The client was selected from the movie A Beautiful Mind (2001). The client for this
study was John Forbes Nash who was a student at Princeton University, and he was competitive, and goal driven in his class. This is supported by his ambition to crack the logic behind the atomic bomb, Russian codes as well as the empirical logic behind love. This movie was based on the life of John Nash who developed symptoms of schizophrenia while being a student at Princeton University.
However, John had a family and his wife Alicia was always there to support him beat the condition. The reason why I selected this movie was because personally I have always had an interest in understanding schizophrenia and the movie provided me with significant exposure on what goes around in the life of a schizophrenia patient. Despite John being diagnosed with schizophrenia, he eventually became functional and he was awarded the Nobel Prize for his mastery in economics. Consequently, this provides an insight that schizophrenia can be managed thus leading to improvements of the lives of schizophrenia patients.
John suffered from schizophrenia which is a severe and chronic mental illness which has an effect on the persons behavior, cognition and emotions. In addition, the mental disorder leads to a loss of touch with reality and sometimes it can occur in the form of episodes. John appeared to be confused, isolated and withdrawn and he could spend much of his time alone trying to figure out solutions to problems which in most times never existed.
As a result, he failed to take care of himself due to lack of interest in hygiene. This included less concerns on dressing, bathing, combing hair and the general organization of his office. This is evident when Alicia entered his office and found that the office was messy, and John had a stack of envelopes in the mailbox. Also, John lacked insight to his illness despite people around him, including his wife, telling him that he had a mental problem.
In addition, John was highly suspicious to the extent that he was hostile towards his wife after she entered the room and turned on the lights. He goes ahead to explain to his wife that the Russians are chasing them, and they need to hide in the car although his wife resisted his idea. Resulting from suspiciousness, John tried to convince his wife that she needs to hide in her sisters house and make sure that she is always in a crowded place. In most episodes of the movie, John was delusional. However, his delusions could be mistaken for genius acts. Taking an incidence at the bar with his friends, John says that a mathematical logarithm could be obtained from the pattern of his friends tie. Also, his professor tells him that he wont be able to achieve much if he continues to skip classes. This shows a lack of interest in an activity that John used to enjoy previously.
It is not a common phenomenon for a sane person to inflict harm on himself. In the psychiatric ward, John was bleeding after causing self-harm on his hand. In addition to self- harm, he also experienced hallucinations. John could talk to Mercee, Parcher, and Charles although these people were never present. After John sees the doctor in the psychiatric hospital, he tries to escape; unfortunately, he fell off the seat and laid on the floor. He believed that the psychiatrist was a Russian interrogator who had come to interrogate him after Charles handed him over to the Russians. Also, John was found scribbling footballers and pigeons on the window as he tried to find an algorithm and most time neglected his time with friends. John was also extremely paranoid to the extent that during his speech, he went ahead to hide thinking that the men in black suit conspired to kill him.
The Diagnostic Statistical Manual V (DSM V) has provided a criterion to be used by professionals in the diagnosis of mental illnesses. For the schizophrenia diagnosis, the patient must show two or more symptoms outlined in DSM V for a period of one month or more than one month (Morrison, 2017). Among these symptoms include hallucinations, delusions,
disorganized behavior, and speech. As a result, the onset of these symptoms must have led to a functional decline of the person in relation to work life, self-care as well as interpersonal relations. Among other symptoms include; derealization, sleep disturbance and cognitive impairment among others. However, these symptoms in category A in DSM V must appear for at least one month with delusions and hallucinations being highly prominent. Nevertheless, these symptoms should not be caused by other disorders like bipolar, schizoaffective and depressive disorders (Gaebel & Zielasek, 2015).
Based on the criterion provided by DSM V on the clinical diagnosis of schizophrenia, it is evident that John has schizophrenia. The onset of this disorder was on his mid-twenties, and this is the probable age that DSM V explains schizophrenia sets in. Additionally, John experienced delusions and Hallucinations more regularly, and this occurred for more than six months. Also, there is an occurrence of self-harm, lack of self-care and lack of insights in regard to his mental illness, paranoia, disturbance of family, school and social functioning. All these symptoms experienced by John are outlined in the DSM V criteria for diagnosing schizophrenia. Since John had no history of other mental disorders and illnesses, it is confirmed that he had schizophrenia.
The article selected for this study was obtained from the Schizophrenia research Journal volume 203 (2019) from page twenty-four to page thirty-one. The title of the article was Cognitive remediation can improve negative symptoms and social functioning in first episode schizophrenia: A randomized controlled trial. The authors for this article were Joseph Ventura, Denise Gretchen, Keneth Subotnik, Laurie Casaus, Michae Boucher, Alice Medalia, Gerhars S. Hellemann, Moris D. Bell and Laith S. Neissherlein. The purpose of the study was to examine the existing potential benefits of cognitive remediation on improving the social function and the negative symptoms of schizophrenia patients primarily in the first episode of schizophrenia.
From this study, I learned that the negative symptoms of schizophrenia do predict the poor function of the schizophrenia patient thus leading to a deterioration of the normal function. Also, it is clear that the negative symptoms cannot be treated by the use of pharmacological options since pharmacological treatments for schizophrenia do target the positive symptoms only like the delusions and hallucinations. Finally, I learned that cognitive remediation (CR) yields better results in improving negative symptoms of schizophrenia as compared to Healthy Behavior Training (HBT) especially in the improvement of social functioning, anhedonia and avolition (Ventura et. al., 2017).
Considering the life of John in the movie A Beautiful Mind (2001), it is evident that he was experiencing the negative symptoms of schizophrenia. However, during his treatment in the psychiatric hospital, the focus was on the positive symptoms. This study relates closely to John because the symptoms under study, social functioning, blunted affect and apathy, were among the symptoms that contributed to Johns functional decline. Fortunately, the study has proven that all these symptoms experienced by John could have been improved through the use of cognitive remediation alongside the pharmacological treatment. This study has impacted enormously on my view towards the client. Before, I had a conviction that schizophrenia symptoms cannot be improved and thus the client cant be helped. However, the study opened a new view of the mental disorder since with the use of cognitive remediation the negative symptoms can be improved.
This study has got a significant implication on nursing practice. First, the study has revealed that cognitive remediation has broad benefits in the treatment of negative symptoms of schizophrenia and this opens a new pathway to the nursing practice. Also, the study has provided nursing practice with evidence on the suitability of cognitive remediation especially on improving negative symptoms experienced by schizophrenia patients. In regard to my future
nursing practice, this study has provided me with new knowledge on cognitive remediation thus enhancing my knowledge base in relation to improving negative symptoms of schizophrenia. Also, it has given me a detailed insight on various ways that can be used to develop the functional capability of schizophrenia patients which is very relevant to my future nursing practice.