Biopsychosocial Influences on Schizophrenia

This essay will explain the biopsychosocial influences on the health and well-being of a patient diagnosed with schizophrenia. To maintain patient and staff confidentiality required by NMC, a pseudonym shall be used to refer to the patient as Norbert. The author will define the meaning of health and well-being while providing important focus on areas such as biological, psychological and sociological theories. The author will further explain the anatomy and physiology of Norbert’s healthcare and how it functions. Furthermore, the author will also explore ways in which health promotion will play a part in improving Norbert’s health and well-being.

The biopsychosocial model was invented by Engel after realizing the limitations in the biomedical model which outlined the microscopic biology as the main cause of human illness.

Norbert is a male in his fifties who has been diagnosed with paranoid schizophrenia; he has a history of drug abuse. Norbert is currently single and has never been married; he is unemployed and currently lives in supported living. Comer, (2010) describes schizophrenia as a mental illness that results in people losing contact with reality. Individuals with schizophrenia present with awkward behaviour, mixed with disturbed mind and disorganized characteristics. The awkward behaviour and character presented by schizophrenia patients is due to the inability of the neurocognitive functioning of the brain. Furthermore, Nestor et al. (2017) suggest that most people with schizophrenia present with positive or negative like symptoms which include hallucinations, delusions, impaired cognition, limited emotional expressions and depression. Schizophrenia can affect anyone (affects any type of human being) and its diagnosis occurs from late teenage years up to the early thirties. The World Health Organization (WHO) has defined health as “a state of complete physical mental and social well-being, not merely the absence of disease or infirmity”.

Nestor et al. (2017) further explains that schizophrenia is the result of an imbalance of neurotransmitters within the membranes tasked to send and receive neurological signals. The neurotransmitters involved are dopamine, glutamate and serotonin. Waugh and Grant (2014) defined neurotransmitters as a chemical reserved and released from the synapse when neurons relay signals to targeted receptor neurons.

The biological factors of the biopsychosocial influences that can affect the human health include genetics, infections, medical pain and trauma. Fiocco and Mallya (2014) suggest that these biological factors affect the health and well-being of a person and if subsequent changes trigger any of these factors, these will have a negative impact on their health and well-being.

Bliksted et al. (2017) describes the positive symptoms of schizophrenia as having thought disorders, movement disorders, hallucinations and delusion. The negative symptoms of schizophrenia will mainly affect emotions. Research carried out in the UK has outlined that schizophrenia is linked to premature mortality in that men diagnosed with schizophrenia die 15 years earlier than women. Furthermore, Crump et al. (2013) has suggested that ischemic heart disease and cancer are two common causes of death in schizophrenia patients.

Norbert is paranoid that he is being monitored by outside forces. These findings are backed by Felmet et al. (2011) when he suggested that depressive and paranoid behaviour may arise as a result of components such as negative and positive symptoms or a reaction to extreme psychosis. Norbert’s symptoms such as low self-esteem, poor hygiene and isolating himself, can be described as neurobiological factors. Norbert also presents with other symptoms which include paranoia, delusion, hallucination and a lack of interest which are derived from brain biochemistry. All these symptoms will need to be treated through the use of antipsychotic drugs; these antipsychotic drugs, however, are known to have a negative effect on patients as most patients may end up developing other physical health problems, such as diabetes, low sex drive, cardiovascular disease, low self-esteem, tremors, diabetes and weight gain. Antipsychotic drugs are very sedating and this may cause patients to experience tiredness, low esteem and interrupted sleeping patterns. Norbert may be prone to other diseases related to antipsychotic medication. He was treated for pneumonia and influenza in the past and there is the chance of a re-occurrence of the pneumonia as he still relies on his antipsychotic medication.

According to DH, (2016), the research conducted proves that there is a high risk of physical health issues which are contributed to a long-term mental health condition and the need for physical activity to combat the problem.

Norbert is reported to have less contact with family and his childhood friends. A study carried out by Gunnmo and Fatouros Bergman (2011) indicates that a lack of social contacts for a schizophrenia sufferer will cause a great impact on their health and well-being. The study outlines that to avoid relapse in a schizophrenia patient, family and friends, and social contact play a major role in reducing the risks of relapse. The feeling of belonging, and the love and support from family brings comfort to schizophrenia patients and reduces the risk of relapse. Employment is a contributing factor that can also reduce risk in a schizophrenia patient when they are given the chance to try and fulfill personal targets, ambitions and desires by working and earning money.

Norbert appears to be lacking in motivation to look for work as he fears that people will call him names when he has episodes of hallucination/paranoia while at work. Norbert has been putting on weight due to the antipsychotic medication he is taking of which one of the side-effects is weight gain. Being overweight has a major impact on Norbert as he lacks self-confidence, blaming this on his size which means he is unable to carry out any warehouse jobs. Norbert will need to work with the Occupational Therapist (OT) to acquire other job skills that he enjoys, as well as identify a gym that will suit him, i.e. one that provides low stimuli physical exercise. A study by Holley et al. (2011) has outlined that physical activities and exercise have a good effect on the mental health and well-being of schizophrenia patients. Activities such as utilizing the gym, cycling, swimming and dance groups, will help Norbert avoid other diseases, such as diabetes and ischemic heart disease. These groups can also be used to encourage and promote social networking, self-confidence, raise awareness and educate patients, whilst promoting the psychological well-being in schizophrenia patients. Norbert could get involved in a community social activity of his choice which could help in building his self-confidence. Other methods to reduce any risk or relapse would be providing quality care, and organizing and implementing evidence-based programmes whilst encouraging Norbert to enjoy his life in social settings.

Since Norbert has been putting on weight, physical exercise will bring a positive effect to his health and well-being. Norbert would need to have a gym instructor to work with him as excessive exercising may also cause heart complications. Norbert will benefit socially by attending the gym as he would have the opportunity of improving his social network by meeting new people. This would have the benefit of boosting his interpersonal relations and self-esteem.

The reason Norbert may feel stigmatized and socially excluded can be linked back to his poor personal hygiene which has resulted from the negative symptoms of schizophrenia. Weight gain, poor personal hygiene and poor diet are major risks that are faced by schizophrenia patients. Norbert currently shares communal areas and has his own bedroom; he tends not to join other peers during meal-times or activity sessions. Norbert normally prefers to eat in his room and does not clean up afterwards; he isolates himself from other peers, and therefore acquiring social skills which will be necessary for his recovery to reintegrate into society will be blocked. Due to not having contact with family or friends, Norbert is likely to have increased paranoia which will result in a limited social and support network.

The biomedical model was commonly used by scientists and it has now been replaced by a more robust model of biopsychosocial factors which separates the research into biological, psychological and social systems. Strickland and Patrick (2015) have declared that the biomedical model will only concentrate on biological or physical aspects of illness, whereby with the biopsychosocial model, the emphasis will be on all aspects of biological, psychological and social factors.

Psychological Factors

Norbert experiences hallucinations and voices telling him “not good things” and these will increase his anxiety. He also experiences ideation, e.g. that he has a house and kids which his wife is taking away from him and that she is hiding his kids from him. Norbert also reports that he has cancer, which is eating away his brain, although a physical examination from specialists has shown negative results for cancer. Norbert’s treatment plan involves the use of atypical antipsychotic drugs and procyclidine hydrochloride tablets for tremors.

Fiocco and Mallya (2014) have suggested that psychological factors are endless in that one cannot limit them to brain dysfunction as there are also other mental factors to consider, such as behaviour and cognitive dysfunction. Ellison Maso and Scior (2015) describe low self-esteem, low self-confidence and lack of decision-making as factors that will dominate the psychological factors of human well-being. The psychological factors that dominate Norbert’s health and well-being are paranoia, hallucinations, self-isolation, lack of self-esteem and confidence. Awan et al (2017) argues that psychological factors cannot be the only major issues which can affect the health of a schizophrenia patient. In Norbert’s case, he is affected by all types of biopsychosocial factors and he will benefit from psychology sessions, Cognitive Behavioural Therapy (CBT), self-help groups, social skills training and art therapy.

Social factors that will have an impact on Norbert’s health and well-being are self-isolation from society, lack of contact from family and friends, not participating in community activities and lack of employment. Plakun, (2018) declared that there are social factors that will negatively affect the health of an individual, such as extreme cultural and religious beliefs, social housing areas, disability, sex, age and racial discrimination. Norbert is not religious; he lives in a relatively safe social housing area that is not known for drugs. Access to illegal substances in his area could have a detrimental effect on his health and well-being.

A negative attitude and a lack of support from family and society is another great contributor to poor well-being in people suffering from schizophrenia or any sort of mental illness, according to Ellison, Mason and Scion (2015). Health promotion would significantly assist in increasing knowledge and equipping the population with a clear understanding of schizophrenia.

According to Awan et al (2017), health promotion improves the well-being of schizophrenia patients in 3 different ways: i) it increases the patient’s knowledge by educating them about the disease; ii) it educates care givers; iii) it educates society and the population about schizophrenia. It is clear that health promotion that is well- programmed and vigorously conducted will decrease the re-occurrence of schizophrenia and increase tolerance in the general population.

Searight (2016) suggested that nursing teams should contribute to health promotion as they deliver a person-centered care, which should be significant and focused on promoting the health and well-being of patients. Furthermore, Searight (2016) states that the health and well-being of an individual could be caused by life events as the brain could be influenced by environmental factors from the external world. As far as Norbert is concerned, he will need to have a robust multidisciplinary team (MDT) that will work closely together using the biopsychosocial model. The MDT will consist of a social worker, psychiatrist, psychologist, general nurse, psychiatric nurse, Occupational Therapist and a general practitioner.

In conclusion, this essay has outlined the difference between biomedical and biopsychosocial models and has discussed how effective these are when using biopsychosocial approaches which consider biological, psychological and sociological influences in order to understand both the health and illness of an individual.

The author has discussed Norbert’s health and well-being in the light of his diagnosis of schizophrenia. For Norbert to enjoy good health and well-being, it is clear he requires an appropriate and functioning social network, the provision of a healthy diet and for him to attend physical exercise sessions. The factors that were affecting Norbert’s health and well-being were self-isolation, the side-effects of his antipsychotic drugs, social isolation and poor personal hygiene. In this context, the author has highlighted the effect and importance that health promotion would have in enabling Norbert to gain self- esteem, self-confidence and enjoy good nutrition and participate in exercise sessions.