Integration of the Biopsychosocial Model in Contemporary Psychiatryby Shaheen E Lakhan, MD, PhD, MEd, MS | March 26, 2006
Psychosis involves a disconnection with reality and perceptions outside the range of normality. Moreover, it is the common multifaceted symptom of psychotic disorders often accompanied by behavioral abnormalities and cognitive impairments. In fact, such characteristics are used to differentially classify conditions. Not only do these special illnesses require substantial medical care, but clinical management involves multidimensional schemata pursuant to the biopsychosocial model.
Psychotic disorders are unique, for they are capable of changing the affected person beyond the scope of more biological ailments, such as cancer. Whereas cancer has distinct TNM classifications (tumor, necrosis, metastasis), disorders involving psychosis are less categorized by biology and neuropathology. Patient and family interviews and medical histories are used for a comprehensive assessment for psychiatric diagnosis. The heterogeneous nature of mental illness is somewhat delineated by the use of diagnostic manuals. Even then, persons diagnosed with the same psychiatric disorder may not necessarily share the same disease etiology. Moreover, psychosis often accompanies poor insight or the “inability to recognize a morbid process within oneself” (ignorance of being ill). Patients who are able to secure treatment are frequently unmindful of their illness.
Diagnostic classification manuals such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (APA, 1994) serve as provisional constructs allowing the international biomedical community to employ inclusion and exclusion criteria based on potential deviations from normal psychological functioning. In fact, they explicitly serve not to educate a particular etiology or pathology. Rather, they reasonably classify disorders by symptom profiles for effective universal communication. Essentially, manuals offer standards for symptom definition and differential diagnosis. However, in the 1980’s the American Psychiatric Association promoted the integration of the biopsychosocial model in contemporary psychiatry.
The American Journal of Psychiatry established treatment recommendations for patients with psychotic disorders (2004). The health care management is delineated into seven phases:
1. Assessing symptoms and establishing a diagnosis.
2. Developing a plan of treatment.
3. Developing a therapeutic alliance and promoting adherence.
4. Providing patient and familiar education and therapies.
5. Treating co-morbid conditions.
6. Attending to the patient’s social circumstances and functioning.
7. Integrating treatments from multiple clinicians.
It is noteworthy to highlight the (ideal) collaboration efforts of practitioners across the biopsychosocial model in the management of psychotic disorders, namely schizophrenia. It is the most debilitating psychiatric disorder, requiring a disproportioned share of medical resources due to its early onset and chronic and severe nature. Modern views on schizophrenia stem from Krapelin (1971) and Bleuler (1950), who underlined long-term deterioration and explicated loose associations in the disease process, respectively. It has since evolved and the medical community has adopted a more objective and rounded diagnostic criteria found in the DSM-IV. In a therapeutic alliance, both psychopharmacological and psychosocial interventions are described as to treat both acute and stable presentations of schizophrenia.
Anonymous. (2004). Part A: Treatment Recommendations for Patients with Schizophrenia. American Journal of Psychiatry, 161(2), 3-56.
APA. (1994). Diagnostic and Statistical Manual of Mental Disorders DSM-IV. New York: Amer Psychiatric Pub.
Bleuler, E. (1950). Dementia praecox or the group of schizophrenias. New York: International Universities Press.
Kraepelin, E. (1971). Dementia praecox and paraphrenia. New York: Krieger.
Mental Context – A Delicate Subject
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