Mental Health Nursing Practice

This article discusses the biopsychosocial factors of John's primary psychosis, the role of nurses in managing this disease, and ethical issues related to the treatment of this disease.

Running head: MENTAL HEALTH NURSING PRACTICE
Mental health nursing practice
Name of the student
Name of the university
Author note

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Response to case study 1.
John is a school student of 18 years and has admitted to the mental health centre for the
primary episode psychosis. Psychosis refers to a damaged relationship with the society and
reality. It is a sign of a critical mental disorder. Psychotic disorder People who are suffering
from this disease may have the problem of hallucination or delusion. John has the hallucination
problem. In this assignment, the biopsychosocial factors of John’s primary psychosis are
described. Along with this, the role of nurses in managing this disease of John and ethical issues
related to the treatment of this disease is also defined. The psychosis disorder of John is related
to the drugs and alcohol. John is admitted to the hospital with the problem of hallucination.
Hallucination is a sensory disorder that allows the person to experience a virtual stimulus that is
they feel actual stimulus although there is no real stimulus. The level of hallucination, in this
case, is also described.
The bio psychosocial factors is quite responsible for John’s disease. Biological factors are
those, which is carried forward from his parents to John. These are mainly genetical
characteristics of John’s father or mother.Any disease that is carried by John's parents can be
crucial biological factor. John is currently suffering from the problem of hallucination that is he
is assuming somebody and continue talking with him or her. He is roaming around the house ad
he thinks that somebody is talking with him.It is the sign of complete hallucination. In case of
psychotic disorder,the brain of a human being is directly involved.the brain consists of nerve
cells,named neurons and as well as with some chemical ,called neurotransmitter.The imbalance
of these neurotransmitter is directly responsible for such kind of psychotic disorders.The
neurotransmitter which is thought to be responsible is the dopamine.Dopamine is responsible for
transmission of signal from nerve to the brain.It is predicted that people with psychotic disorder

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produces too much dopamine than normal individual.However there is various evidence to
support the Dopamine theory of psychotic disorders.In various research it is seen that drugs
dopamine receptor blocker are quite successful in case of psychotic disorder.The anti-psychosis
drugs used to treat this disorders mainly block the binding site for the dopamine.As a result the
dopamine cannot bind to its adjacent receptor and failed to transmit the signal. In case of
primary psychosis,like schizophrenia there is more dopamine. Moreover ,if they bound to the
receptor continuously,the result will be the primary psychosis.In case of dopamine receptor
blocking,in spite of huge dopamine concentration,they unable to bind with the proper
receptor.This mechanism is used to treat primary psychosis (Uchida,2017). On the other hand,
many drugs like amphetamine, also responsible to hike the level of dopamine and this can also
cause psychotic symptoms. According to the John’s case study,John consumes amphetamines
on a regular basis.Amphetamines increases the level of dopamine in his body and that results in
such symptoms.The regular intake of amphetamine also increased level of serotonin which is
also responsible for the onset of psychotic disorder (Ahnaou et al.,2017). Excessive amount of
serotonin can overexcite the nerve tissues and produces uncertain spikes in neuron activity.This
over-excitement can cause psychotic disorders (Fjukstad et al.,2017). John was addicted to
marijuana when he was in grade 9.It is said that marijuana can hike the chances of psychotic
disorder and the persons who have a family history of a of schizophrenia or psychotic disorder
are in great danger. Marijuana and its role in schizophrenia is directed to Cannabis and which
may hike the chances psychiatric disorders. The cannabinoid receptors mainly include two
receptors and they are CB1 and CB2.The marijuana directly affects the endocannabinoid (ECB)
system. Most neurotransmitters are synthesized in presynaptic neurons and works through a
calcium ions.ECBs that are synthesized in the postsynaptic region releases in the synaptic cleft

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and binds to CB1.In the brain ECB deals with neurotransmission systems like dopamine.The
cannabinoid receptor THC are responsible for binding of endogenous cannabinoid in the
brain.The area like hippocampus are supposed to be responsible for the psychotic disorders and it
is found that the concentration of cannabinoid receptors are very high in thise region.On the
other hand cannabis receptor are directly directly associated with the increasing activity of
dopamine receptor.The increase activity of dopaminergic receptor results in the development of
psychotic disorders.The hippocampus has a high concentration of glucocorticoid receptor and it
is a part of hypothalamic-pituitary-adrenal (HPA) axis activation.Subsequent relarase of
glucocorticoid helps in activation of HPA axis. This biological aspects is related to the
development of Psychotic disorder (Desfossés et al.,2010). Sometimes he is talking with himself
also. After admission to the hospital, he started to hear voices of a group of a woman and two
men. As per the case study, John’s biological father has a medical history of Schizophrenia,
which is one of the major psychotic disorder. From his father, the schizophrenic gene has come
to John (van, Kenos & Rutten, 2010). It increases the John’s probability of being a schizophrenic
patient. According to the symptoms of John got his aggressive and violent behavior also from
his father, as his father was brutal to his wife and to his children. The key factor of John’s
disease is the psychological factor. From his childhood faced several psychological trauma. In
several studies it is seen that child who are under the age of 16 and were abused, have the higher
risk of developing psychosis.Childhood trauma is another key factor for developing
psychosis.The children who have been physically abused in their childhood has significantly
developed psychosis disorder in later age. The psychological factors are the most important in
case of John. John’s father was schizophrenic and he used to be violent.John also was abused by
his father.From childhood, John had experienced such abusive behavior of his father. These

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factors are also responsible for the disease. Such early events causes the neurological imbalance
that gives rise to the altered neurological connections that maximizes the chance of psychotic
disorder.The imbalanced neural structure is directly responsible for such psychotic disorders. A
disturbing life event is another crucial factor responsible for John's disease.And it is evident that
John has a very disturbing tragic life event at his childhood.His father divorced her mother when
he was only 8.This affects the child’s mind. John missed his parental care as well. The effect of
this thing has a very long-term effect.Migration is another key issue that is considered as a
reason for psychotic disorder. After the divorce of their parents, they migrated to a new city
and had to change his school. In a new city John was very alone at first and it is quite evident
that in a new city everyone will discriminate a new person from the older one.This migration is
also have a evident role in psychotic disorder of John. As a result, John lost all his close friends
and after that, he failed to make new close friend.These psychological factors are responsible for
John’s present condition. John was very fun loving and socially active. Since last seven months,
he started to isolate himself from other and started to develop symptoms of psychotic disorder.
As per case study ,when he was in grade 9 he was addicted to marijuana and marijuana was
thought to be a key reason for developing psychotic disorder. The friends groups of John was
also addicted to drugs and that influenced John to take drugs. Along with this, John also
consumed alcohol and smoked cigarette occasionally. Lack of a proper friends group pushes
John towards this disease.John himself feels that he is not good and he also thinks that everyone
hated him.The social urge of being good to others is also one of the social factors of John’s
disease.This bad feeling always haunts John to be a good person.As he was abused by his father,
he wanted to be a government spy with some special power in his inner mind So that he can stop
such cases in the future.

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In managing a Psychotic disorder patient, nurses play a crucial role.Nurses should build a
strong relationship with John and should not laugh at him. They should communicate with John
in a very clear and specific language. Nurses would speak with John in a low voice and speak
very slowly. The positive and negative symptoms of John should be assessed by the nurse.
John’s ability to execute activity of daily living( ADLs) should be evaluated by the nurses. They
should keep in mind that once John was addicted to marijuana.As John is suffering from the
problem of hallucination, he has the probability of getting injured due to his problem. Nurses
should keep John in close observation so that any unfortunate incidence would not happen to
him. The patient with such generally has the behaviour of committing suicide. Therefore, the
nurse should carefully look after John, so that he would not do such things. Nurses should assist
John to increase his sense of liability and to help him in learning the social skill.Nurses should
assist John in doing his work and gradually decrease John’s dependency on them as much as
possible (Pinho, Pereira & Chaves,2017). John should be exposed to a realistic condition so that
he can be comfortable with the healthy environment. Along with this they should find the content
of John’s hallucination and should not argue with John in this matter. They should maintain a
peaceful atmosphere around John so that he feels comfortable. To get rid of from this problem,
nurses should monitor John, whether he is taking his medicines correctly or not and also should
monitor if there is any toxicity or hypersensitivity related to any drug. At the same time, they
should monitor John accurately to restrict him retaking drugs and should tell the reality that they
do not hear anything (Melany & Fineout-Overholt, 2011).
The main ethical issues faced when treating a psychotic disorder patient like John is, to
tell the truth. There is a dilemma, to tell the truth to the patient or not. In order to maintain the
patients’ health sometimes, doctors tell a half-truth to the patient. The health care personnel are

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afraid of a risk factor that if they disclose everything, the patient would never return to the clinic
and as a result, they will not receive proper care. The hiding of information to John may be
counted as a lie, but it will give the best result to John’s disease. In such a way, the doctor will
form a relationship with John, and it is the most critical first issue related to their ethics. John is
very ambitious in his life, and he wanted to be a government spy, and he also thought that he has
some special power. While treating John, doctors will be in a dilemma,whether he would allow
John to chase his dream or to restrict him for his health condition. As John has several
limitations due to his disease, there is a chance of getting a bad result related to John's disease.
However several studies show that more moral support from the doctor can improve the quality
of patient’s life.So, in this case, John's doctor should support John in fulfilling his wish (Chen,
Xie & Chen,2017). Another ethical issue faced by the health care professional is related to
consent. In this case, shared decision making can be a right approach. In this approach, John is
more involved in decision making about the treatment, and he also would be provided with more
information related to his medication (Howe,2008). However, if he finds difficulties in taking a
decision about his treatment, health care personnel should involve their family members directly
in the process. These ethical considerations may ultimately help John to improve his quality of
life. The above-depicted health care ethics are the most crucial issues for the health care
personnel in treating the psychotic disorder(Sideman & Nordentoft, 2015).
Lastly, it can be concluded that psychotic disorder is a combination of various
psychological, social and as well as biological factors. There are also some neurotransmitters
which are directly involved in the development of psychotic disorders. Along with this many bad
habits and malpractices of John will also enhance the chances of being a psychotic disorder. The
use of marijuana increases the chemical transmitter of John that promotes this disease too.

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References
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