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Schizophrenia: A Biopsychosocial Approach

Schizophrenia: A Biopsychosocial Approach

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An essay for the 2011 Undergraduate Awards (Lecturer Nomination) Competition by Jenny Cosgrave. It is nominated by Lecturer Catherine Redmond of University College Dublin in the category of Nursing & Midwifery
An essay for the 2011 Undergraduate Awards (Lecturer Nomination) Competition by Jenny Cosgrave. It is nominated by Lecturer Catherine Redmond of University College Dublin in the category of Nursing & Midwifery

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Published by: Undergraduate Awards on Sep 01, 2012
Copyright:Attribution Non-commercial

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10/27/2013

 
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Schizophrenia: A Biopsychosocial Approach
 
The Biopsychosocial model of Health and Illness (Engel, 1977) incorporates threekey aspects of care- social, psychological and biological Nurses in practice commonlyuse this model for a variety of conditions; it is particularly appropriate in the care of apatient with schizophrenia.
Schizophrenia is a chronic illness affecting 1% of the world’s population (Lyon
et al
.,2009). The disorder affects the patient physically, psychologically and socially. Thisstudent nurse cared for a patient newly diagnosed with schizophrenia. For the purpose
of this essay the patient will be named “John”. “John” was twenty years old, he was
admitted after a psychotic episode at home. He became very paranoid about his sister
and thought she was plotting against him. “John’s” parent’s found kn
ives and a notein his bedroom, in which he depicted how he would harm his sister. Prior to this firstpsychotic episode, the patient had been displaying signs of social and occupational
dysfunction. “John” was diagnosed with paranoid schizophrenia. In ord
er tounderstand the care necessary for this patient one must first understand thepathophysiology of the disorder.Schizophrenia is a very complex disorder, with no one definitive biologicalexplanation of the disease. A number of hypotheses have been developed to explainthe disorder; the first of these hypotheses is the neurodevelopmental model. Thismodel suggests that a disruption occurs in the development of the forebrain during theprenatal period (Conklin & Iacono, 2002). This disruption is linked with a higher rateof prenatal complications especially, hypoxia associated complications. In utero, viral
 
2exposure has also been linked with an increased incidence of the disorder (Conklin &Iacono, 2002), as winter births are associated with schizophrenia. Weinberger (1987),cited in Pearlson (2000), suggests that a brain lesion acquired in early life, interactswith normal neurodevelopment that occurs in adolescence and causes abnormalities inthe brain. Overall, the neurodevelopmental model is supported by the presence of neurological anomalies present in the brain of a person experiencing their firstpsychotic episode. The lateral ventricles appear increased in size and the overall brainweight is approximately 5% less on average in patients with the disorder (Pearlson,2000).The Dopamine hypothesis suggests that schizophrenia is associated with anincreased level of the neurotransmitter dopamine in the brain (Maquire, 2002).However, recent studies have suggested that a dysregulation of dopamine in thetemporal areas of the brain and depletion of dopamine in frontal areas rather then anoverall increase exists (Conklin & Iacona, 2002). In the last decade, the dysfunctionof the neurotransmitters serotonin and GABA has also been highlighted in playing arole in schizophrenia. Many of the new drugs used to treat the symptoms of schizophrenia act on these neurotransmitters.Finally, Genetic predisposition plays a huge role in the occurrence of schizophrenia. Studies carried out on twins found that there was a concordance ratebetween 40-50% of schizophrenia in monozygotic twins (Gegman
et al
., 2010) and12% concordance rate among dizygotic twins (Maguire, 2002). The predisposition fora child with two schizophrenic parents is 45% (Pearlson, 2000). These percentageshowever, also reveal that other factors, for example, environmental factors must havea role in the etiology of the disorder (Maguire, 2002). The concordance rate would be
 
3closer to 100% if genetics were the sole cause, leading researchers to conclude thatenvironmental factors must also play a role. At present, it has only been suggestedthat something in the environment may trigger a person, who is geneticallypredisposed, towards schizophrenia but no specific environmental sources have beenfound (Maguire, 2002). Knowledge of each of these hypotheses will give nursesinsight into why certain symptoms occur and how different treatments work.The nursing care of a patient diagnosed with schizophrenia is veryindividualized, depending on their specific diagnoses and symptoms. A number of other psychiatric disorders, including bipolar disorder, personality disorders and
substance induced psychotic disorders were eliminated prior to “John’s” diagnosis of 
paranoid schizophrenia. A detailed history, both physical and psychological was takento determine if the patient displayed any symptoms of schizophrenia related psychosisin the lead up to the psychotic episode. The presence of two or more of the followingsymptoms over a one month period are diagnostic criteria for schizophrenia-hallucinations, delusions, disorganized behavior, alogia (lack of speech) andavolilition (lack of motivation) (Maguire, 2002). Social and occupational dysfunction,over a period of six months, is also included in the criteria. A detailed history taken
from “John” and his parents found that he displayed many of these signs, for example,
auditory hallucinations, delusions and paranoia regarding his sister, along with socialand behavioral dysfunction.
Assessment of “John’s” symptoms on admission and throughout his
hospitilisation is extremely important as symptoms guide treatment plans.
Schizophrenia cannot be cured so treatment is based on controlling the patient’s

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