Psychiatric nursing: What does biology have to do with it?

Psychiatric Nursing: What Does Biology Have To Do With It?

Annette Hayes

There is a plethora of research that investigates the mind/body connection, This article provides a review of the advances in biological psychiatry, which includes the areas of psychobiology and psychoneuroimmunology (PNI). Psychobiology is the branch of biological psychiatry that examines the biology of thoughts, feelings, and behavior. Current research findings that illuminate the neurotransmitter systems of the brain are highlighted. Psychoneuroimmunology is a relatively new branch of science that strives to show the connections between psychology', neurology, and immunology. Research in the area of PNI has yielded much information useful to nursing. Implications of this knowledge for psychi- attic nursing are addressed. Copyright © 1995 by W.B. Saunders Company

C URRENT RESEARCH findings in biological psychiatry and psychneuroimmunology

(PNI) greatly impact nursing practice. Unfortu- nately, there is a paucity of information about these findings in the nursing literature. For example, the biological sciences have produced a copi- ous amount of research findings on PNI and established a journal devoted specifically to the topic. Yet, the Cumulative Index of Nursing and Allied Health Literature does not even list psychoneuroimmunology as a subject heading.

The nursing literature advocates the integration of advances in psychobiology into nursing practice and nursing education (Abraham, Fox, & Cohen, 1992; Hartman, 1993; Lego, 1992; McBride, 1990; McEnany, 1991; Pothier, Stuart, Puskar, & Babich, 1990). This paper provides a review of the advances in biological psychiatry, which includes the areas of psychobiology and psychoneuroimmunology (PNI) and the importance of this knowledge for psychiatric nursing. Although, it is be- yond the scope of this paper to report purely scientific findings, it provides a general under-

From the University of Pittsburgh, School of Nursing, Pittsburgh, PA,. and Conemaugh Hospital, School of Nurs- ing, Johnstown, PA.

Address reprint request to Annette Hayes, MSN, RNC, 3037 Marie Drive, Gibsonia, PA 15044.

Copyright © 1995 by W.B. Saunders Company. 0883-9417-95-0904-000853.00/0

standing of the current trends using research as a means to facilitate understanding of complex information.

Biological psychiatry is a biological science and therefore studies the living organism, focusing on the etiology and treatment of mental illness. Bio- logical psychiatry may be viewed as an umbrella term for its more specific areas of study: psycho- physiology, psychobiology, psychoneurology, psychoneuroendocrinology, psychoneuroimmunology, and others. According to Taber's (1989) psychobiology is defined as "the study of the biology of the psyche, including the anatomy, physiology, and pathology of the mind" (p. 1512). McEnany (1992) defines psychobiology as "the study of the biochemical foundations of thought, mood, emotion, affect, and behavior" (p. 100).

Psychoeuroimmunology (PNI) is a relatively new area of study in the biological sciences. George Solomon (1993) one of the early pioneers of PNI, writes an eloquent history of the evolution of PNI and dates its contemporary origins to the 1960s. Its foundations lie in the research that in- vestigated the effects of stress on the immune system. In 1975 Ader and Cohen found that psychological influences effect the nervous system, which in turn impact the immune system. It is Solomon's thesis that PNI is the integration of psychosomatic medicine, neuroscience, and immunology and that it is a "conceptual breakthrough that offers the

216 Archives of Psychiatric Nursing, Vol. IX, No. 4 (August), 1995: pp. 216-224

WHAT DOES BIOLOGY HAVE TO DO WITH IT? 217

opportunity to approach the body, its health, and disorders from a new systems theoretical perspective" (p. 352). PNI is an extension of the advances made under the genre of biological psychiatry and is in concert with our professional mandate to nurse the patient holistically. However, the do- main of this branch of science is not clear; its boundaries are vague. Perhaps as boundaries be- come more integrated, science will validate what nursing has always known intrinsically; people must be viewed in their totality and nursed holistically.

BIOLOGY OF MENTAL ILLNESS

Biological psychiatry emerged with the advent of psychopharmacology in the 1950s. In the 1970s the synapse became the focus of attention, and in the 1980s, brain research grew to include the role and function of neurotransmitters in emotions and mental illness (McEnany, 1992). Now, in the 1990s, the Decade of the Brain, research is striving to unfold the interrelatedness of mind and body.

Thoughts, feelings, and behavior are made possible by the complex communication that occurs between the cells of the central nervous system and the body in relation to the environment. The cells of the brain and nervous system are called neurons and number over 100 billion. The communication between neurons is chemical and electric in nature and occurs at the synapse, the microscopic area where two neurons meet. The neuron contains chemicals that allow the transmission of electric impulses across the synapse. These chemical com- municators are called neurotransmitters. Nor- mally, after the neuron releases a neurotransmitter into the synapse and completes its function of con- veying the impulse to the adjacent neuron, it is reabsorbed by the presynaptic neuron for further use, reuptake, or it is dissolved by an enzyme, monoamine oxidase (MAO). Research (Heilman & Valenstein, 1993; Olten & Pang, 1992) has shown that there is specificity of the neurotransmitters to certain areas of the brain, thereby gov- erning specific actions. It is this specificity of action that accounts for cognitive functioning and thus the symptomatology of mental disorders (Levin, Decker, & Butcher, 1992). There are three classifications of neurotransmitter: the biogenic amines, the amino acids, and the peptides (Kaplan, Sadock, & Grebb, 1994). Table 1 illustrates the array of neurotransmitters under each classifica-

Table 1. CNS Neurotransmitters

Biogenic Amino Peptides Amines Acids (selected few)

Dopamine GABA Endogenous opioids Norepinephrine Glutamate Substance P Epinephrine Glycine Neurotensin Serotonin Cholecystokinin Acetylcholine Sornatostatin Histamine Vasopressin

tion. The biogenic amines are more often implicated in the psychobiology of mental illness. There are six biogenic amine neurotransmitters: dopamine, norepinephrine, epinephrine, serotonin, acetylcholine, and histamine. They are all synthesized in the neuron.

Dopamine can be found in neural pathways from the frontal lobe to the spinal cord; it is specific to the areas of the brain that influence movement, memory, and emotional response. To date, five different dopamine receptors (D1_5) have been identified on dopamine specific neurons (Kaplan et al., 1994). The dopamine hypothesis of schizophrenia postulates that the available quantity of dopamine, in conjunction with the nature of synaptic receptors, is the basis for schizophrenic symptomatology. The positive symptoms of schizophrenia, hallucinations, delusions, bizarre behavior, and disorganized thinking have been correlated with the hyperdopaminergic process (Robbins, 1993). Antipsychotic medications work by blocking the dopamine receptor site (principally the D 2 receptor) on the receiving neuron at the synapse, preventing activation of the postsynaptic neuron and thereby decreasing the level of dopamine and the symptoms of schizophrenia. The different antipsychotics have the capacity to block other neurotransmitter receptors sites, which leads to variation in effectiveness and side effect profiles. It is this characteristic of antipsychotic medications that leads to polypharmacy (using two or more antipsychotics simultaneously). However, the action of antipsychotics is also found when they are used in other clinical situations, leading researchers to believe that there must be additional biological processes occurring in schizophrenia. According to Kaplan and Sadock (1994), the dopaminergic system can be influential in other psychiatric situations; drug abuse (amphetamine and cocaine) increases dopamine release and interferes with its metabolism whereas low levels of dopa-

218 ANNETTE HAYES

mine may be indicated in the psychobiology of depression.

Norepinephrine and epinephrine function similarly to dopamine and can be found in the neural pathways that serve the cerebellum, forebrain, brainstem, and spinal cord. Although the roles of these two neurotransmitters have not been fully revealed, it is thought that norepinephrine plays a major role in memory (Brito, 1992). Moreover, norepinephrine is linked with psychopathology more often than epinephrine. Like the etiologic theory of schizophrenia, mood disorders were found to respond to tricyclic and MAO inhibitors (MAOI) antidepressants, leading to the theory that depression is a result of alterations in norepineph- fine and serotonin. Tricyclic antidepressants exert their effect by blocking the reuptake of norepinephrine or norepinephrine and serotonin, thereby increasing their synaptic concentrations. MAOIs function similarly, by blocking monoamine oxidase so that it can not metabolize norepinephrine and serotonin. Nine different types of receptor sites have been identified to date (Kaplan et al. 1994). These receptor sites play an important role for other types of medications such as propranolol and clonidine, both of which are used in the medical and psychiatric setting

Serotonin is predominantly found in the neural pathways of the upper pons and midbrain, and four types of serotonin receptors have been identified (Apud, 1993). It is synthesized from the amino

acid tryptophan, found in dietary proteins including milk (McEnany, 1992). Serotonin and its receptor sites have generated a good deal of new research focused on depression and schizophrenia. The newer antidepressant medications, Fluoxetine, Sertraline, and Paroxetine, also known as selective serotonin reuptake inhibitors (SSRI), are a product of that research. SSRIs block the reabsorption of serotonin by the presynaptic neuron, which causes more of it to be available to bind to the receptors of the postsynaptic neuron. This new group of medications acts by inhibiting the reuptake of serotonin, thereby increasing the amount available at the synapse. Because neurotransmitters exhibit a specificity of action, the SSRIs have different side effects and actions than the traditional tricyclic antidepressants (see table 2 for a comparison of side effects). Moreover, because of serotonin's different pharmacological profile, it has been indicated for use in managing depression in the elderly (Salzman, 1993) and in the treatment of depressed people who exhibit symptoms of anxiety (Clayton, 1993). Buspirone is the only antianxiety medication that exerts its action on the serotonin system by inhibiting its release. For this reason it has lower abuse potential than the benzodiazepines, although it takes longer to exert its therapeutic effect (2 to 3 weeks).

Clozapine is also an outcome of the serotonin research. Clozapine does not have the affinity for the D 2 receptor, typical of the other antipsychotics.

Table 2. Side Effect Profiles of Antidepressant Medications

CNS Cardiovascular Other

Insomnia/ Orthostetic Cardiac Weight Anticholinergic Drowsiness Agitation BP Arrhythrnia GI Distress Gain

Drug

Amitr ipty l ine 4 + 4+ 0 4 + 3+ O 4 +

Desipramine 1 + 1 + 1 + 2+ 2+ 0 1 +

Doxepin 3+ 4 + 0 2+ 2+ 0 3 +

Imipramine 3 + 3 + 1 + 4+ 3+ 1 + 3 +

Nortr iptyl ine 1 + 1 + 0 2+ 2+ O 1 +

Amoxapine 2+ 2+ 2+ 2+ 3 + 0 1 +

Trazadone 0 4+ 0 1 + 1 + 1 + 1 +

Bupropion 0 0 2+ 0 1 + 1 + 0

Fluoxetine 0 0 2 + 0 0 3 + 0

Pa roxetine 0 0 2 + 0 0 3 + 0

Sertraline 0 0 2+ 0 0 3 + 0

MAOIs 1+ 1+ 2+ 2+ 0 1+ 2+

KEY: 0 = absent/rare, 2+ = occasionally, 4 + = common.

Note, Data adapted f rom Depression in pr imary care: VoL 2. 1993, U.S. Dept. of Health & Human Services Public Health Service,

Agency for Health Care Policy and Research.


It has an affinity for DI&4, serotonin, histamine, and norepinephrine receptors (Kaplan et al., 1994). Its unique mechanism of action accounts for its success in treating schizophrenia and it is now being considered for use in diverse psychiatric situations. Suppes, Phillips, and Judd (1994) suc- cessfully used clozapine to treat nonpsychotic, rapid cycling, bipolar disordered patients, who had been refractory to treatment. Meanwhile, risperi- done, the newest antipsychotic on the market, has an affinity for serotonin, histamine, and dopamine (D2) receptors. Research is limited on the benefits and risk of this new medication.

Acetylcholine is found in abundance in the central nervous system and has varying psychobiological effects. There are two major types of receptors and multiple subtypes, leading to uncertainty in the specific mechanism of action of acetylcholine (Ka- plan, Sadock et al., 1994). Dopamine and acetylcholine function in relative balance. When the amount of dopamine is altered by blocking receptor sites with antipsychotic medication, the balance is disrupted. Consequently, if the cholinergic and dopaminergic systems are not able to achieve equilibrium, the extrapyramidal effects of antipsychotic medications result: dry mouth, blurred vision, urinary hesitancy, and constipation. The administration of anticholinergic or antiparkinsonian medications (Benztropine mesylate, trihexyphenidyl hydrochloride, procyclidine hydrochloride, etc.) fa- cilitates the equilibrium of that system by blocking the acetylcholine receptors. The acetylcholine system has frequently been implicated in the pathogenesis of Alzheimer's Dementia. Acetylcholine is thought to play a major role in learning and memory (Walsh & Stackman, 1992) and most drug trails have focused on acetylcholine pharmacology (Brito, 1992; Riekkkinen et al., 1992). According to Kaplan et al. (1994), acetylcholine also may be involved in mood and sleep disorders.

Lastly, little is known about the psychobiology of histamine. It is known that histamine is integral in the dilation of small blood vessels of the periph- eral nervous system, allergic reactions, and also that it may be indicated in the psychotropic medication side effects of sedation and hypotension (Brasfield, 1991). Recently, it has also been suggested that it is involved in the psychobiology of sexual behavior, drinking, and spontaneous locomotion (Brito, 1992). Diphenhydramine, used to treat antipsychotic side-effects, not only blocks

histamine H 1 receptors (cimetidine block H2), but also effects the acetylcholine system.

Of interest in the the amino acid group of neurotransmitters, is gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that requires vitamin B6 for its synthesis. Accord- ing to Costa (1991) GABA is present in 30% of nervous synapses. It has key implications in the psychobiology of anxiety disorders (Costa, 1991; Kaplan et al., 1994). Harper-Jaques and Reimer (1992) postulate that GABA plays a role in aggressive behavior by disinhibiting impulsivity. In addition, it has been suggested that GABA is a mod- erator of sleep and plays a role in cognition and memory (Walsh & Stackman, 1992; Zaborszky, 1992). As with schizophrenia and depression, the antianxiety medications were found to have a beneficial effect in the treatment of anxiety. Benzodi- azepines are capable of activating the GABA receptor, which produces the desired response of potentiating GABA.

The peptide neurotransmitters are the newest classification to be discovered, and they outnum- ber the other classifications of neurotransmitters. Their mechanism of action is poorly understood, but it is suggested that they partially serve as reg- ulators for the other neurotransmitters because they are often found together in the same neuron with the neurotransmitters previously described (Kaplan et al., 1994; Zaborszky, 1992). There are many peptides, including the following: endogenous opi- ods, found to coexist with serotonin and norepinephrine neurons and are thought to be involved with stress, pain, and mood; substance P, thought to coexist with acetylcholine and norepinephrine, primarily found in sensory neurons; neurotensin, often found in conjunction with dopamine and hence involved with schizophrenia; cholecystokinin, also found to coexist with dopamine and GABA, has been indicated in eating disorders; and somatostatin, found in GABA and norepinephrine neurons has been implicated in Huntington's disease and Alzheimer's (Kaplan et al., 1994).

The psychobiological mechanisms of thoughts, emotions, and behavior are an intricate and not thoroughly understood system. The various neurotransmitter systems do not operate in isolation. There is a hierarchal order depending on need, similar in nature to the functioning of a symphony orchestra. Moreover, it is proposed that the neurotransmitter systems have the capacity to compen-

220 ANNETTE HAYES

sate and adapt when there are weaknesses or changes in functioning of the other systems (Brito, 1992). The following poem by R.W. Russell (1992) explains it this way:

We may live without conscience; we may live without

heart. We may live without poetry, music, and art. We

may live without politics or nuclear fission. But no one can

live without neurotransmission.

In conclusion, it would appear that neurotransmitters are a salient point, though not a solitary point, in the etiology and management of alterations in mental health (the reader is reminded that this is a simplistic description of a complex process; for a review of psychobiological concepts see McEnany, 1992).

PSYCHOLOGY AND THE IMMUNE SYSTEM

The purpose of the immune system is to protect the body from malignant and infectious microor- ganisms (personal communication Rabin, 1994). The work of the immune system is carried out in various parts of the body: the lymph nodes, spleen, bone marrow, tonsils, thymus, appendix, and small intestine. The circulatory system provides the means for cellular communication and surveil- lance. There are many different types of cells that comprise the immune system: neutrophils, mono- cytes, eosinophils, basophils, and lympocytes (which includes: B, T, and natural killer lymphocytes). Lymphocytes are an important component in immune functioning and their activity is often used as a measure of immune functioning in research. The exact mechanisms of immune system functioning are complex and remain under study (the reader should refer to any current textbook on immunology for further elaboration).

The CNS and the immune system have some similar characteristics. For example, both systems have the capacity of memory; they can react faster and with greater specificity to a second encounter with the same stimulus. Moreover, the immune system, like the CNS, responds to diverse stimuli with circumscribed responses. Rabin, Cohen, Ganguli, Lysle, & Cunnick (1989) delineate the bidirectional nature between the CNS and the immune system. Each system is affected by the activity of the other. The psychobiology of the CNS impacts the immune system as the research findings explicated below will reveal. Conversely, the immune system can affect the CNS through au-

toimmune disease, though this link is less well established.

There is a plethora of research examining the relationship of psychological stress and immune system functioning. Herbert and Cohen (1993b) conducted a meta-analytic review of the literature on stress and immunity. Stress was defined in these studies as negative life events that were ei- ther interpersonal or nonsocial in nature. The pres- ence of stress was shown under diverse conditions, for example: taking academic exams (Kiecolt- Glaser Glaser et al., 1987), social support and job strain (Theorell, Orth-Gomer, & Eneroth, 1990), caregiving for a family member with dementia (Kiecolt-Glaser, Dura, Speicher, Trask, & Glaser, 1991), experimenting marital conflict (Kiecolt- Glaser, Fisher et al., 1987), and daily hassles (Ku- bitz, Peavey, & Moore, 1986). Herbert and Co- hen's (1993b) findings showed a statistically significant relationship between stress and immune system functioning. Specifically, in the stressed populations white blood cell counts were elevated, while T, B, and NK cells were lowered. Also, antibody titers to Epstein-Barr virus (EBV) and Herpes-simplex virus (HSV) were elevated in those studies that used hyperviruses as indicators of immune function. Further, alteration of immune function continued when the duration of the stress was long term. Likewise, Lutgendorf, Antoni, Ku- mar, & Schneiderman, (1994), examined the effects of stress by having subjects disclose trau- matic events. The results of the study indicated that psychological stress can adversely affect immune function. Those who were more involved in the disclosure showed greater immune changes.

Of particular benefit to psychiatric nurses is a study by House, Landis, and Umberson (1988) that found social isolation to be a major risk factor for disease, especially in the elderly, the poor, and African Americans. Persons who were socially isolated and hence at less risk to acquire an infectious disease had greater morbidity. Social isolation was equated with smoking, blood pressure, obesity, and infrequent physical activity (Ca- cioppo, 1994). The connection between lack of social support and altered immune functioning has repeatedly been shown in the PNI research (Kie- colt-Glaser & Glaser, 1992). Interestingly, nursing has always been aware cognitively of the detriment of social isolation and this research has validated this knowledge.


Research findings have been strong in linking depression with alterations in immune system functioning (Birmaher et al., 1994; Herbert & Co- hen, 1993a; Rabin et al. 1989). Specifically, an increased number of circulating white blood cells and a decreased number of lymphocytes have been found in depressed individuals. The most promi- nent alterations in immune functioning were found in older and hospitalized populations. Likewise, Birmaher et al. (1994), in a study of adolescent subjects, found that the incidence of adverse life events was correlated with a lowering of lymphocytes. Herbert and Cohen (1993a) described the possible neuroendocrine and behavioral mechanisms as follows: 1) depression and/or stress acti- vate the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, both respond by releasing cortisol and catecholamine (dopamine, norepinephrine, epinephrine), respectively. Im- mune cells have receptors for cortisol and catecholamines. These substances have the capacity to bind with lymphatic cells and suppress the immune system; 2) actual behavioral manifestations of depression can also account for altered immune functioning. These include changes in sleep, appetite, and activity patterns, as well as increased substance abuse. These findings raise the question of the effect of health practices on immune function. Herbert and Cohen found little evidence in the literature to support a connection between health practices and immune function, but did recount how smoking was found to be a strong predictor of the number of neutrophils and lymphocytes in cir- culation.

Schizophrenia has long been postulated as having an autoimmune component. An autoimmune disease is characterized by the development of antibodies (autoantibodies) to self antigens. Rabin and colleagues (1989) have been studying the hypothesis that autoimmune mechanisms are integral to the pathogenesis of schizophrenia. In a compre- hensive report of their findings they found preliminary evidence that supports their hypothesis: 1) there was an overproduction of autoantibodies and a higher incidence of autoimmune disease in the schizophrenics studied; 2) schizophrenics had a re- duced number of T suppressor cells, which affects immune function; and 3) in schizophrenic brain samples the researchers were able to show specific antibodies to a brain antigen (in this sample, no normal controls were used). As of yet, there is no

conclusive findings to support or refute the autoimmune premise.

The sequela of altered immune functioning, in terms of specific disease pathogenesis, has yet to be elucidated. In one of the few studies to examine long-term physical outcomes, Bartrop et al., (1990) studied bereaved spouse subjects (n = 72 bereaved and 80 controls) for 11 years. Bereaved subjects were found to have significantly more and longer lasting diseases of the circulatory system and psychiatric disorders. All the bereaved subjects experienced a minimum of one illness (respi- ratory and musculoskeletal illnesses were also re- ported). Those who experienced frequent illness in the 2 years after the death of a spouse also had more illness in the remaining years of the study. Hopefully, as this area of science expands the mind/body connection will be increasingly clari- fied.

IMPLICATIONS FOR PSYCHIATRIC NURSING

Psychiatric nurses have traditionally been trained in an interpersonal model of care that only slightly focused on biology. However, it is now apparent that there is a need to incorporate all mod- els of knowledge. Lego (1992) synthesizes it this way: "psychiatric nurses offer patients an atmo- sphere or a relationship designed to change the patient's interpersonal situation, thus changing the intrapsychic situation, thus changing the brain chemistry" (p. 148). This passage reaffirms the need of psychiatric nurses to consider the patient in a holistic manner. It is clear that mental health is not merely the synchronous functioning of neurotransmitters. Nor is it merely the optimal use of coping resources. Mental health, even in the pres- ence of mental illness, is advanced by the harmo- nious functioning of all systems (biological, psychological, and environmental) that make up who we are as human beings.

Psychosocial interventions can impact on biological functioning; as indeed, biological interventions can impact on psychosocial functioning. As has been identified in this paper, stress has a tre- mendous influence on health. For example, typi- cally the hospitalized patient is stressed and feels a sense of isolation. Psychosocial interventions that target this area can be extremely successful in decreasing the negative sequela of stress. Knowing that isolation and stress alter immune function and increase the release of catecholamines, specific in-

222 ANNE] rE HAYES

terventions that increase the patient's connections with his/her world would be beneficial. The psychiatric nurse can facilitate the patient's ability to maintain contact with significant others, while pro- viding emotional support, reassurance, and addressing fears related to hospitalization. Changing the social context, or the way in which a person thinks about or interacts with others around them, can influence an individual's physical and psychological response to stress (Cacioppo, 1994, p. 113). Moreover, psychiatric nurses are in an ideal position to teach stress management skills to hospitalized patients and their families.

Biological interventions for the hospitalized patient might include medication administration. It would be important to remember that the elderly need less medication. Aging causes changes in the neurotransmitter systems and this is usually man- ifested in a decline in cellular functioning (Russell, 1992). Also, after long-term use of antipsychotics, there is a decrease in the firing rate of dopaminergic neurons, which affects the amount of medication needed (Kaplan et al., 1994).

Nutrition is also a biological intervention that psychiatric nurses can address. Nutritional defi- ciencies can result from inadequate intake, pov- erty, anorexia, drug and alcohol abuse, physical illness, and psychosis. Alterations in nutrition can hinder synthesis of neurotransmitters and cells of the immune system. For example, serotonin and GABA both require B vitamins for their synthesis. Foods rich in B6 include yeast, wheat, corn, and liver. Tryptophan, which is integral to serotonin and found to cause depression in persons who had it removed from their diet (Lader, 1994), is found in milk, meat, peanuts, and beans. Moreover, the immune system requires ample protein, vitamin C and E intake to function properly (Carter, 1993). Vitamin E can be readily found in vegetable oils, wheat germ, milk, eggs fish, cereal, and leafy vegetables. Vitamin C can be found in citrus fruits, potatoes, and green and yellow vegetables. Vita- min E is stored by the body while Vitamin C is not. The body requires increased amount of vitamin C during times of physical and psychological stress. An appropriate nursing intervention is to first as- sess nutritional status by ascertaining the patient's dietary habits. The nurse might also consider sup- plemental vitamin administration and assisting with menu selections in addition to possible nutritional counseling by a dietitian. The psychiatric

nurse uses a host of nursing actions that are both biological and psychosocial in nature. However, current research findings gives nurses a better understanding of the ramifications of their nursing actions.

Trygstad (1994) recently surveyed psychiatric nurses from 12 diverse inpatient facilities to deter- mine their learning needs in the biological sciences. Knowledge of medications was found to be a significant area where nurses felt they needed new knowledge. Most of the knowledge deficits identified were in areas addressing the psychobiology of medications including their effects and side effects. As patient populations change to include the more physically ill, psychiatric nurses feel less prepared. Hopefully, this article will ful- fill some of that need.

CONCLUSION

It is important for psychiatric nurses to under- stand the current trends in the biological sciences, so that patients can be better served. During these times of shortened hospital stays and fiscal chal- lenges, it is paramount that nurses stay abreast of current research findings to provide the most ef- fective, cost efficient, and patient-centered care possible. Moreover, it is imperative for nurses to incorporate the results of research into their practice so as to maintain professional growth in a time when financial resources govern. Finally, nurse researchers need to conduct research that uses knowledge from the biological sciences while fur- thering the science of nursing.

ACKNOWLEDGMENTS

The author acknowledges the assistance of Dr. Kath- ryn Puskar and Dr. Bruce Rabin, both from the Univer- sity of Pittsburgh.

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Psychiatric nursing: What does biology have to do with it?