Case Study Essay: Biopsychosocial Factors, Nursing, and Ethics

This essay provides a comprehensive case study analysis of Susan, a 56-year-old woman diagnosed with bipolar disorder (BD). The analysis begins by defining the biopsychosocial model and identifying the biological (genetic lineage), psychological (loneliness), and social (lack of social security) factors contributing to Susan's condition. The essay then discusses the nursing interventions suitable for Susan, including Mindfulness-Based Cognitive Behavioral Therapy (MB-CBT), monitoring lithium levels to prevent toxicity, and strategies to increase medication adherence. Furthermore, the essay addresses the ethico-legal implications of the Mental Health Act in Queensland, emphasizing the importance of comprehensive assessment, patient rights, and informed decision-making. The conclusion summarizes the key biopsychosocial factors and the recommended nursing interventions, highlighting the role of the mental health nurse in providing holistic care and advocating for the patient's well-being, considering ethical and legal guidelines.

Running head: MENTAL HEALTH
Mental Health
Name of the Student
Name of the University
Author Note

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Introduction
Mental health condition hampers the health and well-being of a person. Proper
designing of nursing intervention and highlighting biological, psychological and social
factors help in mitigating the side-effects of mental health complication (Queensland Health,
2016). The following essay is based on the case study of Susan, a 56 years suffering from
bipolar disorder (BD). Bipolar disorder is characterised with episodic mood swing leading to
mania and depression (Grande et al. 2016). The essay is aim to discover the biopsychosocial
factors that have promoted to the disease development in Susan. According to the
biopsychosocial model of the mental assessment, the development of the mental health
complications within a particular individual is inherently linked with several factors like
biological, social and psychological (Naylor et al. 2016). The essay will also state three
nursing interventions directed towards Susan and management of other ethico-legal
implications.
Biopsychosocial model of assessment (150)
Naylor et al. (2016) are of the opinion that psychotherapists approach in order to
conduct mental health assessment has a significant influence over the conceptualization and
treatment of mental health. In order to biological, social and psychological factors
contributing to the disease development a detailed assessment of the individuals must be
understand. The assessment of the individual must be taken in the domain of mental health
history, history of the mental health and family, history of substance abuse, medical history,
the degree of trauma, forensic history, cultural and spiritual needs of the individual and the
overall presentation of the problem. Hodgson, Lamson and Kolobova (2016) are of the
opinion that in order to get a detailed overview of the psychological factors promoting to the

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development of the mental health complication, proper Mental State Examination is required
to be undertaken.
The factors contributing the development of bipolar disorder
There are two types of bipolar disorders namely bipolar I disorder, bipolar II disorder.
In bipolar I is characterized with one or more manic episodes or mixed (mania and
depression). In bipolar II disorder there occurs severe major depressive episodes along with
one hypomanic episode. There are no manic or mixed episodes. Susan is suffering from rapid
recycling bipolar disorder (RRBP) (Grande et al. 2016). Susan has numerous admissions to
hospital and her last admission was six months ago for mood stabilization. Grande et al.
(2016) reports that in RRBP, the cycle of elevated mood to depression surface at least 4 times
per year and the condition is more common in women than male. The risk factor that triggers
the BD include having a first-degree relative with BD like parent or sibling, high periods of
stress, anxiety or depression, traumatic event in past like sexual or physical abuse and
substance abuse like uncontrolled intake of alcohol, drugs and tobacco (Grande et al. 2016).
Biological factor contributing to disease development: Genetic lineage
The biological factor in Susan that contributed to the disease development is genetic
lineage. The case study revealed that Susan’s brother also suffered from Bipolar Disorder
(BD) and committed suicide 10 years ago. According to Amerio et al. (2015), the people who
are suffering BD are more likely to have family history for mood disorders. Özdemir et al.
(2016) further highlighted that there is a significant relationship between the level of kinship
and subsequent heritability of the mood disorders like BP. The study also highlighted that the
susceptibility of the disease either in the paternal or maternal side is equally significant
towards genetic transmission of the disease. For the hereditary pattern in BD, the genetic
transmission of the disease is complex and might also take place through autosomal

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transmission or through non-mendelian hereditary inheritance (mitochondrial). In case if
Susan, the mode of transmission of the pattern of transmission is not clear as the case study
failed to highlight the mental state of Susan;;s mother or father.
Psychological factor contributing to disease development: Loneliness
Several psychological factors contribute to the development of bipolar disorder.
Social cognition, comprehension of emotion, theory of mind, autobiographical memory,
empathy is few of the psychological aspect that contributes the development of BD (Fletcher,
Parker & Manicavasagar, 2014). The case study reveals that Susan was devoted to her mother
who passed away 2 years ago. Susan was never married and her brother committed suicide 10
years ago. Both her sisters are married. Thus, she has no companion at home. Keyes et al.
(2014) are of the opinion that staying alone and sudden loss of parents, increase in the
vulnerability of developing BDs. The tenure of bereavement is associated increased risk of
developing multiple psychiatric disorders and the severity of the disorder increases with time.
The main symptoms exhibited include maniac episodes along with increased rate of anxiety.
This cumulates to the development to bipolar disorder. Susan has a long history of BD but
staying alone at home with no companion further lead to the development depression and this
in turn transforms into periodic outbreak of manic episodes (Fletcher, Parker &
Manicavasagar, 2014). The loneliness of Susan is evident from her animated conversations
about holiday trips with her friends in the middle of night.
Social factor contributing to disease development: lack of social security
Susan is an attractive woman who loves to dress in bright yet flamboyant colours and
applying vivid make up. She also found patting her arm to nurse, calling her “darling”. She
was also found objectifying her body and has been disinhibited while talking with male
neighbours. Holt-Lunstad et al. (2015) stated that with aging, the overall burden of mental

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illness increases. Such burden is not only dependent on the magnitude of depression,
dementia or schizophrenia but also relies on other types of social supports and institutional
arrangements coming from family members. Though Susan’s sisters cares for her, but they
are unhappy with the extravagant expenditure Susan make on her shopping. At present Susan
is unemployed and has her disability pension and is dependent on her sisters to carry out her
expenses. The lack of social security either from spouse or through job is the reason behind
the disease development of Susan (World Health Organisation, 2014). The absence of the
social security, Susan is suffering from low self-esteem and this might be a reason her
extravagant dressing sense and over-friendliness with the people from opposite sex and
manner in which she objectify her own body. Prolong tenure of social insecurity leads to the
development of BD (Holt-Lunstad et al., 2015)
Nursing interventions
Nursing intervention 1: Psychological therapy: Mindfulness-based cognitive
behavioural therapy (MBCBT)
MB-CBT is a modified version of cognitive behavioural therapy that use mindfulness
practices like breathing and medication exercises. By the application of these tools, MB-CBT
therapists help the client to understand how to drift apart from the negative thoughts and
leads to downward depressive state of mind (Lovas & Schuman-Olivier, 2018). Chiang et al.
(2018) stated that MB-CBT is helpful in decreasing the relapse of BD, both type I and type
II. It also helps in improving the depressive symptoms, severity of mania and other complex
psychological functioning of the body. The application of the MB-CBT will help to Susan to
recover from frequent episodes of depression. The application of the mindfulness-based
therapy by the nursing professional must be undertaken in the presence of a trained
psychotherapist. The application of the therapy can be both under the hospital setting of in

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residential settings however, the surrounding environment must be quite or non-stimulating.
The proper application of the MB-CBT will help Susan to recover from her sudden
depressive state of mind and thereby helping to increase the medication adherence. However,
Lovas and Schuman-Olivier (2018) are of the opinion that application of the MB-CBT is not
suitable during acute manic stages. It would be the duty of the psychotherapist to understand
the appropriate stage of the MB-CBT application. T
Nursing intervention 2: Monitoring periodic lithium levels
Lithium, the mood stabilizer is not metabolized. It is reabsorbed in the proximal
tubule and is subsequently excreted through urine. The periodic concentration of lithium in
the body needs to be monitored in order to ensure clients’ safety. The toxic level of lithium is
denoted when its concentration in the blood serum increases above 1.5mEq/L (Alda, 2015). It
would be the duty of the nursing professional to monitor the patient strictly in order to
identify the signs of lithium toxicity. The preliminary signs of lithium toxicity include
increase level of nausea, vomiting, decrease co-ordination, slurred speech, drowsiness,
weakness in muscles and diarrhoea. Any possible indication of lithium toxicity must be
handled with immediate cessation of medication along with informing the concerned doctor.
Malhi and Outhred (2016) are of the opinion that gastric lavage or administration of
intravenous saline injection can be used to remove oral lithium or removal of lithium through
urine respectively.
Nursing intervention 3: Increase in medication adherence
Susan is prescribed with 250 mg of Lithium in the morning and 500 mg at night along
with 100 mg of Sertraline during the morning. Lithium is used as a mood stabilizer and
Sertraline is anti-depressant. Her current psychological stage is attributed to lack of
compliance of medication management. However, case study highlights that Susan is till now
not willing to take medication and does not want her mood to get levelled as she loses the

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feeling of exhilaration. Thus nursing intervention will include education of the primary care
giver, Susan’s sisters about the importance of medication management in case of Susan and
intake of medication must be management regularly. Susan’s health literacy though important
but will not help to bring any change in the therapy plan at this stage due to complex mental
orientation. The increase in healthy literacy of family members will help to increase
medication adherence of Susan and thus helping to reduce her episodic mood swing
(Riebschleger et al., 2019).
Ethico-legal implications
The Mental Health Act, Queensland (2016), is a legally binding document that
highlights the legislation of involuntary assessment followed by treatment and protection of
person suffering from complex mental illness. Thus under this ethico-legal implication, it is
the duty of the mental health nurse to conduct a comprehensive assessment of Susan in order
to improve her overall health and well-being. The comprehensive assessment of Susan must
be done with the help of the mental health assessment tool of through DSM-V in order to
understand whether Susan is suffering from BD1 or BD2. This understanding will help in the
implementation of the person-centred interventions (Queensland Health, 2016).
The Mental Health Act also promoted Safe-guarding of the rights of the person
suffering from mental health. The main ethico-legal right of the person suffering from mental
health complications include respect to autonomy, beneficence (doing good), non-malefience
(avoiding harm) and providing justice, veracity (telling the truth) and fidelity (Queensland
Health, 2016). The case study highlight the Susan is reluctant in getting admitted to hospital.
Thus it would be the duty of the nursing professional to tell her the truth (veracity) about her
current mental health condition and why she needs treatment. This will help to increase her

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health literacy while increasing the provision for informed decision making. Informed
decision making will help to respect the person’s autonomy (Queensland Health, 2016).
Conclusion
Thus from the above discussion, it can be concluded that the main biopsychosocial
factors that are contributing to the development of BD in Susan is her hereditary lineage
(biological), her loneliness or lack of companionship at home (psychological) and lack of
proper job and social security as she is not married and is at present unemployed (social). The
main nursing interventions that will be suitable for Susan include implementation of the MB-
CBT in order to reduce the depressive state of mind, proper monitoring of the patient in order
to detect any possible signs of lithium toxicity and increasing the health literacy of the
primary care givers of the family members. It would also be the duty of the mental health
nurse to function as per the guidelines of the Mental Health Act proposed by Queensland
Government in the year 2016 in order to secure the ethico-legal guidelines.

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