A beautiful mind video- mental health

What is the DSM-V diagnosis of the main character?

Paranoid Schizophrenia

NEGATIVE SYMPTOMS

- apathy - affect is flat or bunted - alogia- poverty of speech - poor social functioning - anhedonia- no pleasure - social withdrawal - avolition (no motivation)

How does the character meet these criteria? What positive and negative symptoms of Schizophrenia did the main character exhibit?

- POSITIVE: paranoid, agitated, hallucinations, thinking people are following him, delusions - NEGATIVE: rigidity, expressionless face

Discuss your perceptions of what was real and what was a delusion or hallucination?

- The moments never happened when they think they did. Finding this out would be devastating. - The little girl that calls him uncle john NEVER GETS OLD - When no one else sees what you are seeing. - Imaginary roommate named Charles -Imaginary William Parcher - The psychiatrist is a Russian spy - thinking he works for a government classified project - digging in his arm to find the implant - the little girl

What medications would you anticipate the patient to be on? Side effects you observe?

- Typical antipsychotic- Thorazine- Haldol (haloperidol) - Atypical antipsychotic- Clozaril Abilify (aripiprazole) Risperdal (risperidone) Geodon (ziprasidone) Zyprexa (olanzapine) SIDE EFFECTS: - shuffling gait - rigity - decreased libido - lethargic - unresponsive - anticholinergic - EPS - orthostatic hypotension

List and describe therapeutic communications and non- therapeutic communications techniques that you observed in the movie?

- When the wife acts out and breaks mirror - Rejecting - Disapproving - Why questions- requesting an explanation - offering general leads - presenting reality - silence

What is Schizophrenia caused by?

- a combination of factors such as -- including - genetic predisposition - biochemical dysfunction - psychosocial stressors

Delusion?

- a false belief or opinion - Delusions of.... grandeur persecution reference control or influence somatic Delusions paranoia religiosity medical thinking

Schizophrenia phase

- active phase of the disorder - psychotic symptoms are prominent, delusions, hallucinations, impairment in work, social relationships and self-care

Schizophrenia

- acute illness - stabilization - maintenance and recovery - relapses- frequent, longer periods of time to recover, non- compliance with medications

prodromal phase

- begins with a change from premorbid functioning and extends until unset of psychotic symptoms - sudden withdrawal, peculiar behavior, eccentric, role functioning is impaired, personal hygiene is neglected, disturbances in communication, ideation and perception

Nursing measure

- do not reach out and touch a person - avoid challenging the delusion - decrease anxiety with empathy - preventing relapse - patient teaching - family education - promoting medication compliance - promoting adequate communication - assistance with self care

What interventions (both medical and nursing) were helpful or would be helpful for this character?

- establish trust & rapport - maximize level of functioning - promote social skills - ensure safety - deal with halluincations by presenting reality - encourage family involvement - ensure adequate nutrition - promotes compliance with drug therapy - Journaling everyday before bed - therapy - social activities that are small - not feeding into the delusions - cognitive behavioral psychotherapy - support groups - rehabilitation to help with social skills and other things

Schizophrenia risk factors

- genetics - 10 times higher risk in first degree relatives - twin studies 4 times higher in monozygotic- 50 times that of gen population - children of schizophrenic parents - excess of dopamine dependent neuronal activity in the brain ** older meds hit our positive symptoms ** hit all the pathways with our meds - environmental influences -- lower socio economic status -- probity a result of the disease

Risk factors for Schizophrenia?

- genetics - excess of dopamine dependent neuronal activity in the brain - environmental influences - physiological influences -

Real?

- it means its not in your head, someone else can see what you are seeing also

What would be the priority nursing assessment and diagnosis for Mr. Nash?

- mental health - Depression - safety - thought content - medication adherence

treatment

- recovery model - group, family, and individual therapy - socail skills training - milieu therapy - behavioral therapy - case management pact - medications

Side effects to meds

- sedation - photosensitivity - orthostatic hypotension - decreased libido - increased prolactin - ECG changes - agranulocytosis - EPS- parkinson, akinesia, dystonic, akathisia - NMS - Anti- cholinerigic - metabolic syndrome

Hallucination?

- seeing or experiencing feelings that aren't real (inside the mind) you make up. - perceptual experiences without actual external sensory stimuli - usually auditory - command hallucinations

Residual Phase

- similar to prodromal phase with flat affect and impairment in tole functioning are prominent - periods of remission and exacerbations

the premorbid phase

- the schizoid personality - indifferent - cold - aloof - loners

What are the criteria for this diagnosis?

-they have to meet 2 or more of these: - Delusion - Hallucination - Disorganized speech - abnormal psychomotor behavior - negative symptoms - on a scale of 0-4 - disturbances of affect, votation and speech - persecutory beliefs of various kinds

Four phases of Schizophrenia

1. the premorbid phase 2. prodromal phase 3. Schizophrenia phase 4. residual phase

Movie portray the mental health system correctly? treatment on?

Yes - insulin shock therapy but we no longer do it anymore - meds we still use but have more that work better

Schizophrenia caused by

a combination of factors - genetics predisposition - biochemical dysfunction - dopamine (need serotonin as well to get rid of negative symptoms - physiological factors - psychosocial stressors

POSITIVE SIGNS & SYMPTOMS

disorganized thinking and speech - loose associations - neologisms - clang associations -word salad -circumstantially - pressured speech - preservation disorganized behavior - agression - agitation - cataonia - regression - waxy flexibility