Treatment of Schizophrenia - Essay Example

Reflective Case Study on A Beautiful Mind [Client’s Name] [School/University] The identification of schizophrenia is very important in designing athe treatment process and medication of the mental disease. Mental and psychological disorders have been well understood in the modern world. Today, clinical identification of mental and psychological disorders can be easily done using clinical tools such as DSM-IV TR. However, such thing could not be said about those that have serious mental and psychological issues before the development of the clinical tools employed in modern times. In those times, there is no way for psychologists and clinical practitioners to determine the mental condition of individuals during the earlier periods and so such cases remained untreated until they become fully developed that treatment can no longer be applicable. This is the predicament experienced by John Nash in his life and as was depicted in A Beautiful Mind. Synopsis A Beautiful Mind is a biographical sketch of John Nash (played by Russell Crow), a mathematical genius from West Virginia who won a Carnegie Prize in Mathematics and was considered as the most promising mathematician during the 1950s. Nash’s work on Game Theory was very impressive that it became one of the most important foundations in modern economics. He was also made prominent by his proofs on the most difficult mathematical problems of all time, making him very close in prominence to geniuses like Newton and James Clark Maxwell. However, his genius came with a price. John Nash was afflicted with paranoid schizophrenia which he endured for more than 30 years. The main foci of the film are the genius of John Nash and the price he has to pay for being one. The first part of the film showed how he achieved his moment of ‘enlightenment’ when he formulated his Group Dynamics Theory, a theory that prompts major revision of the existing economic theories during the period. The young genius, however, finds it hard to make positive social relationships. He is competitive by nature and does not share a lot about himself to other students. These characteristics have aided the development of his mental instability. Moreover, his introvert behavior and his lack of proper social skills made it hard for anyone to notice that there is something wrong with his mental wiring. The closest semblance he has to a positive social relationship is with his roommate, Charles Hermann who is a literature student. The later parts of the movie showed his marriage to his student Alicia (played by Jennifer Connely) and his slow decent towards madness. He became an unwilling spy for Department of Defense (DOD) under Parcher for many years. As the years go by, solving and decoding secret algorithms around him became a norm. He was detached even though he has married, confined in his own mad world filled with people depending on him for salvation. Later, he figured that there are people wanting to capture and kill him for the information he provided Parcher. However, it was established that he was actually mentally ill with what is now known as paranoid schizophrenia, one of the several types of schizophrenia where the person afflicted with the condition has an abnormal interpretation of reality. Because of his mental instability, Nash’s personal and professional life suffered tremendously. He lost his job and he almost lost his family to his delusions. The last leg of the film showed how Nash was able to confront his demons. All these time, Nash did not look beyond the things and events in his life. His social aloofness allowed him to create walls that are too thick for any healthy and positive social connection to occur. Moreover, the walls he created left him with his thoughts that run very wild over the years. It turned out that his roommate Charles, Charles’ nephew Marcee, and the head of the intelligence office Parcher are all part of his delusions. It took him quite a long time before he identified that what he felt, seen or heard were all fabrics of his imagination. When he finally came around after a long and painful process, Nash got back his job and won once again the respect of his colleagues. At the closing of the film, the three entities from his mind watched him as he was about to leave the auditorium in Stockholm during the Nobel Prize awarding ceremony. Nash ignored these three characters which signifies that he has finally understood that these characters are figments of his imagination. Reflection Judging the movie on the merit of its ability to portray the internal struggles of a person with paranoid schizophrenia rather than on the accuracy of the portrayal of the life of Nash, any critic could argue that the movie is brilliant as much as it is moving. For example, Nash did not actually experience seeing Hermann or Parcher but rather he heard the voices of these entities on his head but the movie showed them as real individuals he get tot interact with. Although the movies personalized these hallucinations, the producers admitted of paying more attention to the dramatization of Nash’s life and what he went though rather than on the accuracy of the film or of Nash’s actual schizophrenic experience. (SIGNS AND SYMPTOMS) Symptoms Schizophrenia is characterized by paranoid delusions (unreal beliefs), auditory hallucinations, social dysfunction, and disorganization of speech and thinking (Addington et al, 2005). There are five known types of schizophrenia whose development depends on the progress of the symptoms experienced by patients. These are paranoid, hebephrenic, catatonic, residual, and undifferentiated schizophrenia. The type of schizophrenia acquired by patients tends to change over time since the stages of development of schizophrenia changes (Podsobinski, 2007). This means that patients with one type of schizophrenia may develop other types of schizophrenia in the long run. Unlike other forms of schizophrenia, paranoid schizophrenia typically does not include disorganizations of speech and thinking. This is seen in the case of John Nash. John Nash has remained one of the most prominent thinkers of the modern times even though he has suffered mentally from the illness. In the movie, John Nash was already experiencing the onset of his mental condition while in Princeton. This takes the form of hallucination where he unknowingly created the character of Charles Hermann, his roommate that studied literature. Apparently, Nash has no idea that Hermann is unreal.. In the movie, Nash’s interaction with Herman is so true that anyone would believe that Hermann is one of the many geeky and nerdy Princeton University students. Despite the early onset of hallucinations, Nash remained very intelligent. Nash’s intellectual capacity which remained sharp (albeit hazy at times) is one of the solid proof that paranoid schizophrenia does not affect the organization of thoughts. Typical manifestations of paranoid schizophrenia include preoccupation with more than one delusion [or thoughts of grandeur and persecution (or both)] and frequent auditory hallucinations (Andreasen et al, 1999). A delusion is a strong belief of or about something which clearly unreal or does not happen in real life (First et al, 1995). Delusions that are experienced by patients having paranoid schizophrenia can be bizarre (totally impossible) and non-bizarre (can be possible). In John Nash’s case, his delusions or belief of grandeur is considered non-bizarre and is composed mainly of being a part of a government’s agency that hired his intellectual skills to decode encrypted messages in the news and in other publications. Nash’s delusions are considered non-bizarre because there is a strong semblance between his delusions and his reality. His intellect is superior compared to everyone around him which makes him stand out from the rest. The superiority of his thoughts made him an important person during the Cold War where his mathematical prowess was needed to decode an encrypted message from the enemy of the United States. Eventually, a William Parcher (played by Ed Harris) made contact with him and recruited him to join the Department to crack codes to ensure the safety of the general American public. Parcher left Nash with very specific instructions on how Nash should send him the cracked code. However, it was later revealed that the whole experience with Parcher was a part of his delusions. Nash was made to feel that he is an indispensable citizen and that his genius is one of the main elements in keeping the peace achieved by the American people. This clearly is a constructed thought of grandeur. People afflicted with paranoid schizophrenia are constantly in fear of persecution and harbor mad thoughts and attitudes which very often results in self-destructive behaviors (Andreasen et al, 1999). Oftentimes, the paranoia experienced by these patients tends to go through the extreme, making them do crazy things in the process. In the case of John Nash, his paranoia is shown in the movie as the “undercover Russian agents” that are out to get him for helping the US government decode the encrypted messages. He even considered the officials of the psychiatric facility as Soviet kidnappers even though it was clear that the intention of these people is to treat him. He also attempted to manually remove the implants he got on his arm (which was also a part of his delusion) in order to avoid the Russian agents from tracking him. (CURRENT PREVALENCE OF THE CONDITION) Paranoid schizophrenia is responsible for 40% of all the cases of schizophrenia (Michels & Michels, 1997). Symptoms of schizophrenia tend to appear during early adulthood (from 25 to 30 years old). While there is no way to exactly determine the speed of the mental degradation of patients, clinical observations as well as the accounts of the relatives indicate that paranoid schizophrenia is marked by anger, irritation, extreme jealousy, and overly argumentative behavior (First et.al., 1995; Fujinawa, 1981). Negative manifestations of paranoid schizophrenia include the lack of behavior which is typically seen as lack of emotion or inappropriate emotional response. In the case of John Nash (as was shown in the film), it took a number of years interval before his mental condition developed into a full blown paranoid schizophrenia. (SUGGESTED AXIS OF THE CONDITION) Paranoid schizophrenia is classified under AXIS I of DSM-IV TR (Podsobinski, 2007). Axis I contains all conditions of the mental health except for mental retardation and psychological disorders. Mental disorders that belong to Axis I are typically the disorders that require immediate attention or those disorders that typically bring patients to clinic doors. Schizophrenia Causes The causes of schizophrenia were not yet established although some environmental and genetic factors are known to increase the probability of developing paranoid schizophrenia (Fujinawa, 1981). Individuals that have family members with history of schizophrenia are 10 times more likely to develop the disorder compared to individuals from the general population (Kendler & Hays, 1981). However, the development of schizophrenia is not determined by genetic components; rather, schizophrenic disorder is influenced by it. Data indicates that about 60% of the patients diagnosed with schizophrenia do not have family members that have the same diagnosis (Peled, 1999). Another possible cause of paranoid schizophrenia is the influence of the environment on individuals. Some of the environmental risk factors in the development of schizophrenia include malnutrition and exposure to viruses while the baby is in the womb or during infancy and the experience of trauma and abuse during childhood (Winokur, 1985). There are researches that showed that the elevated production of cortisol increases the probability of developing paranoid schizophrenia (Andreasen et al, 1999; Peled, 1999). The body produces the hormone cortisol when it is under stress for a prolonged period of time. The presence of excessive dopamine and low levels of glutamate also contributes to high risk of developing paranoid schizophrenia (Beck & Trowsdale, 2000). Dopamine was earlier identified to be one of the main indicators of chemical imbalances occurring in the brain of patients with schizophrenia (Crowe et al, 1979). Excessive dopamine in the brain restricts the production of glutamate. Excessive dopamine in the synaptic gap can be acquired from the use of amphetamine (Seeman et al, 1976) which explains why individuals under the influence of amphetamine experience delusions and paranoia similar to that of schizophrenia. Since A Beautiful Mind focuses largely on the development of Nash’s schizophrenia that there is nothing said about his life as a young boy or about his nuclear family, it is very hard to determine whether his paranoid schizophrenia is influenced by genetics or was triggered by environmental factors such as drug dependence. What could be a more likely case that influence the development of Nash’s schizophrenia is too much mental stress and fatigue. It is somehow clear from the development of the movie that John Nash is not an ordinary person. Instead of socializing with his friends and fellow bright students, Nash lived a life apart from the rest of the society. He has confined himself in a very lonely space where his only comforts are his thoughts and the mathematical problems running through his head. As was seen in the movie, Nash spent months working diligently on mathematical problems. One can only imagine the mental stress caused by his very strong focus on the problems at hand. Since Nash was not shown to take any form of drugs containing amphetamine, it is most likely that the environmental factor that triggered the development of his paranoid schizophrenia is the increased cortisol levels caused by the level of stress he experienced solving mathematical problems. Treatments Paranoid schizophrenia is commonly treated with medications and psychological interventions (Lieberman et al, 1996). The earliest type of antipsychotic medication includes chlorpromazine, clozapine, olanzapine, haloperidol, and trifloperazine. There are two general classifications of antipsychotics – the typical antipsychotic and the atypical antipsychotics (Perkins & Liberman, 2006). Typical antipsychotics (or first generation antipsychotics) are developed to specifically treat acute mania, agitation, and other conditions related to schizophrenia. Second generation antipsychotics have similar function to first generation antipsychotics but on a wider scale which typically include bipolar disorder and psychotic mania (Kalinowsky, 1980). Other approved modern treatment programs for paranoid schizophrenia include nicotine patch, cognitive – behavioral therapy, meta-cognitive training, and family therapy or education (Kendler & Hayes, 1981; WInokur, 1985; Zimmerman et al, 2005). However, some of these antipsychotics induce other physical and psychological diseases like weight gain, myocarditis, and neuroleptic malignant syndrome (Seeman et al, 1976; Jones, 2000). (PSYCHOSOCIAL ISSUES) In the case of John Nash, his sexual and emotional relationships with his wife as well as his intelligence suffered tremendously because of the antipsychotic medication and the insulin shock therapy he received. Because of the negative effects of his medications and insulin shock treatment, he was forced to stop the medication unbeknownst to his wife and the staff of the psychiatric ward. This caused a relapse on his psychosis where he almost killed his son by accident and where he drove Alicia away in fear. Recommendation (PSYCHOSOCIAL ISSUES) John Nash has made a reputation before his mental condition experienced a sharp decline. Luckily for him, he did not receive as much discrimination or labeling from his immediate society or from his family. Moreover, Nash was treated for his medical condition with much respect and dignity due to his status in life. But the actual struggles of John Nash while coping with recovering from his paranoid schizophrenia was not explored deeper. Only the dramatic impact of his life was exploited by the filmmakers, resulting to an award winning film about how one man struggles to get back to his normal self. While the acting and the storyline remained loyal to the book about Nash’s life, the oversimplification of the social, emotional, mental, and psychological experiences of John Nash to fit the economics of the movie makes the film somewhat inaccurate. Thus, it is highly recommended that the movie should be watched with the thought of entertainment in mind rather than to gather information of how complicated a schizophrenic’s thoughts are. This is because the movie did not accurately portray what occurs inside a schizophrenic’s mind, has overblown some of the symptoms of schizophrenia, and added color to the struggles of the schizophrenics. References Addington, D., Bouchard, R., Goldberg, J., Honer, B., Malla, A. , Norman, R., & Tempier, R. (2005). Clinical Practice Guidelines: Treatment of Schizophrenia. Canadian Journal of Psychiatry.50:7-57 Andreasen, N., Nopoulos, P., O'Leary, D., Miller, D, Wassink, T., Flaum, M., (1999). Defining the Phenotype of Schizophrenia:Cognitive Dysmetria and its Neural Mechanisms. Biological Psychiatry. (46); 908–920. Beck S, & Trowsdale J. (2000). The Human Major Histocompatibility Complex: Lessons from the DNA Sequence. Annu Rev Genomic Hum Genet 2000;1:117–37. Crowe, R., Thompson, J., Flink, R., & Weinberger B. (1979). HLA Antigens and Schizophrenia. Archive of General Psychiatry. 36:231–3. First, M., Spitzer, R., Gibbon, M., & Williams, J, (1995). Structured Clinical Interview for DSM-IV Axis I Disorder-Patient Edition (SCID-I/P). Biometrics Research Department, New York State Psychiatric Institute, New York. Fujinawa A. (1981). The Paranoid Symptoms which Appear in the Latter Half of Life. Clinical Psychopathology. 2:7–19. Lieberman J., Koreen, A., Chakos, M, et al. (1996) Factors Influencing Treatment Response and Outcome of First-episode Schizophrenia: Implications for Understanding the Pathophysiology of Schizophrenia. Journal of Clinical Psychiatry, 57 Suppl 9, 5–9 Michels, K., Michels R., (1997). Clinical Case: Unknown (Clinical Case Conference). American Journal of Psychiatry. 154, 1599–1601. Michels R. & Marzuk, P. (1993). Progress in Psychiatry. New England Journal of Medicine. 329:552–60. Jones, K. (2000). Insulin Coma Therapy in Schizophrenia. Journal of the Royal Society of Medicine 93: 147-149. Kalinowsky, L. (1980) The Discovery of Somatic Treatments in Psychiatry. Comprehensive Psychiatry 21: 428-435 Kendler KS, & Hays P. (1981). Paranoid Psychosis (Delusional Disorder) and Schizophrenia. A Family History Study. Archive of General Psychiatry. 38:547–51. Peled, A. (1999). Multiple Constraint Organization in the Brain: A Theory for Schizophrenia. Brain Resolution Bulletin. 49, 245–250. Perkins, D. & Lieberman, J. (2006). The American Psychiatric Publishing Textbook of Schizophrenia. Washington, D.C: American Psychiatric Publishing. Podsobinski, L. (2007). In The Grip of Paranoid Schizophrenia: One Man's Metamorphosis Through Psychosis. Lulu. N.C., USA. Seeman, P., Lee, T., Chau-wong, M., & Wong, K. (1976). Antipsychotic Drug Doses and Neuroleptic/Dopamine Receptors". Nature 261 (5562): 717–719 Winokur G. (1985). Familial Psychopathology in Delusional Disorder. Comprehensive Psychiatry .26:241– 8. Zimmermann, G., Favrod, J., Trieu V., Pomini,V (2005). The Effects of Cognitive Behavioral Treatment on the Positive Symptoms of Schizophrenia Spectrum DisorderL A Meta Analysis.Schizophrenia Research 77 (1): 1–9 Read More