Bipolar II Condition by attending to maladaptive thoughts and behaviors that are associated with mood swings and how one can identify and alter them (Özdel et al., 2021). Sessions will address psychoeducation about the nature of bipolar disorder, identifying triggers for mood episodes, and developing coping strategies on stress management techniques and regulating emotions. Moreover, we will target the stabilization of daily routines and sleep patterns through interpersonal and social rhythm therapy IPSRT, which is one of the essential strategies in the prevention of mood swings.

For pharmacologic treatment, it would be proper to initiate lamotrigine (Lamictal), whose efficacy in mood stabilization and prevention of depressive episodes in Bipolar II Disorder has been well established (Haenen et al., 2024). The low starting dose and gradual titration according to response and tolerability will be very important for this medication. Liver function tests and tracking dermatologic reactions will give guidelines for dosing adjustment and safety monitoring. These will be supplemented with non-pharmacologic approaches, including regular exercise, sleep hygiene, and mindfulness-based practices, to support well-being and resilience while the patient is under medication management. Assessing, Diagnosing, and Treating Adults with Mood Disorders

An alternative therapy to consider is light therapy, particularly during the winter months when PP may experience seasonal affective disorder (SAD). Light therapy can help regulate circadian rhythms and improve mood by simulating natural sunlight exposure (Gitlin & Malhi, 2020). It will be crucial to first set up follow-up parameters on a weekly basis to track drug compliance, symptom reaction, and any negative effects. By the time PP is stabilized, these follow-up intervals can be extended to monthly visits to assess the effectiveness of treatment, make any further therapy adjustments, and provide support for psychoeducational components.

An appropriate health promotion activity for PP would be initiating regular exercise programming based on activities she enjoys or can do. Aerobic exercise enhances physical well-being in general but also improves mood due to increased endorphins and reduced stress hormones. Assistance with joining community-based exercise opportunities will help ensure socialization and support beyond the clinical environment.

I will provide information and resources on Bipolar II Disorder, its symptoms, and treatment options, as well as how one might manage the disorder. Stressing the value of taking prescriptions as prescribed, seeing early indicators of mood disorders, and applying buffering mechanisms during stressful times can help empower PP in her treatment journey. Moreover, the role of social support networks and ways to effectively communicate with loved ones about her condition will be discussed to decrease stigma and increase overall well-being.

References

Abdoli, N., Salari, N., Darvishi, N., Jafarpour, S., Solaymani, M., Mohammadi, M., & Shohaimi, S. (2022). The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, pp. 132, 1067–1073.

Dennison, C. A., Legge, S. E., Hubbard, L., Lynham, A. J., Zammit, S., Holmans, P., … & Walters, J. T. (2021). Risk factors, clinical features, and polygenic risk scores in schizophrenia and schizoaffective disorder depressive-type. Schizophrenia Bulletin, 47(5), 1375–1384.

Gitlin, M., & Malhi, G. S. (2020). The existential crisis of bipolar II disorder. International Journal of Bipolar Disorders, 8(1), 5.

Haenen, N., Kamperman, A. M., Prodan, A., Nolen, W. A., Boks, M. P., & Wesseloo, R. (2024). The efficacy of lamotrigine in bipolar disorder: A systematic review and meta‐analysis. Bipolar Disorders.

McIntyre, R. S., Berk, M., Brietzke, E., Goldstein, B. I., López-Jaramillo, C., Kessing, L. V., … & Mansur, R. B. (2020). Bipolar disorders. The Lancet, 396(10265), 1841-1856.

Özdel, K., Ayşegül, K. A. R. T., & Türkçapar, M. H. (2021). Cognitive behavioral therapy in treatment of bipolar disorder. Archives of Neuropsychiatry, 58(Suppl 1), S66.

Stubbe, D. E. (2020). They practice cultural competence and humility when caring for diverse patients. Focus, 18(1), 49-51.

NRNP-6665 Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders

NRNP-6665 Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders

Subjective

CC: “I have been referred to the office for a mental health checkup. I have a history of discontinuing medication”

HPI: P. P. is a 25yo Caucasian female. She reports visiting the office for a mental health assessment. P. P. reports a history of discontinuing medication, stating that she feels like the drug squashes her personality. The patient reports being hospitalized for mental health four times. Was previously diagnosed with anxiety, depression, and bipolar disorder. She is not currently using medications to manage her mental health symptoms. P. P, reports a history of auditory hallucinations and suicidal ideas. She further reports losing interest in various activities, adding that others believe she is depressed. At times, she feels motivated and energized.  She denies taking her medications during these creativity periods and can skill sleeping for five days continuously. P. P. also becomes too talkative during the creative episodes, lasting for about a week.

Substance Current Use: P.P. reports current cigarette smoking. Denies cannabis abuse or alcohol use. Denies use of other illicit substances, including stimulants.

Medical History: P.P. reports polycystic ovaries and hypothyroidism diagnoses.

• Current Medications: Medication for managing hypothyroidism. Oral contraceptive pills for managing her polycystic ovaries.
• Allergies: P. denies a history of known allergies.

• Reproductive Hx: P.P. reports being sexually active. Her L. M. P. was the previous month. P. P. discloses having multiple partners.

ROS:

• GENERAL: P. denies recent weight changes.

HEENT: P. P. denies head deformities, blurred vision, ear pain, nasal discharge, or swallowing difficulties.

• SKIN: P. denies skin bruising.
• CARDIOVASCULAR: P. denies experiencing chest tightness.
• RESPIRATORY: P. denies sputum production.
• GASTROINTESTINAL: P. denies reflux.
• GENITOURINARY: P. denies recent urinary frequency.
• NEUROLOGICAL: P. P. denies ataxia or persistent headaches.
• MUSCULOSKELETAL: P. P. denies muscle stiffness.
• HEMATOLOGIC: P. P. denies an incident of abnormal bleeding.
• LYMPHATICS: P. P. denies painful lymph nodes.
• ENDOCRINOLOGIC: P. P. reports hypothyroidism.

Objective:

Diagnostic results:

Mood Disorder Questionnaire (MDQ): P. P. answered “Yes” in 9 out of 13 questions, confirming bipolar symptoms.

Assessment

Mental Status Examination: P. P. is a 25yo Caucasian female. She appeared appropriate for her age and was well-groomed. P. P. is alert and oriented to time, places, and events. Her affect is bright with an elevated and euthymic mood. She speaks in a pressured speech. P. P. is goal-directed and focused. Suicidal ideations and auditory hallucinations were reported during the psychiatric assessment. She denies visual and auditory hallucinations. NRNP-6665 Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders

Diagnostic Impression

Bipolar I Disorder (BID): This form of bipolar disorder is associated with a complete mania symptoms’ set. Persons with BID experience elevated mood accompanied by at least three other symptoms, such as elevated goal-directed activity, a reduced need for sleep, grandiosity, distractibility, pressured speech, racing thoughts, and reckless behaviors. These symptoms persist for a minimum of one week or need hospitalization (Kowalewski et al. (2021). The patient meets the DSM-5 criteria for BID since she was hospitalized for failure to sleep for five consecutive days. P. P. also reported feeling motivated and energized and being too talkative during creative periods, lasting for about a week. Lastly, P. P. answered “Yes” in 9 questions in the MDQ, making BID the most accurate pertinent diagnosis.

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Bipolar II Disorder (BIID): This mood disorder consists of past or current episodes of major depression. The depressive episodes interspersed with hypomanic periods lasting for a minimum of four days (Hategan et al., 2024). P. P. reported feeling energized during creative periods. Moreover, the patient had depressive episodes. She states that other people claimed she was depressed. She also reported losing interest in activities, making BIID a correct current diagnosis.

Major Depressive Disorder (MDD): This mood disorder is primarily characterized by a depressed mood or losing interest in activities lasting for two weeks or more (Fraile-Martinez et al., 2022). P. P. reports losing interest in getting out of bed and losing her motivation and creativity. However, MDD is ruled out since these symptoms had not been experienced two weeks before the psychiatric assessment.

Reflections

The preceptor’s evaluation and diagnostic impression in this scenario are supported. Patients with depressive symptoms are diagnosed with various mood disorders. Besides, I learned that BID can occur together with BIID. A different practice involves asking for P.P.’s discharge reports to collect a detailed mental health history for appropriate diagnosis and treatment. Ethical consideration is nonmaleficence which protects patients from potential harm (Horstkötter & de Wert, 2020). Thus, the mental health provider should not prescribe the patient that might cause undesired side effects. health promotion involves educating P. P. about barrier methods to reduce the risk of sexually transmitted infections since she reports having multiple intimate partners.

Case Formulation and Treatment Plan:

2. P. should be prescribed Depakote 250mg orally twice daily. Depakote is an effective treatment for mood symptoms in adults with bipolar I disorder (Baldessarini et al., 2019). Another recommendable medication is olanzapine 2.5mg orally daily. These medications are recommended since they would be well-tolerated without undesired side effects. As a result, P. P. would adhere to these medication therapies, stabilizing her mood.

References

Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular Psychiatry, 24(2), 198-217. https://www.nature.com/articles/s41380-018-0044-2

Fraile-Martinez, O., Alvarez-Mon, M. A., Garcia-Montero, C., Pekarek, L., Guijarro, L. G., Lahera, G., … & Ortega, M. A. (2022). Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine. Frontiers in Oncology, 12, 956923. https://doi.org/10.3389/fonc.2022.956923

Hategan, A., Cheng, T., & Saperson, K. (2024). Late-Life Bipolar Disorders. In Geriatric Psychiatry: A Case-Based Textbook (pp. 277-295). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-031-47802-4_11

Horstkötter, D., & de Wert, G. (2020). Ethical considerations (pp. 145-159). Springer International Publishing.

Kowalewski, W., Walczak-Kozłowska, T., Walczak, E., & Bikun, D. (2021). Nursing care in bipolar disorder – case study. Pomeranian Journal of Life Sciences, 67(1). https://doi.org/10.21164/pomjlifesci.772  NRNP-6665 Week 4: Assignment Assessing, Diagnosing, and Treating Adults with Mood Disorders

Case Study: Petunia Park

Case Study: Petunia Park

Subjective:

CC (chief complaint): Mental health assessment

HPI: Petunia Park, is a 25-year-old who presents to the clinic for mental health assessment. The patient reports having four psychiatric hospitalizations, with the most recent being in spring 2020. She reported having episodes of high energy and creativity lasting about a week, followed by depressive periods. She further reported experiencing hypersexual behavior during “high” periods. Other symptoms that the patient reported included low mood, lack of motivation, fatigue, and reduced interest. She reported to having a history of taking and stopping medications since they made her feel like they squashed her creativity.

Substance Current Use: She reported smoking nicotine; 1 pack per day, taking alcohol in later teens and used marijuana once, which made paranoid. She denied taking cocaine, stimulants, inhalants, sedatives, or other illicit drugs.

Medical History:

• Hypothyroidism
• Polycystic ovary syndrome

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• Current Medications: Thyroid medication and birth control pills for the PCOS.
• Allergies: No known allergies
• Case Study: Petunia Park

• Reproductive Hx: Experiences regular menses. Denies being pregnant. Acknowledged engaging in frequent sexual encounters with multiple partners.

ROS:

• GENERAL: Patient admitted to experiencing periods of low energy and being fatigued.
• HEENT: Denies headache, blurred vision, running noses, or sore throat.
• SKIN: Denie having any skins rashes.
• CARDIOVASCULAR: Denies having heart palpitations
• RESPIRATORY: Denies experiencing shortness of breath or coughing.
• GASTROINTESTINAL: Admitted that her appetite fluctuated with mood, having poor appetite during “creative” episodes and tendency to overeat during ‘crash” periods
• GENITOURINARY: Admitted having regular menses. Denied experiencing painful sensation or pain when urinating. Denies any significant changes in urination frequency.
• NEUROLOGICAL: Has a history of auditory hallucinations during sleep deprivation.
• MUSCULOSKELETAL: Denied experiencing muscle or joint pain.
• HEMATOLOGIC: Denied having uncontrolled bleeding
• LYMPHATICS: She denied having swollen lymph nodes
• ENDOCRINOLOGIC: reports having hypothyroidism

Objective:

Vitals

Temp 98.2  Pulse  90 Respiration 18  B/P  138/88

Physical Findings

Alert and oriented

Appeared disheveled

Mood labile, fluctuating between elevated and depressed

Speech pressured at times

Tangential thoughts

Diagnostic results:

Urine drug and alcohol screen negative.

CBC within normal ranges

CMP within normal ranges.

Lipid panel within normal ranges.

Prolactin Level 8; TSH 6.3 (H)

Assessment:

Mental Status Examination:

The patient is a 25-year-old female patient whose physical appearance fits her stated age. She appears neatly groomed and appropriately dressed. The patient is alert and well-oriented to time, place, and person. Her mood is labile and shifts between depressed and elevated. Her thought process indicates that she was having racing thoughts in her episodes of high energy and with pressured speech. She has no delusions or obsessions. She is noted to having a history of suicidal ideation but have not had it in the recent past. It can be noted that she has fair judgement and intact cognition.

Diagnostic Impression:

1. Bipolar I Disorder, most recent episode manic; According to Mousavi et al. (2021) bipolar I disorder is “a chronic and recurrent psychiatric disorder in which a person has a manic episode for 1 week, which may present before or after hypomanic or major depressive episodes” (p.1). The patient presented with symptoms including manic and hypomanic episodes, chronic stress, and heightened risk of sudden mood swings.

1. Major Depressive Disorder with psychotic features: This is a mental disorder where an individual has depression together with loss of touch of reality (psychosis) (Wang et al., 2021). The patient suffers from a both low mood and psychosis. In this case, the patient presented with hypomanic episodes evident, which is not a feature of MDD, and thus informed the decision to rule it out.

1. Schizoaffective Disorder, bipolar type: Diagnosis of schizoaffective disorder, bipolar type, requires one to have a minimum of two of these symptoms in a month, and with one of the symptoms being from the first three, “delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms” (Paul et al., 2021). In this case, the patient did not satisfy these conditions and hence it was ruled out. Case Study: Petunia Park

Reflections:

The provided an opportunity of carrying out a comprehensive psychiatric evaluating involving gather detailed history of patient’s symptoms. Patient’s history of mood swings, periods of high energy and creativity, followed by depressive episodes, is consistent with Bipolar I Disorder. It is important to ensure provision of a comprehensive treatment that addresses the indicated symptoms

Case Formulation and Treatment Plan:

Non-pharmacotherapy

Cognitive behavioral therapy: CBT will be used to treat the negative thought pattern, enhance coping approaches, and promote adherence to the treatment plan.

Pharmacotherapy

Imitating mood stabilizers: Lithium; dose 300mg 1-2 times daily and antipsychotics: Aripiprazole: Dose 10 mg daily

Psychoeducation;

The patient will be educated on the importance of adhering to the medications provided as well as the impact of nicotine of mental health.

Health promotion activities;

The patient will be advised on the importance of proper nutrition, regular sleep pattern, and need of addressing stress triggers.

Follow-up and Monitoring

The patient was scheduled for a follow-up appointment after four weeks to monitor treatment response, possible side effects, and adherence to the regimens.

References

Mousavi, N., Norozpour, M., Taherifar, Z., Naserbakht, M., & Shabani, A. (2021). Bipolar I disorder: a qualitative study of the viewpoints of the family members of patients on the nature of the disorder and pharmacological treatment non-adherence. BMC psychiatry, 21, 1-11. https://doi.org/10.1186/s12888-020-03008-x

Paul, T., Javed, S., Karam, A., Loh, H., & Ferrer, G. F. (2021). A misdiagnosed case of schizoaffective disorder with bipolar manifestations. Cureus, 13(7). https://doi.org/10.7759/cureus.16686

Wang, M. Q., Wang, R. R., Hao, Y., Xiong, W. F., Han, L., Qiao, D. D., & He, J. (2021). Clinical characteristics and sociodemographic features of psychotic major depression. Annals of General Psychiatry, 20, 1-8. https://doi.org/10.1186/s12991-021-00341-7 Case Study: Petunia Park

Petunia Park Focused SOAP Note template

Petunia Park Focused SOAP Note template – Assessing, Diagnosing, and Treating Adults with Mood Disorders

Subjective

CC (chief complaint): “I have a history of taking medications and then stopping them. I do not think I need them. I feel like the medication squashes who I am.”

HPI: Petunia Park, 28, is a Caucasian bipolar disorder medication follow-up patient. Sleep deprivation led to her being caught outside inadequately dressed and disoriented three months ago, which got her hospitalized. Her pharmaceutical nonadherence is due to the belief that they “squash her creativity.” She experiences weekly bouts of depression that leave her exhausted, unmotivated, unable to get out of bed, overeating, and losing her creativity and self-esteem. This frequently occurs after one week of “high, high, high” mood, rushed speech, rushing thoughts, and impulsivity. When she has “lots of energy to do many things,” she sleeps 2-3 hours per night and feels rested (American Psychiatric Association, 2022). She obsesses about writing her autobiography, drawing, and producing music, believing she is talented enough to become renowned. Hypersexual, she seeks new partners due to increased libido. She denies suicidal/homicidal ideation but cites a 2017 overdose suicide attempt. She denies any manic or hypomanic episodes in the past three months while using lurasidone but says it made her feel different (Boland et al., 2022).

Substance Current Use

• Nicotine: 1 pp. Not interested in quitting
• Alcohol: None since age 19, when she realized it worsened her symptoms
• Illicit drugs: Denies current use; tried cannabis once but became paranoid; denies any other lifetime use

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Past Psychiatric History

• Bipolar I disorder with prior episodes of mania and psychosis, diagnosed in late adolescence.
• Generalized anxiety disorder
• ADHD
• Multiple prior hospitalizations for mania with psychosis and one for suicidal gesture (overdose) in 2017
• No history of suicide attempts or self-injurious behavior outside of overdose
• No history of substance use treatment
• Petunia Park Focused SOAP Note template

Family Psychiatric History

• Mother with bipolar I disorder
• Father with substance use disorder, currently incarcerated
• Brother with likely schizophrenia but undiagnosed

Medical History

• Hypothyroidism
• Polycystic ovary syndrome

Current Medications

• Levothyroxine 100mcg PO daily
• Oral contraceptive pill (OCP)
• Lurasidone 40mg PO BID (recently self-discontinued)

Allergies: NKDA

Reproductive Hx:

• LMP last month
• Sexually active with inconsistent condom use
• Denies current STI symptoms or history of STIs
• No history of pregnancy or abortion

ROS:

GENERAL: No weight loss, fever, chills, weakness or fatigue. Appetite increased with depression and decreased with mania.

HEENT: Denies visual changes, hearing loss, rhinorrhea, and sore throat.

SKIN: No rash or pruritis.

CARDIOVASCULAR: No chest pain, palpitations or edema.

RESPIRATORY: Denies cough, dyspnea, wheezing.

GASTROINTESTINAL: No nausea, vomiting, diarrhea, constipation, abdominal pain. Appetite increases significantly during depressive episodes, leading to weight gain.

GENITOURINARY: Denies dysuria, hematuria, and discharge. Reports increased libido during manic episodes leading to risky sexual encounters.

NEUROLOGICAL: No syncope, seizures, or focal neurological deficits. Denies current AH/VH. Prior episodes of grandiose auditory hallucinations when manic and sleep deprived, telling her she is “great and wonderfully talented.”

MUSCULOSKELETAL: Denies arthralgias, myalgias, joint swelling.

HEMATOLOGIC: Denies anemia, easy bruising, and bleeding. Has no known history of clotting disorders.

LYMPHATICS: No adenopathy.

ENDOCRINOLOGIC: Reports 5-10lb weight gain when depressed. Denies polyuria, polydipsia, and heat/cold intolerance.

Objective

VS: Sitting BP 138/88  | Pulse 90 | Temp 98.2 °F (36.8 °C) | Resp 18 | Wt. 160 lbs | BMI 27.1 | SpO2 100% RA

Labs: CBC, CMP WNL; TSH 6.3 mIU/L (H); Urine hCG negative; Urine drug screen negative

Physical Exam

• General: Well-developed, well-nourished female dressed appropriately with good hygiene. No acute distress.
• HEENT: Normocephalic/atraumatic, EOMI, PERRLA, notable mydriasis. Moist mucous membranes. No pharyngeal erythema or tonsillar exudates.
• Neck: No JVD, lymphadenopathy, or thyromegaly.
• Cardiovascular: Tachycardic rate, regular rhythm, no murmurs/rubs/gallops. Pulmonary: CTAB. No accessory muscle use.
• Abdomen: Normoactive BS, soft, nontender, nondistended. No palpable hepatosplenomegaly.
• GU: Deferred. Rectal: Deferred. MSK: No clubbing, cyanosis, or edema. Full ROM. 5/5 strength in upper and lower extremities.
• Neuro: AOx3, no asterixis. Gait with a standard base.

Mental Status Examination

28-year-old cooperative, eye-contact-making woman. She is friendly and willing to talk about her art. Frequently gesticulating increases psychomotor activity. Speech is rushed but clear. Fluent, medium loudness, and prosody. The mood is “pretty good, a lot better than last week.” Bright, expansive affect, but impatient when probed about family history. The mental process is straight and goal-oriented with some circumstantiality. No conceptual drift or vague linkages. Grandiose fantasies about creative ability and renown. Denies auditory or visual hallucinations but says they can occur when manic and sleepless—denial of paranoia. Refuses suicide or homicidal thoughts; one low-lethality attempt with no present plan. Knowledge, attention, and abstraction-based cognition are intact. However, the severity of the condition and the need for treatment seem unclear. Hypersexuality lowered impulse control (Boland et al., 2022).

Differential diagnoses

• Bipolar I disorder, severe manic episode with psychotic characteristics.
• Substance/medication-induced bipolar and related disorder, with onset during withdrawal
• Bipolar II disorder
• Cyclothymic disorder
• Borderline personality disorder

Bipolar I disorder fits the patient’s symptoms. She has alternating manic and depressed episodes lasting about a week. Her severe manic symptoms include decreased sleep, goal-directed activity, pressurized speech, idea flight, distractibility, grandiose delusions, and psychosis (American Psychiatric Association, 2022). These crises severely impair social and occupational performance. Manic episodes exclude bipolar II and cyclothymia, which constitute hypomania rather than mania (Yatham et al., 2018). Borderline personality disorder can cause emotional lability, impulsivity, and unstable relationships, but its symptoms are episodic and psychotic (Boland et al., 2022). Despite her negative urine drug test, quick lurasidone termination could cause withdrawal mania. Before lurasidone, she had many manic episodes, supporting the diagnosis of bipolar I disorder (American Psychiatric Association, 2022). Petunia Park Focused SOAP Note template

Reflections

This patient shows how difficult bipolar I disorder management is, especially for a patient with poor insight. Her hypersexuality and impulsivity put her in danger of unexpected pregnancy and STIs. Therefore, she needs safe sex practices and dependable contraception. Harmonizing her autonomy with the need to protect herself and others is ethical. If her manic symptoms develop, she may need involuntary hospitalization for stabilization (Goodwin et al., 2016). With consent, her family and support system could share collateral information and encourage drug adherence. Her brother’s untreated symptoms are likewise troubling and need evaluation.

Sociocultural, her creative endeavors define her; therefore, it is important to validate them while informing her about untreated mania. Exploring her medication attitudes and resolving adherence hurdles such as cognitive dulling anxiety may avoid relapses (Geddes & Miklowitz, 2013). Her mother’s bipolar condition may offer psychoeducation and therapy models. Avoiding medical depression requires monitoring and treating her hypothyroidism.

Case Formulation and Treatment Plan

Bipolar I condition causes manic and depressed episodes with remission. However, this patient cycles faster and has more mood episodes (Boland et al., 2022). Her late adolescent onset is usual, and her family history of bipolar disorder and other psychiatric diseases suggests hereditary loading. She may be grandiose when manic, but her creativity gives her purpose and self-esteem. Though she may have been euthymic on lurasidone before, its abrupt cessation certainly caused her manic episode.

Stabilizing mood and preventing relapse are treatment goals. Lithium is the first-line treatment for bipolar I illness and reduces suicidal behavior (Yatham et al., 2018). Given her impulsivity and questionable adherence, a long-acting injectable (LAI) antipsychotic may be better for quick stabilization. Risperidone LAI prevents manic relapse and maintains therapeutic levels even if she misses an injection (Fountoulakis et al., 2016). Start with 25mg IM q2 weeks and titrate as needed. Monthly doses of aripiprazole monohydrate are another option. If LAI monotherapy fails, lithium may be added (Goodwin et al., 2016).

When euthymic, psychotherapy is needed. Cognitive-behavioral and interpersonal therapy can challenge medication misperceptions, increase coping skills, regulate sleep/activity, and strengthen therapeutic alliances (Geddes & Miklowitz, 2013). If her support system participates, family-focused therapy may lower relapse risk. Psychoeducation on bipolar disease can help patients understand their illness, recognize relapse signs, and create a crisis plan. To track symptoms and overcome adherence hurdles, frequent follow-up is necessary.

Optimizing her thyroid function is medically necessary to prevent depression. If these drugs are started, lithium and valproate levels must be checked (Yatham et al., 2018). Given her sexual behaviors, mood stabilizer teratogenicity education and dependable contraception are essential. STI screening and safer sex counseling should be routine. Finally, fostering healthy habits like exercise, stress management, and drug abstinence can boost resilience and wellness. Evidence-based medication plus a thorough psychosocial approach may improve symptoms and functioning. Bipolar I disorder is chronic and recurring. Therefore, constant care and vigilance are necessary to preserve stability and quality of life.

References

American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787.x03_Bipolar_and_Related_Disorders

Boland, R. Verdiun, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Fountoulakis, K. N., Yatham, L., Grunze, H., Vieta, E., Young, A., Blier, P., Moeller, H. J., & Kasper, S. (2016). The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BD-2017), part 2: Review, grading of the evidence, and a precise algorithm. International Journal of Neuropsychopharmacology, 20(2), 121-179. https://doi.org/10.1093/ijnp/pyw100 Petunia Park Focused SOAP Note template

Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682. https://doi.org/10.1016/s0140-6736(13)60857-0

Goodwin, G. M., Haddad, P. M., Ferrier, I. N., Aronson, J. K., Barnes, T. R. H., Cipriani, A., Coghill, D. R., Fazel, S., Geddes, J. R., Grunze, H., Holmes, E. A., Howes, O., Hudson, S., Hunt, N., Jones, I., Macmillan, I. C., McAllister-Williams, H., Miklowitz, D. M., Morriss, R., Munafò, M., … Young, A. H. (2016). Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 30(6), 495–553. https://doi.org/10.1177/0269881116636545

Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., Sharma, V., Goldstein, B. I., Rej, S., Beaulieu, S., Alda, M., MacQueen, G., Milev, R. V., Ravindran, A., O’Donovan, C., McIntosh, D., Lam, R. W., Vazquez, G., Kapczinski, F., McIntyre, R. S., … Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97–170. https://doi.org/10.1111/bdi.12609

NRNP-6665 Week 4: Assignment

NRNP-6665 Week 4: Assignment – ASSESSING, DIAGNOSING, AND TREATING ADULTS WITH MOOD DISORDERS

It is important for the PMHNP to have a comprehensive understanding of mood disorders in order to assess and accurately formulate a diagnosis and treatment plan for patients presenting with these disorders. Mood disorders may be diagnosed when a patient’s emotional state meets the diagnostic criteria for severity, functional impact, and length of time. Those with a mood disorder may find that their emotions interfere with work, relationships, or other parts of their lives that impact daily functioning. Mood disorders may also lead to substance abuse or suicidal thoughts or behaviors, and although they are not likely to go away on their own, they can be managed with an effective treatment plan and understanding of how to manage symptoms.

In this Assignment you will assess, diagnose, and devise a treatment plan for a patient in a case study who is presenting with a mood disorder.

RESOURCES

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

NRNP-6665 Week 4: Assignment WEEKLY RESOURCES

TO PREPARE

• Review this week’s Learning Resources. Consider the insights they provide about assessing, diagnosing, and treating mood disorders.
• Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
• Review the video, Case Study: Petunia Park. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.
• Consider patient diagnostics missing from the video:Provider Review outside of interview:

  Temp 98.2  Pulse  90 Respiration 18  B/P  138/88

  Laboratory Data Available: Urine drug and alcohol screen negative.  CBC within normal ranges, CMP within normal ranges. Lipid panel within normal ranges. Prolactin Level 8; TSH 6.3 (H)

THE ASSIGNMENT

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomatology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?
• Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
• Reflection notes: Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion, and disease prevention that takes into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

BY DAY 7 OF WEEK 4

Submit your Focused SOAP Note.

SUBMISSION INFORMATION

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1. To submit your completed NRNP-6665 Week 4: Assignment, save your Assignment as WK1Assgn+last name+first initial.
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Assessing, Diagnosing, and Treating Adults with Mood Disorders: Petunia Park

Subjective:

CC (chief complaint): The patient complains of noncompliance with prescriptions, getting frequent agitation, and having alternating mood swings of “being joyful and being depressed.”

HPI: The patient is a 25-year-old female with a previous history of mental illness. The onset of her current symptoms was about seven days ago. She describes her symptoms as being “squashed” some of the time and believes that it is her hard work ethic that is making her mentally unstable. Symptoms are intermittent in duration but can last for up to seven consecutive days. Symptom characteristics include being severe, unrelenting, and recalcitrant. They are aggravated by being wakeful and somewhat relieved by sleep and medications. The timing of her symptoms is anytime day or night. She rates their severity at 6/10.

Substance Current Use: She is a tobacco smoker and consumes a pack a day. She denies use of any other drugs or substances.

Medical History: She suffers from polycystic ovarian syndrome or PCOS as well as hypothyroidism.

• Current Medications:

• Levothyroxine 100 mcg by mouth every day (for hypothyroidism).

• Allergies: NKDA.
• Reproductive Hx: She describes herself as a heterosexual female currently in a relationship. She has n children and her LMP was 05/29/2024.

Review of Systems or ROS:

• GENERAL: Denies fever, chills, fatigue, weight loss, or malaise.
• HEENT: Negative for headaches, light sensitivity, ear discharge, ear pain, rhinorrhea, sore throat or difficulty swallowing.
• SKIN: Negative for itching, eczema, or rashes.
• CARDIOVASCULAR: Denies chest pain, palpitations, or peripheral edema.
• RESPIRATORY: Denies coughing, dyspnea, wheezing, or producing sputum.
• GASTROINTESTINAL: Denies N/V/D as well as changes in bowel movements.
• GENITOURINARY: Negative for dysuria, cloudy urine, or abnormal vaginal discharge.
• NEUROLOGICAL: Denies dizziness, syncope, ataxia, paresis, paralysis, pins and needles, or loss of bowel and/ or bladder control. NRNP-6665 Week 4: Assignment
• MUSCULOSKELETAL: Denies muscle pain, back pain, or joint pain.
• HEMATOLOGIC: Negative for a history of blood and/or clotting disorders.
• LYMPHATICS: Denies lymphadenopathy or having had a splenectomy before.
• ENDOCRINOLOGIC: Negative for excessive thirst, excessive drinking of water, excessive eating, excessive sweating, heat/ cold intolerance, or a history of hormonal therapy/ treatment.

Objective:

Vitals: T 98.2; P 90 ; R 18 ; B/P  138/88

Diagnostic Lab Results: Urine drug tests, CMP, and full blood count were unremarkable. TSH was elevated at 6.3 on testing.

Psychometric test: Young Mania Rating Scale or YMRS tool.

Assessment:

Mental Status Examination: The patient is a 25-year-old female who is well-groomed for the occasion, time of the day, and the weather. She has normal appearance and gait with no obvious physical abnormalities. She is concious and aware of the place, time, space, person, and event. She is cooperative and maintains good eye contact throughout. Her speech is clear, coherent, and goal-oriented although pressured in rate. She displays no obvious mannerisms or tics. Her self-reported mood is “happy” and the observed affect is euphoric hence mood-congruent. She denies having suicidal or homicidal thoughts. She also denies getting hallucinations or delusions. Her immediate, short-term, and long-term memory is good. Her abstraction is also good as she can make sense of idioms. Her insight and judgment are somewhat impaired. Impression: Bipolar I disorder (APA, 2022; Boland et al., 2021; Stahl, 2021).

Diagnosis and Differential Diagnoses

1. Bipolar I Disorder: 296.42 (F31.12)

The euphoria and “happiness” described in the MSE means that this patient is in the manic phase of bipolar I disease. In her CC she stated that she usually has alternating depressive feelings and elation. She thus meets the diagnostic criteria for BD I as one requirement is that the patient must have had at least one manic episode (APA, 2022; Boland et al., 2021). According to the DSM-5-TR, the diagnostic criteria also include insomnia, excessive excitement, abnormally high self-esteem, talkativeness, distractibility, and excessive energy amongst others.

1. Major Depressive Disorder (MDD): 296.22 (F32.1)

One of the poles of BD I is depression. This patient can thus be mistakenly diagnosed with MDD when she is on the depression pole (APA, 2022). However, this cannot be true as she has also experienced mania making this BD instead.

1. Attention-Deficit/ Hyperactivity Disorder or ADHD: 314.01 (F90.2)

ADHD is a distant possibility but still plausible since it usually starts in childhood but goes up to adulthood. The irritability, distractibility, insomnia, social isolation (from peers), and inattentiveness amongst others may lead to a wrong diagnosis of ADHD. However, it may also be comorbid with the BD I. NRNP-6665 Week 4: Assignment

Case Formulation and Treatment Plan:

1. Cognitive behavioral treatment (CBT) brief therapy 45/ session x 8 weeks (Corey, 2023).
2. Lithium (Eskalith) 300 mg orally BID (Stahl, 2020).
3. Regular physical activity and a diet rich in fresh fruits and vegetables.

Reflection

I did everything according to the book for the patient (Carlat, 2023). I also observed all ethical principles including autonomy, fidelity, justice, beneficence, and nonmaleficence (Haswell, 2019). Social determinants of health applicable to the client included low educational achievement and poor access to quality mental health care. I tailored health education for her according to these and then gave her a return date for follow up after 4 weeks.

 References

American Psychiatric Association [APA] (2022). Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5^th ed. Author.

Boland, R., Verdiun, M., & Ruiz, P. (Eds) (2021). Kaplan and Sadock’s synopsis of psychiatry, 12^th ed. Wolters Kluwer.

Carlat, D.J. (2023). The psychiatric interview, 5^th ed. Wolters Kluwer.

Corey, G. (2023). Theory and practice of counselling and psychotherapy, 11^th ed. Cengage Learning.

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 5^th ed. Cambridge University Press.

Stahl, S.M. (2020). Stahl’s essential psychopharmacology: Prescriber’s guide, 7^th ed. Cambridge University Press. NRNP-6665 Week 4: Assignment

NRNP-6635 Week 1: Discussion

NRNP-6635 Week 1: Discussion – FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY sample 1

Psychopathology is the study of mental disorders and unusual behavior that can be influenced by many factors, including biology (Genetic and neuroscientific), psychology (thoughts), and social factors (social surroundings). Psychopathology is the discipline that provides psychiatrists with basic knowledge about the abnormal phenomena that affect the human mind and with a valid, reliable method to appraise them (Stranghellini & Broome, 2014).

Biological Factors: Genetic and Neuroscientific Influences.

Genetic Influence: The genetic influence in mental disorders, known as heritability, has been studied mainly in conditions like schizophrenia, bipolar disorder, and major depression. Studies show that people with relatives affected by these disorders are more likely to experience similar mental health challenges. Family studies using modern methodology show substantial familial aggregation for all major psychiatric disorders, including depression, schizophrenia, bipolar disorder, and alcohol dependence, as well as many syndromes, such as panic disorders (Smoller et al., 2019). Also, certain genes and genetic variations can influence mental disorders.

Neuroscientific influence: Neurotransmitters, such as serotonin, dopamine, and glutamate, play a significant role in how we feel and think. When these chemicals are out of balance, it can lead to conditions like depression, schizophrenia, or anxiety. Also, things that happen when we are growing up, or what our mothers were exposed to while pregnant, can influence conditions like autism or ADHD.

Psychological Factors: Behavioral and Cognitive Processes, Emotional, Developmental.

Behavioral and Cognitive Process: This approach suggests that normal and abnormal behaviors are learned or influenced by their environment. Maladaptive behaviors can be learned through operant and classical conditioning. Operant (instrumental) and classical (Pavlovian) conditioning are taught as the simplest forms of associative learning (Colomb & Brembs, 2010). According to the cognitive processes of psychopathology, abnormal behavior results from faulty mental processes or thinking patterns, such as overgeneralization, which can significantly contribute to disorders like depression and anxiety.

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Emotional and Developmental: Emotional processes play a crucial role in mental disorders, particularly in terms of emotion regulation and stress management. For example, someone suffering from depression may struggle with chronic sadness and anhedonia. Developmentally, early childhood experiences such as abuse can lead to the development of mental disorders and sometimes result in an insecure attachment style. Mental disorders can also develop during critical developmental periods or stages, such as adolescence.

Social, Cultural, and Interpersonal Factors
Socioeconomic status and social support can impact the development of mental disorders. An individual’s financial situation and the support they receive from others can impact their mental health. Financial struggles and living in poor conditions can contribute to higher stress levels, resulting in mental disorders. Cultural norms have a significant impact on how people express, understand, and deal with mental illness. Some may feel ashamed, avoid seeking help, or worry that others might judge others. Managing these cultural differences can be very stressful. Furthermore, strong interpersonal relationships are crucial for mental well-being. Supportive friends and family can help reduce stress, whereas social isolation can increase the risk of mental health issues.

In conclusion, mental health problems arise from a combination of biological factors, cognitive patterns, and social interactions. Understanding these components is crucial for developing effective interventions and treatments for mental health conditions.

References

Stanghellini G, Broome MR. Psychopathology is the basic science of psychiatry. British Journal of Psychiatry. 2014;205(3):169-170. doi:10.1192/bjp.bp.113.138974

Colomb, J., & Brembs, B. (2010). The biology of psychology: ‘Simple’ conditioning? Communicative & Integrative Biology, 3(2), 142-145. https://doi.org/10.4161/cib.3.2.10334

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. Molecular Psychiatry, 24(3), 409. https://doi.org/10.1038/s41380-017-0010-4

NRNP-6635 Week 1: Discussion – FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY sample 2

Factors That Influence the Development of Psychopathology

A detailed understanding of the complex interplay of factors that influence the development of mental health disorders is crucial for accurate diagnosis and effective treatment. One such factor is genetics. The existing research indicates that conditions such as schizophrenia, bipolar disorder, and major depressive disorder have significant hereditary components (Haywood et al., 2022). For example, there are higher concordance rates for these disorders among identical twins than fraternal twins, demonstrating a strong genetic link (Haywood et al., 2022). In addition, apart from genetics, another major biological factor that predisposes an individual to psychiatric complications is neuroscience. According to Remes et al. (2021), dysregulation of neurotransmitters, particularly serotonin, dopamine, and norepinephrine, is associated with depression and anxiety. Furthermore, structural anomalies, such as enlarged ventricles seen in some individuals with schizophrenia, and functional irregularities, like reduced prefrontal cortex activity in those with depression, highlight the importance of brain structure and function in psychopathology (Remes et al., 2021).

Aside from biological variables, psychological factors are also highly implicated in mental health issues. In this case, behavioral theories emphasize the role of conditioning and learning in developing maladaptive behaviors (Deckert et al., 2023). For instance, phobias arise through conditioning, where an initially neutral stimulus becomes associated with a fear response due to past experiences (Deckert et al., 2023). Likewise, in relation to cognition, negative automatic thoughts and dysfunctional attitudes contribute significantly to disorders like depression and anxiety (Deckert et al., 2023). It is well-documented that individuals with depression exhibit negative thoughts about themselves, their world, and their future, which perpetuates their symptoms (Deckert et al., 2023). Besides, still in relation to psychological factors, emotional regulation, and early attachment experiences are crucial for mental health. According to Bosmans and Borelli (2022), there is no dispute that secure attachment in early childhood fosters healthy emotional development, while insecure attachment leads to increased vulnerability to mental disorders.

Lastly, sociocultural factors also impact mental health. This is because strong social support networks are known to improve resilience and aid recovery from mental health issues (Remes et al., 2021). Likewise, cultural norms and values shape the expression, perception, and classification of mental disorders. In this case, somatic symptoms of depression are more commonly reported in some cultures compared to others, hence reflecting cultural variations in how psychological distress is manifested (Remes et al., 2021).

References

Bosmans, G., & Borelli, J. (2022). Attachment and the Development of Psychopathology: Introduction to the Special Issue. Brain Sci, 12(2). https://doi.org/ 10.3390/brainsci12020174Links to an external site.

Deckert, J., Eichner, F. A., Kohls, M., Störk, S., Heuschmann, P. U., Hein, G., Gelbrich, G., Weißbrich, B., Dölken, L., Kurzai, O., Ertl, G., Barth, M., & Morbach, C. (2023). Differential network interactions between psychosocial factors, mental health, and health-related quality of life in women and men. Psychiatric Reports, 13(1). https://doi.org/10.1038/s41598-023-38525-8Links to an external site.

Haywood, D., Baughman, F., Mullan, B., & Heslop, K. (2022). What accounts for the factors of psychopathology? An investigation of the neurocognitive correlates of internalizing, externalizing, and the P-factor. Brain Sci, 12(4). https://doi.org/ 10.3390/brainsci12040421Links to an external site.

Remes, O., Mendes, J. F., & Templeton, P. (2021). Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature. Brain Sci, 11(12). https://doi.org/ 10.3390/brainsci11121633Links to an external site.

NRNP-6635 Week 1: Discussion – FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY sample 3

Week 1 initial Discussion  post

Factors Influencing the Development of Psychopathology

The emergence of psychopathology, which involves the presentation of mental disorders, is a multifaceted process impacted by biological, psychological, and social factors. Each of these components plays a crucial function in influencing an individual’s mental well-being.

Psychopathology refers to the field of research that focuses on mental diseases and maladaptive behaviors. It is commonly known as unusual psychology. According to Butcher and Kendall (2018), it is imperative for mental health professionals in the fields of psychiatry, psychology, and social work to possess a comprehensive understanding of the etiology of mental disorders. According to Butcher and Kendall (2018), child and teenage psychopathology is more intricate and potentially more adaptable than adult psychopathology. Psychopathology is composed of various elements including physical, physiological, genetic, and neurological components such as neurotransmitters, neurophysiology, and neuroanatomy (Butcher & Kendall, 2020).

Biological psychologists focus on the psychological factors that influence the behavior of both humans and animals. MacDuffie and Truman (2019) seek to understand the influence of various cognitive processes, such as genetics and neurochemical composition, on human behavior. Psychologists can deepen their understanding of the development of psychopathology by studying the brain and physiological mechanisms that influence cognitive, behavioral, and emotional processes. An analysis of the biological factors that influence psychopathology is highly significant as it provides valuable insights for developing and implementing ways to avoid and intervene in psychopathological illnesses.

Psychological variables refer to the long-lasting mental, emotional, and behavioral processes that occur across a person’s lifetime. This process involves changes in three areas: behavior, cognition, and social-emotional functioning (Sadoc et al., 2018). Personality traits are typically understood as essential qualities that cover an individual’s behavioral patterns, emotional reactions to social encounters, and the act of self-reflection and evaluation throughout their life. However, individuals may occasionally display joy, tears, anger, introspection, or vicious behavior. It is important to emphasize that the variability of an individual’s “personality” is not the main focus. Instead, the key feature is the overall balance of their cognition, affect, and behavior, rather than their immediate reactions to specific situations. Sigmund Freud emphasized the importance of the early parent-child bond in the development of mental illness (Sadoc et al., 2018).

Individuals from lower socioeconomic levels exhibit a greater incidence of mental illness compared to those from higher socioeconomic groups. Social cultural aspects refer to a variety of beliefs, attitudes, and conceptions that have an impact on the development and maturity of an individual. Ethnicity is a fundamental aspect of cultural identity and should be distinguished from the notion of race. Ethnicity is the state of belonging to a group that is defined by common cultural, traditional, and familial connections. The term “race” refers to a group of people who have common physical characteristics, as well as cultural and historical histories (MacDuffie & Strauman, 2019). The absence of understanding concerning a patient’s racial and ethnic differences leads to inconsistencies in the procedures of evaluating, diagnosing, and treating. The fundamental elements of their composition mostly comprise habits, morals, and actions. Cheung and Mak (2017) contend that social cultural factors play a crucial role in shaping an individual’s level of community involvement and level of maturity. There exists a robust link between emotional and behavioral disorders and environmental factors. While mental illnesses may share many similarities, the study of abnormal psychology is primarily shaped by social interpretations and cultural beliefs. The presentation, expression, categorization, and treatment of illnesses display differences based on cultural circumstances (Cheung & Mak, 2017).

References

Butcher, J. N., & Kendall, P. C. (2020). 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/10.1037/0000065-001.

Cheung, F. M., & Mak, W. W. S. (2016). 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/10.1037/0000064-006.Links to an external site.

Jackson, C. E., & Milberg, W. P. (2017). 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

MacDuffie, K. E., & Strauman, T. J. (2019). Understanding Our Own Biology: The Relevance of Auto‐Biological Attributions for Mental Health. Clinical Psychology: Science and Practice, 24(1), 50–68.

Mechanic, D., & McAlpine, D. D. (2012). The Influence of Social Factors on Mental Health. Principles and Practice of Geriatric Psychiatry, 95-98. https://doi.org/10.1002/0470846410.ch17

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2018). Kaplan & Sadock’s synopsis of psychiatry (11thed.). Wolters Kluwer.

FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY – NRNP-6635 Week 1: Discussion Essay

FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY – NRNP-6635 Week 1: Discussion Essay Sample 1

   Main Discussion Post

Psychopathology, which helps clinicians explore mental health disorders and progress, is influenced by several factors, such as biological, psychological, social, and interpersonal factors. The theoretical perspective on psychopathology that a Psychiatric Mental Health Nurse Practitioner (PMHNP) adopts significantly influences their approach to diagnosis, treatment, and patient interaction (Schultze-Lutter et al., 2018).

Biological Factors that Affect the Development of Psychopathology

Biological factors such as genetic predisposition and neuroscientific affect psychopathology because genetic predisposition plays a role in how many mental health disorders are developed. There is various research to support that genetics plays a role in conditions such as schizophrenia and other mental disorders due to the significant heritable components (Wilson & Rhee, 2022). Genome-wide association studies (GWAS) have identified multiple genetic variants associated with psychiatric conditions such as ADHD, depression, and schizophrenia, meaning that genetic variations contribute to the risk of many mental health disorders (Waszczuk, 2022). Understanding these genetic influences helps psychiatric providers consider family history and genetic counseling in their practice. Research on neurobiology has provided insights into identifying structures of the brain associated with mental disorders, including depression and anxiety. For example, a reduction in the structural connectivity between the prefrontal cortex and amygdala has been linked with depression and anxiety. Neural patterns have also been used to predict future symptoms of depression and anxiety (Craske et al., 2023).

 Psychological Factors that Affect the Development of Psychopathology

Several behavioral and cognitive theories explain how maladaptive behaviors can be learned and maintained and how thought patterns affect mental health, thus both affecting psychopathologies. Exposure to stressful or traumatic events can condition individuals to develop anxiety disorders. Studies during the COVID-19 period have shown the adverse effects of loneliness on physical and mental health that could affect psychopathology (Admon & Klavir, 2021). Cognitive theories focus on how thought patterns influence emotions and behaviors. Negative cognitive biases and distorted thinking patterns have been linked to depression and anxiety (Admon & Klavir, 2021).

An individual’s emotional regulation and developmental experiences significantly influence mental health and affect psychopathology. Studies support that adverse childhood experiences (ACEs) such as abuse and neglect are linked to increased rates of substance abuse, anxiety, and depression (Zitzmann et al., 2024).

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Social, Cultural, and Interpersonal Factors

Social determinants of health, such as unemployment, education, socioeconomic status, and social support, are linked to higher rates of mental disorders throughout their lives. People in lower socioeconomic tiers often experience higher stress levels, limited access to healthcare, and increased exposure to violence, all of which contribute to the development of psychopathology. Studies support the association of mental health disorders with life circumstances (Kirkbride et al., 2024).

Culture affects psychopathology. Cultural background affects how individuals express, perceive, and cope, whether the individual seeks help or the course of mental illness. Cultural factors can also protect individuals from the development of mental health disorders (Guruje et al., 2020).

Interpersonal factors are also important in mental health and affect psychopathology. Poor quality and abusive relationships can contribute to the onset of mental disorders, while solid support systems can prevent mental health problems (Fleck et al., 2023). For example, the relationship between a parent or caregiver and a child significantly impacts the child’s development. It forms the basis for developing social and cognitive abilities, secure attachment, and physical and mental health. An individual’s interpersonal relationships can protect them from mental health issues or increase their risk of developing psychopathology (Fleck et al., 2023).

Psychiatric mental health nurse practitioners (PMHNP) should keep in perspective the many factors that contribute to psychopathology and adopt them when assessing, diagnosing, treating, and even interacting with patients. The multifaceted nature of psychopathology emphasizes the need for PMHNPs to adopt an integrative approach in their clinical practice.

                                                                                                   References

Admon, R., & Klavir, O. (2021). Cognitive and behavioral patterns across psychiatric conditions. Brain Sciences, 11(12), 1560.                             https://doi.org/10.3390/brainsci11121560

Craske, M.G., Herzalleh, M.M., Nusslock, R., Patel, V. (2023). From neural circuits to communities: An integrative, multidisciplinary roadmap for       global mental health. Nature Mental Health, 1, 12-24. https://doi.org/10.1038/s44220-022-00012-wLinks to an external site.

Fleck, L., Fuchs, A., & Kaess, M. (2023). The Significance of relationships in developmental. Psychopathology and Youth Mental Health.      Psychopathology, 56(1-2), 5–7. https://doi.org/10.1159/000529417Links to an external site.

Gureje, O., Lewis-Fernandez, R., Hall, B. J., & Reed, G. M. (2020). Cultural considerations in the classification of mental disorders: Why and how     in ICD-11. BMC Medicine, 18(1), 25. https://doi.org/10.1186/s12916-020-1493-4

Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. L.     (2024). The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry: Official Journal of     the World Psychiatric Association (WPA), 23(1), 58–90. https://doi.org/10.1002/wps.21160

Waszczuk, M.A. (2021). The utility of hierarchical models of psychopathology in genetics and biomarker research. World Psychiatry, 20: 65-66.      https://doi.org/10.1002/wps.20811Links to an external site.

Wilson, S., & Rhee, S. H. (2022). Special issue editorial: Leveraging genetically informative study designs to understand the development and familial transmission of psychopathology. Development and Psychopathology, 34(5), 1645–1652. https://doi.org/10.1017/S0954579422000955

Schultze-Lutter, F., Schmidt, S. J., & Theodoridou, A. (2018). Psychopathology-a precision tool in need of re-sharpening. Frontiers in Psychiatry, 9,     446. https://doi.org/10.3389/fpsyt.2018.00446Links to an external site.

Zitzmann, J., Rombold-George, L., Rosenbach, C., & Renneberg, B. (2024). Emotion regulation, parenting, and psychopathology: A systematic       review. Clinical Child and Family Psychology Review, 27(1), 1–22. https://doi.org/10.1007/s10567-023-00452-5

FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY – NRNP-6635 Week 1: Discussion Essay Sample 2

Week 1 Discussion: Factors That Influence the Development of Psychopathology

The development of psychopathology is a multifaceted phenomenon influenced by a complex interplay of various factors, including biological, psychological, and social/cultural/interpersonal elements. Understanding the multidimensional nature of mental disorders is crucial for nurse practitioners (NPs) in providing comprehensive and effective care (Hennessy et al., 2022). This discussion explores the biological (genetic and neuroscientific), psychological (behavioral and cognitive processes, emotional, developmental), and social, cultural, and interpersonal factors that contribute to psychopathology’s expression, classification, diagnosis, and prevalence, highlighting the importance of an integrative approach.

Biological Factors

Genetic predispositions and neuroscientific findings play a significant role in the development of psychopathology. Genetic factors can increase an individual’s vulnerability to certain mental disorders. For instance, studies have shown that individuals with a family history of schizophrenia or bipolar disorder have a higher risk of developing these conditions (Boland et al., 2022). Specific gene variations and interactions have been linked to various mental disorders, such as the serotonin transporter gene (5-HTTLPR) and its association with depression and anxiety disorders (Boland et al., 2022).

Neuroscientific research has revealed that abnormalities in brain structure, function, and neurotransmitter systems can contribute to the manifestation of mental disorders. For example, imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine have been implicated in the development of depression, anxiety, and other mood disorders (McNaughton, 2020). Structural and functional abnormalities in brain regions such as the prefrontal cortex, amygdala, and hippocampus have also been associated with various psychopathologies, including schizophrenia, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) (McNaughton, 2020).

Psychological Factors

Psychological factors, encompassing behavioral and cognitive processes, emotional regulation, and developmental stages, significantly influence the development of psychopathology. Maladaptive thought patterns, such as negative self-talk, overgeneralization, and cognitive distortions, can perpetuate and exacerbate mental health issues like depression and anxiety disorders (Hennessy et al., 2022). Additionally, difficulties in regulating emotions and coping with stress can increase the risk of developing psychopathology (Hennessy et al., 2022). Individuals with poor emotion regulation strategies may resort to maladaptive behaviors, such as substance abuse or self-harm, as a means of coping with intense emotions.

Developmental factors also play a crucial role in the manifestation of mental disorders. Adverse childhood experiences, such as abuse, neglect, or trauma, can have long-lasting effects on an individual’s psychological and emotional well-being (Hennessy et al., 2022). These experiences can shape an individual’s perception of the world, interpersonal relationships, and coping mechanisms, increasing their vulnerability to psychopathology. Additionally, disruptions in attachment patterns and insecure attachment styles have been linked to the development of various mental disorders, including personality disorders and anxiety disorders.

Social, Cultural, and Interpersonal Factors

Social, cultural, and interpersonal factors play a crucial role in the development, expression, and perception of psychopathology. Societal stigma and discrimination surrounding mental health issues can exacerbate psychological distress and hinder individuals from seeking treatment (Hennessy et al., 2022). Cultural beliefs, norms, and values can influence the interpretation and expression of psychological distress and the acceptability of certain behaviors or symptoms (Hennessy et al., 2022). For example, somatic symptoms may be more readily acknowledged and accepted in some cultures than emotional or psychological symptoms.

Interpersonal factors, such as family dynamics, social support systems, and relationships, can either serve as protective factors or contribute to the development of psychopathology. Dysfunctional family environments, including poor communication, conflict, and lack of emotional support, have been associated with an increased risk of mental health problems (Hennessy et al., 2022). Conversely, strong social support networks and positive relationships can buffer against the detrimental effects of stress and adversity, promoting psychological resilience. Furthermore, socioeconomic factors, such as poverty, lack of access to health care, and exposure to violence or trauma, can contribute to the development and perpetuation of mental health issues (Hennessy et al., 2022). These factors can create chronic stress, limit access to resources and support systems, and exacerbate existing vulnerabilities.

References

Boland, R., Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

Hennessy, E., Heary, C., & Michail, M. (2022). Understanding youth mental health perspectives from theory and practice. Open Univ Press.

McNaughton N. (2020). Personality neuroscience and psychopathology: Should we start with biology and look for neural-level factors? Personality Neuroscience, 3, e4. https://doi.org/10.1017/pen.2020.5

FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY – NRNP-6635 Week 1: Discussion Essay Sample 3

Factors that Influence the Development of Psychopathology – Discussion

Several factors play a significant role in the development of psychopathology. Psychopathology refers to the study of mental illness. Human beings are different. The variations in sequencing of the human genome contribute to the phenotypical differences and differences in susceptibility to diverse pathologies. Psychopathology can arise from complex etiological traits because of polygenic inheritance, locus heterogeneity, presence of phenocopies, and incomplete penetrance.  Studies reveal that psychological, biological, social, and cultural factors can affect the development of psychopathology. An in-depth understanding of the development of a mental disorder simplifies the process of identifying the right intervention. The discussion explores the different factors that influence the development of psychopathology.

Biological Factors

The biological factors that influence the development of psychopathology mainly involve genetic and neuroscientific factors. Genome studies identify that mental health disorders are polygenic, which indicates a combination of rare variants of larger effects and several common variants of small effects. For instance, schizophrenia is a result of SNP variation (Smoller et al., 2019). In effect, specific genetic variations are associated with an increased risk of developing certain psychiatric disorders. Furthermore, psychiatric disorders are associated with neuroscientific factors that include brain chemistry, function, and structure. Neurotransmission has been associated with several mental illnesses. For instance, serotonin is significantly lower among people diagnosed with depression. The finding results in the identification that changes in neurotransmitters add to the complexity concerning the development of psychiatric disorders. Brain imaging studies have also been linked to psychopathology. For example, people with schizophrenia have different brain structures compared to other people. The changes are mainly evidenced in reduced gray matter, and total cerebrum volume with enlarged brain ventricles, including the cerebrospinal fluid fills the cavities.

Psychological Factors

Studies identify the correlation between emotional and social processing to psychiatric disorders. Attention biases, including positive and threat biases, contribute to the development of various psychiatric disorders. For example, children exhibiting attention biases to threat are more likely to possess anxiety symptoms with less effective emotion-regulation skills, and more social avoidance (Troller-Renfree et al., 2018). In contrast, children with positive biases tend to have adaptive emotion-regulation skills, approach behavior, and positive affect. Emotional factors are also associated with the development of mental disorders. The link between the deleterious effects of early psychosocial deprivation on social and cognitive behaviors shows that stress has an effect on the development of the brain. From this lens, the experiences during the early developmental stages might result in the development of psychiatric conditions. Studies also reveal that children who have a history of trauma with poor attachment styles are more likely to suffer from psychiatric disorders later in life (Troller-Renfree et al., 2018). Finally, emotional dysregulation is linked to difficulties in the management of one’s emotions, which can worsen one’s psychopathology. Such children might exhibit issues with managing their emotions or they can become extremely sensitive. FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY – NRNP-6635 Week 1: Discussion Essay

Social, Cultural, and Interpersonal Factors

Social, cultural, and interpersonal factors have a significant effect on the development of psychopathy. A myriad of social factors within one’s environment contribute to one having mental health issues. The social environment involves the existing societal dynamics, family dynamics, one’s socioeconomic status, education level, and social support. Having adequate resources, such as being employed and having social support are closely associated with positive psychiatric development. Nonetheless, experiencing social stressors, such as a lack of financial resources or exposure to stigmatization or discrimination is linked to the development of psychopathy (Lebowitz, & Appelbaum, 2019). Moreover, the culture of a patient and cultural experiences affect psychopathy. One’s culture defines how they view the world. Culture describes a shared set of values, norms, and beliefs. Cultural context affects how people view things in life ranging from responses to psychological distress. They also affect how one interprets and views mental illnesses and the accompanying symptoms. Culture can also affect whether an individual seeks help when diagnosed with mental health disorders, which can reduce the development of other mental issues. Studies have also revealed that interpersonal relationships have a significant effect on mental health. Interpersonal relationships are evidenced based on how one interacts with peers, the family dynamics, and how one navigates romantic relationships. Having healthy relationships translates into positive mental health effects. However, lack of social support and poor relationships can exacerbate psychopathology.

Conclsion

Psychopathology is multifaceted. The development of psychopathology is highly influenced by a myriad of factors, including biological, psychosocial, social, cultural, and interpersonal factors. However, it is essential to understand that the interaction between these factors has a major effect on psychopathology. Consequently, comprehending the interplay between these factors and the contribution of individual factors in the development of psychopathology aids in the identification of the most effective intervention. Thus, an understanding of the factors associated with the development of psychology fosters the adoption of a holistic approach, which addresses the diverse dimensions.

References

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, 555–577. https://doi.org/10.1146/annurev-clinpsy-050718-095416Links to an external site.

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. Molecular Psychiatry, 24(3), 409–420. https://doi.org/10.1038/s41380-017-0010-4Links to an external site.

Troller-Renfree, S., Zeanah, C. H., Nelson, C. A., & Fox, N. A. (2018). Neural and Cognitive Factors Influencing the Emergence of Psychopathology: Insights From the Bucharest Early Intervention Project. Child Development Perspectives, 12(1), 28–33. https://doi.org/10.1111/cdep.12251Links to an external site.  FACTORS THAT INFLUENCE THE DEVELOPMENT OF PSYCHOPATHOLOGY – NRNP-6635 Week 1: Discussion Essay