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Depression and the Biopsychosocial Model

Describe about the Mental Health Nursing for Biopsychosocial Factors.

This essay aims to analyze a selected case study for discussing the suitable biopsychosocial factors as well as nursing management or interventions pertinent to the selected case. The case study that has been chosen for this essay is Case 3- Depression. In the given Case study, Amy who is a 75-year-old woman was diagnosed with depression for the past ten years. The patient felt depressed after being diagnosed with diabetes as well as hypertension. The patient felt loneliness after the expiry of her husband and was more depressed since then. The patient has two daughters who do not stay with her. The patient’s family history revealed that her mother also suffered from depression and expired fifteen years ago. The patient has feelings of worthlessness, helplessness and hopelessness. She also thinks that she is a burden for her daughters. In addition, the ethical implications of the selected case study will be discussed in this essay.

Depression is a mental or psychological disorder, which is prevalent in the existing populations, particularly in the elderly individuals (Gilbert, 2014).  It results in the development of feelings like hopelessness, sorrow and helplessness. A person suffering from depression frequently loses his/her interest in the activities in which he/she felt happiness and was comfortable before (Bewernick et al., 2012). The other symptoms that are prevalent in this condition include feelings of loneliness, loss of appetite and difficulty in decision-making process (Lopresti Hood & Drummond, 2013). In this, case study, it is clear that the patient was least interested in the activities. Additionally, the patient also experienced loss of appetite since she lost six kilograms in the last two months and was not able to sleep properly.

It is generally believed that every mental/psychological disorder results because of the complex interaction and combination of social, biological and psychological factors. It is concerned with a theory known as the ‘Biopsychosocial model’ of causation and mostly several professionals of mental health accept this model (Buckner et al., 2013). These mental health professionals are concerned to tackle the persons experiencing mental health issues such as depression. This model states that the biological, psychological and social factors are interdependent and crucial in terms of the development of a disease. It can also be said that the mind as well as the body are not autonomous and are diverse things. The similar things influence the body and the brain. Wellness and sickness are not merely a concern of an individual’s physical condition but are also influenced by the social and psychological status of a person. This model encourages the mental health experts to elucidate the phenomenon such as depression by investigating all the pertinent biological, psychological as well as social factors that are responsible for the progression of disorders such as depression (Clare et al., 2012).

Biological Factors

In terms of the biological factors, it had been recognized that the individuals experiencing depression have an impaired functioning in their immune, endocrine and nervous systems. Additionally, it can make an individual more susceptible for developing different bodily disorders. Likewise, the individuals suffering from a physical disorder are mostly probe to develop depression (Buckner et al., 2013).  A number of different researches have also suggested that the genes have an influence in transmitting depression from parents to the offspring (Rawat et al., 2015). Several individuals may be more prone for developing depression with regard to their genetic constitution along with the biological factors that makes them more vulnerable for developing depression in their life span. A neurotransmitter, named Serotonin has a key role in the different biological functions such as memory, appetite, quality of sleep and concentration. Nonetheless, this theory is under study. Several researchers believe that when a person has a feeling of sadness, then the serotonin level in his/her brain becomes disproportionate. Additionally, the key function of the serotonin levels is compromised. Therefore, antidepressants are recommended to increase the serotonin levels (Gilbert, 2013).

The psychological factors that are accountable for the development of depression comprise negative patterns of thinking, lack of coping skills, impaired emotional intellect and judgment problems. These psychological factors are also influenced by biology up to certain extent. For example, the inherited temperament or biologically based characters of the individuals can persuade them to be comparatively apparent to act in ways of the characteristics of depression (Clare et al., 2012).

The social factors like harassment, encountering the distressful circumstances and lack of societal support also have a role in the development of depression in the individuals. A number of researches have revealed that distressing societal events are able to serve as triggers to switch the gens on and off and leading to the alterations in brain functioning (Gilbert, 2013). Social as well as environmental cause of depression can also be controlled as compared to real suffering. The unexpected death of a very close individual also leads to the development of feelings such as loneliness and sorrow (Clare et al., 2012). It is apparent in the provided case study as the patient was more depressed after the expiry of her husband. At times, the individuals lack information that is needed to cope up with the circumstances, which are psychologically stressful and because of this an individual encounters depression (Rawat et al., 2015).

Psychological Factors


The nursing management or intervention, which is appropriate for the depressed individuals, is Cognitive Behavioral Therapy (CBT) (Fava et al., 2014). It believes that the mental state of an individual is directly linked to his/her thought process.  The behaviour, mood, physical state, and self-sense is affected through negative dysfunctional thinking. This therapy’s goal is to help a person in learning and identifying the negative pattern of thoughts, assessing their validity, and replace them with positive thinking ways (Driessen et al., 2013). Likewise, the therapists who practice CBT intend to help their patients to alter those patterns of behaviour that come up because of dysfunctional thinking. The individuals are prone to become depressed because of negative thinking and behaviour, which makes them to think their life, is worthless. The practitioners of this therapy think that, when the behavior and thought patterns of the individuals are altered, therefore their frame of mind also changes (Driessen et al., 2013).

CBT is based on behavioral activation and cognitive restructuring. Behavioral activation concerns the learning process to overcome the hindrances for participating in the pleasant activities (Yoshimura et al., 2014). While in cognitive restructuring, the patient and the therapist works jointly to alter the thinking patterns. CBT focuses on the condition of the patients i.e. what and how an individual believes more than why an individual believes in that manner It stresses on precise problems of a person. Problem behaviors as well as problem thoughts are recognized, prioritized and tackled particularly in those sessions, which consists of an individual or groups (Driessen et al., 2013). The patients or clients working with the therapists are asked to define their goals for all the sessions with goals of a long-term. These goals may take additional time to get accomplished. Numerous goals maybe targeted to be completed prior to the end of the sessions of CBT (Fava et al., 2014).

The approach of Cognitive Behavioral Therapy is educational as the therapist to examine and note down the negative thoughts and psychological images of the clients uses structured experiences of learning. The main goal is to discover how the patient’s physical state, behaviors and mood are affected by those thoughts (Driessen et al., 2013). Additionally, the patients or clients are also taught the essential skills of coping such as problem solving skills and scheduling the pleasant experiences. The clients undergoing this therapy are anticipated for participating enthusiastically in the role of learning, in and between the sessions (Fava et al., 2014). In these sessions, they clients are given homework or assignments. Some of them are given the grades in the initial stages and the evaluation of assignments is done in the commencement of the subsequent session. CBT utilizes several strategies along with behavioral experiments, imagery and Socratic questioning. The treatment of the patients is strictly time bound (Yoshimura et al., 2014).

Social Factors

In addition to this, the nursing management or intervention that can be employed for treating depression is pharmacological treatment. For the treatment of depression, several types of medications can be utilized. The symptoms of the disease are improved through enhancement of the accessibility of certain brain chemicals, which are called neurotransmitters (Perry, Potter & Ostendorf, 2015).  It is believed that these chemicals can aid in the regulation brain circuits, which has an effect on feelings. The major antidepressants include- Selective Serotonin reuptake inhibitors, Tricyclic antidepressants, norepinephrine reuptake inhibitors and Monoamine oxidase inhibitors. Approximately one-half of the primary care patients who are depressed have a limited response towards these medications or drugs (Baird, 2015). Only one third of the individuals suffering from depression undertake treatment concerning a single depressant achieve remission that indicates complete resolution of the symptoms in the next three months. The possibility of improvement of the patients concerning antidepressants is influenced by the cultural as well as medical factors. The predictors of positive response with respect to the treatment includes the severity of a lower baseline, higher income, higher education level, private insurance, shorter episodes of depression and higher physical and psychological level (Baird, 2015). 

Besides all these, art and craft group activities can be effectual to manage the depressive symptoms. The mental or psychological well-being of the patients experiencing depression may be encouraged by the activities of arts and crafts because it is considered as a recreation or remediation therapy. These therapists often consider the therapeutic relationship as a key for facilitating the examination of the patient’s emotional concerns. It is furthermore involved with the person activities in the process of arts and crafts group activities since it encourages the wellbeing of the clients or patients. The creative art therapist’s frequently monitor the arts for facilitating the development of emotional responsiveness and understanding, encouraging self-actualization and expressiveness (Perry, Potter & Ostendorf, 2015). 

The ethical implications involved with the treatment of depressed patients comprise the intervention that controls the treatment of the symptoms of depression. The exploitation of an evidence-based psychotherapy involves and ethical censure of contemporary supervision of depression (Glannon, 2016). CBT requires individuals for understanding the impact of depression and in several cases, a reaction to the conditions that are predominantly traumatic. In addition, cognitive behavioral therapy teaches the individuals that a depressed frame of mind prejudices information processing in a manner, which encourages impractical negativity. Paul Biegler has argued that in the ethical treatment of the patients suffering from depression, the patient’s insights are obtained from the therapeutic procedures leads to the promotion of independence (Marco et al., 2016). The therapists who are concerned with the treatment of depression have an ethical commitment to promote the independence of the patients experiencing depression in their lives. The therapists also have an ethical obligation, which is important for prescribing psychotherapy for treating depression. In addition to all of these, there are ethical questions that arise in the selling of antidepressants that are manufactured by the pharmaceutical companies (Foye et al., 2015).

Nursing Management or Intervention for Depressed Individuals - Cognitive Behavioral Therapy (CBT)

In the end, it can be concluded that the discussed nursing management and interventions can be recommended to the patient in the given case scenario. The symptoms of depression needs to be considered and should be treated quickly. Depression is inescapable and leads to the development of feelings like helplessness, hopelessness as well as distress. The patients suffering from depression frequently loses their interest in the activities in which they felt happiness and were comfortable previously. The other symptoms that are prevalent in this condition include feelings of loneliness, loss of appetite and difficulty in decision-making process. Therefore, these interventions and nursing management can assist the patient in the given case scenario to overcome the symptoms of depression. These interventions focus on the problems, which are specific in the patients suffering from depression, and can enhance the self-confidence of the patient as it leads to the elimination of the negative thinking patterns of the patient effectively.

References

Baird, M. S. (2015). Manual of critical care nursing: nursing interventions and collaborative  management. Elsevier Health Sciences.

Bewernick, B. H., Kayser, S., Sturm, V., & Schlaepfer, T. E. (2012). Long-term effects of nucleus accumbens deep brain stimulation in treatment-resistant depression: evidence for sustained efficacy.Neuropsychopharmacology, 37(9), 1975-1985.

Buckner, J. D., Heimberg, R. G., Ecker, A. H., & Vinci, C. (2013). A biopsychosocial model of social anxiety and substance use. Depression and Anxiety, 30(3), 276-284.

Clare, L., Nelis, S. M., Martyr, A., Roberts, J., Whitaker, C. J., Markova, I. S., ... & Morris, R. G. (2012). The influence of psychological, social and contextual factors on the expression and measurement of awareness in earlyâ€Âstage dementia: testing a biopsychosocial model. International journal of geriatric psychiatry, 27(2), 167-177.

Driessen, E., Van, H. L., Don, F. J., Peen, J., Kool, S., Westra, D., ... & Dekker, J. J. (2013). The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. American Journal of Psychiatry

Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2014). Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal of Psychiatry.

Foye, S. J., Kirschner, K. L., Wagner, L. C. B., Stocking, C., & Siegler, M. (2015). Ethical issues in rehabilitation: A qualitative analysis of dilemmas identified by occupational therapists. Topics in stroke rehabilitation.

Gilbert, P. (2013). Depression: The challenges of an integrative, biopsychosocial evolutionary approach. The Wiley-Blackwell Handbook of Mood Disorders, Second Edition, 229-288.

Gilbert, P. (2014). Depression: The evolution of powerlessness. Psychology Press.

Glannon, W. (2016). Ethical issues in neuroprosthetics. Journal of neural engineering, 13(2), 021002.

Lopresti, A. L., Hood, S. D., & Drummond, P. D. (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. Journal of affective disorders, 148(1), 12-27.

Marco, C. A., Venkat, A., Baker, E. F., Jesus, J. E., Geiderman, J. M., & ACEP Ethics Committee. (2016). Prescription Drug Monitoring Programs: Ethical Issues in the Emergency Department. Annals of emergency medicine.

Perry, A. G., Potter, P. A., & Ostendorf, W. (2015). Nursing interventions & clinical skills. Elsevier Health Sciences.

Rawat, V., Dawson, D., Schilders, M. R., & Kennedy, G. A. (2015). Sleep disturbances among Victorian paramedics and the impact of demographic and biopsychosocial factors. The Time of Your Life. Australasian Chronobiology Society, Melbourne, Australia, 12-17.

Yoshimura, S., Okamoto, Y., Onoda, K., Matsunaga, M., Okada, G., Kunisato, Y., ... & Yamawaki, S. (2014). Cognitive behavioral therapy for depression changes medial prefrontal and ventral anterior cingulate cortex activity associated with self-referential processing. Social cognitive and affective neuroscience, 9(4), 487-493.

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