Sample Answer Key for Worksheet to Accompany A Beautiful Mind Date: Your name: Name of the client: John

Nash Name of the movie: A Beautiful Mind What is the chief complaint? (In the clients own words and report of others) John reports his activities of working for the government, decoding spy messages in newspapers and magazines, and trying to help his country as real and actual events. Because he is paranoid and suspicious, he may be reluctant or unwilling to give any information. Johns wife, Alicia, reports that John is engaged in imaginary activities, such as cutting out articles, posting them in the shed, and coming and going all hours of the night. He is hypervigilant and suspicious of everyone and everything. He is secretive with her, refusing to share much information about his activities. He talks to himself or can be heard talking to someone else when no one else is there. He isnt doing well at work and is failing to complete most normal daily activities. Based on the above information and a close viewing of the movie, what questions would you raise during history taking? What are some possible answers? You might base your questions on: History of the clients illness Past psychiatric history, treatment, and treatment outcomes Psychosocial history When did John first have symptoms or problems? How long has this been going on? During graduate school, Johns first major hallucination was of his roommate, Charles. Later, he had a hallucination of Charles niece. Both remained with him over many years, even after he realized they were not real. Following graduation, he did some decoding work for the government, followed by his second major, long-lasting hallucination (believing that he was a secret agent), and the delusional belief that the government had hired him to find and decode secret messages in magazines and newspapers. What previous treatment has John had? Was treatment successful?

Early in the course of his illness, John received insulin shock therapy, which was not particularly effective and was abandoned as a treatment modality. Initial medications prescribed for John did not effectively rid him of hallucinations, but did improve some of his symptoms and functional abilities. Side effects (such as impotence) were intolerable, so he quit taking the medications. Very soon, his psychotic symptoms intensified, and he began cutting out articles and using the shed as a command post for his secret operations. One day he left his son in the tub, placing him in danger of drowning. He also shoved his wife and child to the floor, believing they were in danger (the result of his hallucinations). As the years progress, hallucinations persist, even though John knows they are not real. He has gained weight (possibly from medication) and has a shuffling gait. Others around John ridicule him.

What kind of support does John have? In the movie, Alicia is supportive throughout Johns life. He maintains contact with Martin (from college), who tries to help him integrate into life at Princeton again. Overall, however, John is fairly seclusive and isolated from others. The movie also demonstrates the stigma of having a psychiatric disorder. Others ridicule John and his behavior; colleagues and the academic world shun him for years. What strengths does John demonstrate? His intellectual abilities are an asset. He can recognize that Charles niece never gets any older, which proves to him that she is not real. Alicias support and their relationship is a stabilizing influence for John. What other observations do you have about the clients behavior? John has some peculiar mannerisms/gestures (e.g., putting his hand on his head, pointing). Early in the movie, John is very confident in his abilities; later, his self-esteem becomes quite low after years of symptoms and social isolation. At one point, John physically cuts his arm (without regard to his safety) trying to remove an identification number he thought was implanted there. In your opinion, is the diagnosis discussed above accurate? Yes

What DSM-IV-TR criteria support (or negate) this diagnosis? 1. John has symptoms of psychosis: delusions, hallucinations, and grossly disorganized thinking/behavior. 2. John demonstrates negative signs of schizophrenia: lack of volition or goal-directed activity, flat affect. 3. The disorder has caused disruption in major life areas (work, relationships, and self-care). What treatment plan would you outline? Atypical antipsychotic medications to improve symptom control with minimal side effects; involvement in meaningful, productive activity; increased social contact; family education With what expected outcomes? John will interact with others. John will distinguish reality from unreal experiences (delusions and hallucinations). John will express thoughts and feelings to others. John will comply with prescribed treatment, including medications. John will maintain a functional daily routine. John will maintain a balance of rest, sleep, and activity. John will seek or accept assistance when indicated.