NRSG263 Principles of Nursing Mental Health

Subject Code : nrsg263
University : Australian Cathloic University Gradesaviours is not sponsored or endorsed by this college or university.
Subject Name : Medical Sciences

Introduction

Schizophrenia is a complex mental disorder in late adolescence or early adulthood onset. It is associated with positive and negative symptoms such as hallucination, delusion, social withdrawal, cognitive impairment, disorganized speech and lack of motivation (McCutcheon, Marques & Howes, 2020). The movie ‘A Beautiful Mind’ is based on the real-life story of Nobel prize winner and mathematician, John Nash. The movie depicts the struggles of Nash, who was suffering from paranoid schizophrenia. The significance of the movie is that it has significantly portrayed the experiences of people living with the disease and the impact of such illness on loved ones (Shaiffudin et al., 2022). The aim of this report further develops an understanding of schizophrenia through the main characters of the movie John Nash and learn more about the etiology and pathophysiology of the condition. In addition, the report will discuss the psychosocial impact of schizophrenia on individuals, family members and the community. Lastly, the report will review the role of mental health nurses in implementing non-pharmacological interventions to promote functioning in patients with schizophrenia.

Etiology and Pathophysiology of the Mental Illness in the Movie:

Schizophrenia is a disorder characterized by positive and negative symptoms. Positive symptoms imply distortion of normal function evidenced by delusion, hallucination and disorganized behaviour. In addition, negative symptoms represent the absence of normal behaviours such as anhedonia, blunted affect and poor social function (Correll & Schooler, 2020). In the movie ‘A Beautiful Mind’, Nash was experiencing delusion and auditory hallucinations. He had the delusion that he was appointed by the government for code-breaking. He had delusions about Charles, an agent. He developed an obsession with cracking codes in his daily life. As the disease progresses, she developed difficulty in handling emotions (Ida Nur, 2021). The evidence on the etiology of schizophrenia shows the interconnection between genetics and environment. According to Ashifa (2020), genetic inheritance is the cause behind 50-80% of schizophrenia diseases. This has been defined by the various twin studies. The study by Narayan, Shikha and Shekhar (2015) gives the justification that the lifetime risk of schizophrenia in the general population is only 1 % compared to 6.5% in first-degree relatives. In the case of monozygotic twins, a concordance rate of 50% has been found and it is higher than dizygotic twins whose rate has been found to be 10-19%.

Similarly, the study by Henriksen, Nordgaard and Jansson (2017) gave an overview of various twin studies that give insight into the risk of schizophrenia in twins. This study also confirmed a high concordance rate for monozygotic twins compared to dizygotic twins. In addition, findings from adoption studies were documented. These studies revealed that children of mothers with schizophrenia have the same risk of developing the disorder irrespective of the fact that they were raised by their biological parents or adopted families. In addition, environmental factors play a role in the causation of the disease. It may include factors such as pregnancy complications, history of childhood trauma, social isolation, urbanicity and drug abuse. Obstetric complications have been identified as a risk factor for schizophrenia. The use of forceps and low birth weight are factors that influence the early age onset of psychosis. In addition, the trauma of adversities in different forms has been found to increase the likelihood of schizophrenia in individuals (Stilo & Murray, 2019).

To understand the cause behind the manifestation of symptoms in John Nash, having an understanding of the pathophysiology of the condition is important. According to Patel et al. (2014), abnormalities in neurotransmission are the main cause behind the pathophysiology of schizophrenia. Most of the theories are related to the deficiency of neurotransmitters such as dopamine, serotonin and glutamate in the brain. The positive symptoms of schizophrenia are seen due to excessive activation of D2 receptions via the mesolimbic pathways. Four dopaminergic pathways have been implicated in producing symptoms of the disease. Low dopamine level has an impact on the extrapyramidal systems and contributes to motor symptoms. In addition, the mesolimbic pathway plays a role in the manifestation of positive symptoms. This pathway extends from the extra tegmental area to the cortex and low mesocortical dopamine contributes to the cognitive deficit and negative symptoms in patients. Due to such changes, neuroanatomical abnormalities are seen in patients (Sonnenschein, Gomes & Grace, 2020).

Psychosocial Impact of Schizophrenia on Individual, Family and the Community

In addition to psychological challenges, the diagnosis of schizophrenia is associated with many psychosocial impacts. Patients struggle to express their emotions, socialize with groups and struggle in their relationships (Suttajit et al., 2015). In the movie, Nash experienced a similar issue. He was not able his express his emotions and handle interpersonal relationships. In the movie, various instances were found when Nash lacked social and emotional awareness. He does not show how to act in certain situations and it is depicted in one scene in the movie when he abruptly asked a woman a weird question in a bar. Evidence shows that due to the severity of the disease, personal and social relationship and the patient’s ability to self-care is affected. A study revealed the correlation between negative symptoms and global functioning. The presence of severe negative symptoms was one of the main predictors of poor verbal fluency, worse social adjustment and disability after 1 and 3-year follow-ups (Suttajit et al., 2015).

Similarly, the issue of social isolation or loneliness due to the disease is common in patients with schizophrenia. These patients are subjected to stigma and have greater clinical challenges. They experience greater socio-environmental problems and their perceived sense of belonging is low. All these issues may increase the chances of loneliness or social isolation in patients (Eglit et al., 2018). In the movie ‘A Beautiful Mind’, after initiation of treatment, Nash was found to socially isolate from society. The diagnosis of schizophrenia has an impact on personal relationships and the well-being of families too. Nash’s wife Alicia was the one who had to balance her relationship as well as take care of caregiving responsibilities. Alicia had a newborn son and she was feeling overburdened by caring responsibilities.

Similar experiences have been reported by family members in the research literature. According to Lippi et al. (2016), one of the major problems in the treatment of schizophrenia is that the needs of the family members are ignored. It is a disease that negatively affects family members. They need to deal with negative experiences such as neglect of family members, disruption in daily activities, loss of employment or absenteeism, increase in caregiving workload, neglect of hobbies and poor quality of life. Many times due to the sufferings of others, they start engaging in guilt and self-blame. They are overwhelmed by sadness and emotional distress. These issues give the implication to implement proper family psycho-education so that they learn not only to deal with the illness but also their expressed emotion. Some of the programs that can be useful for family members of schizophrenia patients are peer-led family support and psychoeducation, family group therapy and family interventions. In addition, schizophrenia has an impact on the community as it leads to productivity loss, an increase in healthcare resources and violation of the human rights of affected individuals in the community. The study by Oyelade and Nkosi‐Mafutha (2021) show that individuals with schizophrenia have low motivation and experience decreased drive towards work and productivity. This can have an adverse effect on the national and family economy.

Role of Mental Health Nurse in Non-pharmacological Intervention

In the treatment of schizophrenia, the use of pharmacological intervention is important to treat positive symptoms. However, non-pharmacological intervention plays an important role in helping patients lead productive life along with the disease. Some common non-pharmacological approaches to the management of schizophrenia are cognitive behavioural therapies (CBT), psycho-education and family therapy (Stevović et al., 2022). Mental health nurses have a role in advising patients regarding relevant therapy and the impact of these interventions on patients. Much evidence shows that the above non-pharmacological interventions are implemented by nurses. According to the study by Ma et al. (2020), nurse-led CBT is effective in improving insight and reducing negative symptoms in the patient. These interventions are primarily provided by mental health nurses and they play a role in understanding negative thought patterns and supporting them to develop positive coping skills. However, one of the main problems is that very few mental health nurses are trained in implementing brief CBT interventions (Layton et al., 2020). Hence, professional training in this area is needed to provide clinical professionals to nursing professionals and patients.

The role of mental health is important in the implementation of brief psychoeducation for people with mental illnesses like schizophrenia. This is important because many patients lack awareness of their symptoms and the cause of the disease. Mental health nurses have a role in improving the self-efficacy of these clients through needs-based psychoeducation. In the study by Kumari, Joseph and Singh (2023), an advanced practice nurse was involved in providing psychoeducation and supportive programs to patients. The focus of the session was to promote an understanding of mental illness, promote sleep hygiene, and anxiety, increase adherence to medications, developing the problem-solving and coping abilities of the patient. They also introduced patients to family and community support resources. The results of the analysis revealed significantly greater improvement in the mental and overall health status of patients. The study gives the implication to involve more number of mental health nurses in non-pharmacological interventions. Similarly, nurses can play a role in implementing family therapy and helping families effectively deal with schizophrenia. They can provide advanced knowledge on diagnosis, risk factors and protective factors for patients. Knowledge of the disease and preventive steps can make family members calm and deal with problems in an efficient manner. It can lead to better adherence to medication and management of the prognosis of the illness (Caqueo-Urízar et al., 2015). Thus, the mental health system should engage in arranging training resources for mental health professionals to promote better services.

Conclusion

The report provided a summary of the main character and difficulties faced by Nash in the movie ‘A beautiful mind’. Using the context and life experience of Nash, the report explored the impact of schizophrenia on various aspects of the life of individuals and their family members. The etiological of the disease revealed links between genetic and environmental factors. In addition, the role of dopamine and its associated pathway was found to play a role in the pathophysiology of schizophrenia. The exploration of the psychosocial impact of the diseases revealed that individuals with schizophrenia face challenges in their social and personal relationships and in expressing their emotions. The disease contributed to burden and emotional distress for a family member due to additional caregiving responsibilities and disruptions in work routine and daily life. The study gives the implication that non-pharmacological interventions such as psychosocial therapy and cognitive behavioral therapy should be actively implemented to promote recovery and engagement in meaningful activities.

References

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