¶ … Beautiful Mind Paranoid Schizophrenia

Diagnosis and Supporting Evidence

A Beautiful Mind is a film that characterizes the story of a brilliant mathematician named John Forbes Nah Jr. He suffered from paranoid schizophrenia and the story is based on the real events of his life and his struggle with the disease. At the start of the film Nash is a mathematics graduate student in Princeton University, well-known for his brilliance. Although arrogant, he is socially-inept and spends most of his time making efforts to discover some new innovative equation in mathematics. As the film progresses, about half way, Nash begins developing signs of schizophrenia as the audience sees half of the situations and places were actually only illusions. One of Nash's first imaginary characters that he experiences is Charles Herman, his roommate, who is a student of Literature at the university.

Schizophrenia has been identified as split mind and refers to a split from reality expressed through disorganized thinking, inappropriate emotions, disturbed perceptions, and inappropriate actions (Tandon et al., 2013, p. 5). Nash experiences severe hallucinations as well as delusions which lead to the diagnosis of paranoid schizophrenia. Being a subtype of schizophrenia, paranoid schizophrenia is expressed through hallucinations and delusions with (in general) cases of grandiosity or persecution (Shedler et al., 2010, p. 1027).

In order to diagnose paranoid schizophrenia, it is important to see two things as discussed in DSM V. When examining the symptoms of schizophrenia (Criterion A), they are hallucinations, delusions, disorganized speech, catatonic behavior or grossly disorganized, negative symptoms like alogia, or avolution, or affective flattening. For the paranoid type of schizophrenia, it falls under 295.90 (F20.9) and this subtype differs slightly from the initial symptoms of schizophrenia (Tandon et al., 2013, p. 7).

A. Preoccupation with frequent auditory hallucinations or one or more delusions.

B. None of the following is prominent: catatonic or disorganized behavior, disorganized speech, or inappropriate or flat affect.

A more in-depth analysis of symptoms is identification that the person must have for a major portion of the time since the onset of the disturbance, one or more of the symptoms discussed, and a lower level of functioning in self-care, interpersonal relations, or work before the onset. Ongoing signs of the disturbance often last for a minimum of six months. During this period, there must be at least one month where behaviors meet criteria for active phase symptoms. This may include periods of residual or prodomal symptoms.

During these residual or prodomal periods, manifestation of signs may only be seen via negative symptoms or by two or more of the listed symptoms such as odd beliefs or unusual perceptual experiences. Disorders that have been ruled out with schizoaffective disorder is bipolar or depressive disorder. This is because manic or major depressive disorders do not typically occur concurrently with active-phase symptoms. If they do occur at the same time or during the same period of the schizoaffective disorder, they only persist for a minority of the entire duration of residual and active periods of the disorder.

Other mental disorders that may be associated with a psychotic episode can be due to a substance or other medical condition. Persons with a minor or major neurocognitive disorder or delirium may present with psychotic symptoms, but this could be in relation to cognitive changes that are consistent such disorders. Those with substance abuse problems may show symptoms from Criterion A for schizophrenia, but the chronological relationship with the substance can be identified and established.

In the case of Nash, when he started developing the symptoms he was eventually put into a psychiatric hospital. There he received anti-psychotic medications. He was also treated with insulin shock therapy. However, he always had problem recognizing his mental disorder and when he stopped taking his medications because he felt lethargic and hollow, he would go back to seeing hallucinations. The first was his "roommate." The second was Parcher. Parcher asks Nash to assist the pentagon in deciphering code. This is a fun idea for Nash and he takes it upon himself to devise a scenario where he has to find and stop a Russian nuclear bomb. To Nash, this is a real situation. In reality, it is a hallucination. It is all made up just like the time he meets Charles' niece, Marcee.

He tries to continue living a normal life, proposing and marrying Alicia. However, as his life continues, he begins demonstrating paranoid schizophrenia as he notices men outside stalking him. There are no men outside doing this, but he believes they are real. To add to...

If he does not help, the Russians will locate him. When he gets sent to the psychiatric hospital and diagnosed by Dr. Rosen, a psychiatrist, he cuts his wrist to remove the implant Parcher had put inside, finding that it is gone. After ten weeks of insulin shock therapy, he is eventually released.
While he acts normal after treatment, he goes back to his psychotic episodes because Nash believes what he sees is real instead of hallucination. When he takes the antipsychotic medications prescribed to him, he's fine. But when he gets off them, he beings having hallucinations again. It got so bad that when Alicia left their baby in his care, he had another hallucination and thought Charles was taking care of the baby. The turning point happens when he is confronted by Alicia, attempts to run away and sees Marcee again, but this time he realizes she is not real because she has not aged since he last saw her.

From then on he signs commitment papers back at the hospital in order to stay and receive therapy. Both positive and negative symptoms have been described in the book and shown in lesser detail in the film. Nash demonstrates all positive symptoms of schizophrenia. He displays disorganized thinking with his inability to distinguish reality from hallucinations, he shows inappropriate emotions when he runs away from Alicia and is paranoid that people are stalking him, he has disturbed perceptions concerning Parcher and his "government job," and demonstrates inappropriate actions such as hitting Alicia and leaving his baby unattended. The delusions and hallucinations are quite clear as shown through Charles, Marcee, and Parcher.

Description of the disorder

Paranoid schizophrenia exists as a subtype of schizophrenia and is shown through a patient's delusions or false beliefs, that an individual or individuals are plotting against member of their family or them. It is the most common subtype of schizophrenia. Most people with paranoid schizophrenia have auditory hallucinations. They may have false beliefs of personal grandeur such as they are much more influential and powerful than they are in reality. They may also dedicate a disproportionate amount of time in developing ways of protecting themselves from perceived threats.

In general, people with paranoid schizophrenia have less difficulty with memory, concentration, and dulled emotions when compared to other subtypes. This means they can function and think more successfully. While paranoid schizophrenia is manageable, it is a chronic condition and may lead to suicidal thought and behavior. In a 2013 article, researchers found physical differences in the brains of those with paranoid schizophrenia than those unaffected by the disease. "Reductions of grey matter volume (GMV) in the prefrontal and temporal cortex have been described which are crucial for the development of positive and negative symptoms and impaired working memory (WM)" (Zierhut et al., 2013, p. 1063).

Aside from these physical differences in the prefrontal and temporal cortex, there are also changes in the cingulate and ventrolateral prefrontal cortex, among other areas. "In schizophrenia patients, reductions of GMV were evident in anterior cingulate cortex, ventrolateral prefrontal cortex (VLPFC), superior temporal cortex, and insula. GMV reductions in the superior temporal gyrus (STG) were associated with positive symptom severity as well as WM impairment" (Zierhut et al., 2013, p. 1063). This may explain some of the recurring symptoms with the disorder such as detachment, anxiety, delusions, anger (mild irritation to rage and fury), and aggression/violence. It may also play a part in the auditory hallucinations and delusions the person experiences. While visual hallucinations are possible, as seen with Nash, it is rare, much like catatonia or disturbances in speech.

Another article researched whether patients with paranoid schizophrenia had difficulties in emotion recognition and face processing. " ... there is a SZ subgroup with predominantly paranoid symptoms that does not show problems in face processing and emotion recognition, but visuo-perceptual impairments" (Sachse et al., 2014, p. 509). While the autistic subgroup had difficulties the SZ subgroup did not. The symptoms and effects of the disorder do not affect things like emotion recognition, at least to a severe degree, however because of the way the disorder affects the brain, the impulsive behaviors like aggression and anger can come from the imbalance of neurotransmitters in the body. Experts believe an imbalance of the neurotransmitter dopamine, may be involved in a person developing schizophrenia (Noll, 2007, p. 121). Research also shows this imbalance could occur because of genetics. Regardless of its origins, there are treatments available to…