Movie/ Episode Synopsis
The film “A beautiful Mind” depicts the life of mathematical genius Dr. John Nash. Nash is admitted into Princeton to study mathematics and unlike his colleagues; he has the dream to discover an original mathematical concept. He spends a lot of time alone or with his roommate Charles who on many occasions convinces him to push himself further towards his goals. Nash becomes a renowned mathematician working for wheeler labs at which point he meets Parcher, a government agent who gives him a secret assignment that will prevent the Russians from detonating a bomb on American soil. It is later revealed that Nash had imagined Charles, Marcee, Parcher, and the events that surrounded their interactions when his wife Alicia commits him to a mental institution following his anxious and paranoid behavior. The film follows Nash’s struggle with distinguishing reality and fantasy, keeping his family together and maintaining his integrity as a mathematical genius. After years of trying, Nash is able to control his symptoms, becomes a lecturer at Princeton and goes on to receive a Nobel Peace prize for his achievements in mathematics and economics.
Diagnosis
295.90 Schizophrenia 293.89 Catatonia Associated with another Mental Disorder
Rationale
According to the DSM-5 manual the criteria for diagnosis of schizophrenia includes Criterion A-F with various specifications. Criterion A dictates that a patient must show two or more of the following symptoms for a one month or less if the disorder is successfully treated: Delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms such as decreased emotional expression or depression. One of the two minimum criteria must be among the first three mentioned above. In the film, ‘A beautiful Mind’, Dr. Nash meets the criteria for this diagnosis as he has delusions where he believes that he is a spy on an important mission, He hallucinates about having a friend named Charles and his niece Marcee and about meeting Parcher. He has disorganized speech as depicted in the scene where Nash is giving a lecture at Harvard before he is apprehended by Dr. Rosen. Nash seems to lose himself mid-sentence as he speaks and this is made worse by paranoia when he spots Dr. Rosen and his men. Nash also exhibits catatonic behavior. For instance when he is holding his crying son and does not react to the baby’s frantic screams. Instead, he stares dead on, silently.
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Criterion B states that the symptoms of the disorder interfere with daily functioning in areas such as work, interpersonal relations, or self-care. When Nash experiences his psychotic episodes, he is unable to continue with his work at Wheels Labs and as a lecturer because he became too paranoid and anxious to operate normally. Nash’s relationship with his wife also takes a toll as he is unable to help with the baby or fulfill his marital responsibilities.
In Criterion C, signs of disturbance persist for at least six months including one month of symptoms or less if there is successful treatment. During this period, a patient may experience states prodromal or residual symptoms where the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed above. Nash meets this criterion because he continues to experience hallucinations and disorganized speech for years even with medication. He was however able to manage his delusions and came up with ways to distinguish reality from fantasy.
In Criterion D, Schizoaffective disorder and depressive or bipolar disorder with psychotic features are ruled out because either due to a lack major depressive or manic episodes with the psychotic symptoms, or if mood episodes during active-phase symptoms were only present for a minority of the total duration of the active and residual states.
Criterion E dictates that the disturbance should not be resultant from substance use or abuse. Nash meets this because apart from occasional alcohol, he does not use other drugs.
Criterion F states that a history of autism spectrum disorder or a communication disorder of childhood onset warrants the additional diagnosis of schizophrenia if there are prominent delusions or hallucinations, and required symptoms of schizophrenia for at least 1 month or less if successfully treated. Nash shows no signs of either of these two disorders.
Differential Diagnosis
The diagnosis of schizophrenia is made if the psychotic episode is persistent and not attributable to the physiological effects of a substance or another medical condition.
Major depressive or bipolar disorder with psychotic or catatonic features. The distinction between these disorders and schizophrenia is dependent on the progressive relationship between the mood disturbance and the psychosis, and on the intensity of the depressive or manic symptoms. The diagnosis becomes depressive or bipolar disorder with psychotic features if delusions or hallucinations occur exclusively during a major depressive or manic episode, the diagnosis is.
Schizoaffective disorder. There must be a major depressive or manic episode that occurs together with the active-phase symptoms, and the mood symptoms must occur throughout the symptomatic period for this diagnosis to be made. Schizoaffective disorders last for less than the six months specified by Criterion C for chizophrenia.
Obsessive-compulsive disorder and body dysmorphic disorder. Patients with these disorders have poor or absent insight, and delusional preoccupations. However, they differ from schizophrenia due to their prominent obsessions, compulsions, preoccupations with appearance or body odor, hoarding, or body-focused repetitive behaviors.
Delusional disorder. This disorder can be distinguished from schizophrenia by the absence of the other symptoms characteristic of schizophrenia such as auditory or visual hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms.
Schizotypal personality disorder. Schizotypal personality disorder is different from schizophrenia because its distinguishing symptoms are associated with persistent personality features.
Posttraumatic stress disorder. This disorder involves having flashbacks that have a hallucinatory quality, and it may be accompanied by a high level of paranoia. However, a traumatic event that is causing the symptoms must be present to make this diagnosis.
Autism spectrum disorder or communication disorders. These disorders may resemble psychotic episodes associated with schizophrenia but they are distinguished by the patient’s limited ability for social interaction, repetitive behavior, inhibition, and other cognitive and social deficits. Patients with ASD are at high risk of schizophrenia comorbidity.
Course of the Disorder
The onset of psychotic symptoms associated with schizophrenia usually begins between late adolescence and mid-30s where earlier occurrence is rare. The average age for onset of the initial psychotic episodes is mid-20s for males and late-20s for females. The onset can be a
The onset may be abrupt or slow where the latter is usually the case for most people. Impaired cognition is common, and alterations in ones thought process are commonly seen during development and they precede the emergence of psychosis. Cognitive impairments may persist when other symptoms are in remission and contribute to the disability of the disease.
In most cases, schizophrenia persists for the entire lifetime where only 20% of patients ever reach full remission. Some patients experience alternating cycles of active psychosis and remissions while others experience progressive deterioration. However, most individuals with schizophrenia learn to manage their symptoms and develop ways to distinguish reality from fantasy so they can function effectively in society. This may be associated with the decline in levels of dopamine produced in the body as one ages. Negative symptoms are more
Persistent over the course of the disease and they complicate treatment as they have to be treated individually.
Treatment
The recommended course of treatment for schizophrenia is to combine pharmacological interventions with psychotherapy (Hasan et al., 2015). Especially during the onset of psychotic symptoms when it is hard to talk a person through the condition, antipsychotic drugs are recommended. These drugs usually act by blocking dopamine receptors in the brain so as to reduce feelings of aggression and anxiety. Depending on the advancement of the disease and the patient’s biological characteristics, antipsychotics are effect from within hours of initial dosage to several weeks especially when it comes to managing more severe symptoms such as delusions and hallucinations (Picchioni & Murray, 2007). Pharmacological interventions are also used to elevate negative symptoms that may accompany the disease. Antipsychotics may be taken until the psychotic episode has passed or throughout the life time in severe cases.
Psychological interventions can also help schizophrenia patients to cope with the symptoms of the disorder. They also help to reduce negative symptoms of the disease. Psychological interventions recommend that a patient have a support system of people that love them as having a link to the real world can often help one stay above the madness (Picchioni & Murray, 2007). Common psychological treatments include: cognitive behavioral therapy (CBT), family therapy and arts therapy. CBT aims to help you identify the thinking patterns that cause delusional thoughts and behavior, and teach a patient to replace these with more realistic ideas (Hasan et al., 2015). Family therapy offers the patient care and support so that they can cope better with the condition without feeling stigmatized and alienated. Arts therapy helps to promote creative expression and it works by helping the patient express the thoughts and experiences related to the disorder (Picchioni & Murray, 2007). Arts therapies also decrease the negative symptoms of schizophrenia in some patients.
References
Hasan, A., Falkai, P., Wobrock, T., Lieberman, J., Glenthøj, B., & Gattaz, W. F. (2015). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia Part 3: Update 2015 Management of special circumstances: Depression, Suicidality, substance use disorders and pregnancy and lactation. The World Journal of Biological Psychiatry , 16 (3), 142-170. doi:10.3109/15622975.2015.1009163
Picchioni, M., & Murray, R. (2007). Schizophrenia. The BMJ , 335 (7610), 91–95. Retrieved from [10.1136/bmj.39227.616447.BE]
