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Mr. Nash is in his mid-thirties. He is married and lives with his wife and their son. Mr. Nash has been combating mental illness since he was at Princeton in Graduate school. Mr. Nash had made up a fictional world before he meet his wife and let his hallucinations take over once they were married. This caused some disconnect in his relationship with her and she had committed for help after he almost stuck at her and son. His primary symptoms were: Hallucinations, delusions, socially awkward, disorganized speech in interactions with others, and bizarre behaviors. The precipitants that occurred are that Mr. Nash was made fun of at Princeton and made up friends and a fake life to cope with all of this social reticule. Mr. Nash seeks to have control over his hallucinations and delusions and also has strong feelings about not being hospitalized again.
The presenting problem is that Mr. Nash seems has been diagnosed with Schizophrenia with multiple episodes, Continuous disorder. He is suffering from hallucinations, delusions, social awkwardness, disorganized speech in interactions with others, and bizarre behavior. This diagnosis is present with Schizophrenia with multiple episodes, Continuous disorder. Mr. Nash’s wife wants him to seek treatment for the hallucinations and delusions because they are disrupting the family that they have started. The relationship between Mr. Nash and his wife has been strained for many years due to her discovering that his job was just a hallucination. Mr. Nash has made great strides towards understanding that his hallucinations and delusions are not real. However Mr. Nash still struggles with the functionality of real life and is always wondering and asking what is real or not.
Mr. Nash is modeling a coincident behavior for someone with a diagnosis of Schizophrenia. Mr. Nash’s behavior has been up and down with outburst of genius and insane ideas. He currently is handling his hallucinations and delusions by not engage with them at all. This is working but the idea of not knowing if someone he is talking to is real or not has hindered his abilities to search for new job opportunities or engage in new friendships outside of family and work. Mr. Nash at the current status is non-suicidal and currently functioning on a very high level of the spectrum of Schizophrenia.
Mr. Nash’s has experienced many life events. He was raised by well-educated parents in Virginia and was known to be an introvert but very interested in education. He attended Princeton to seek a degree in mathematics. While at Princeton, he expressed bizarre social interactions. He developed a hallucination of Charles which was his roommate and his niece Marcie. After graduation he began working at MIT, to which he worked on theories and taught classes in mathematics. In one of those classes he meet his future wife. During his courtship of his wife he started having the hallucination of Parcher. Parcher worked for the U. S. department of defense where Mr. Nash had taken a job as a decoder. Mr. Nash spent years doing the work of what his hallucination Parcher told him to do until his wife discovered that it was all in his mind.
Mr. Nash’s overall temperament appears to be extremely balanced with his hallucinations. He admits that sometimes his hallucinations are so strong that he can’t even avoid them without speaking back. He has been able to keep his current job but is still struggling with social awkwardness towards others. He said that normally his outburst come on days where he has not been able to sleep or work on his theories all day. There is no evidence that either one of his parents suffered from the symptoms of Schizophrenia.
Mr. Nash’s overall physical condition is affected by the 1st generation mediation to which he is still taking for his symptoms. These medications can affect the overall appetite, sexual functioning, and may cause drowsiness. All of the side effects of the medications can affect his mood and increase his body to start to shut down. It is very important that Mr. Nash seek 2nd generation medication before the side effects destroy his bodies functioning.
There was no mention of any drug or medication abuse. Mr. Nash does smoke cigarettes. A recommendation to see if 2nd generation mediation would help Mr. Nash with the side effects of current medication.
Multicultural issues that Mr. Nash has and will continue to experience are rooted in his social awkwardness and communication skills with peers and colleagues. Mr. Nash experienced a great deal of discrimination towards the way he acted in the public eye. Was constantly being picked on for doing odd activities throughout his day. Society prejudice towards those with diagnosable disorders is very difficult to understand.
The disabilities like schizophrenia are hidden disabilities because they exist in the mind not on the physical body. Many individuals with this diagnosis or similar ones will not tell anyone they meet with the fear of being treated differently after someone knows their “secret”. In order to help someone like Mr. Nash, therapist should help encourage a state of independence like interviewing for jobs, managing money, doing their own laundry, or performing other daily living skills to help remove the social stereotypes if someone like Mr. Nash would want to explain his diagnosis to someone new. It is up to therapists and other professionals to educate themselves and the general public to remove the negative social stereotypes that have been put in place. By doing so it could help those who are experiencing a life with a diagnosis disorder to be more positive and have a fulfilled life without discrimination.
For Mr. Nash’s Treatment plan it would be important to encourage his medication by introducing him to a psychiatrist for reevaluation and to have his medications upgraded to the new 2nd generation antipsychotic medications that have less side effects. In doing this approach we can be aware of his past struggles with the old medication that forced him to relapse and hide his meds from everyone. Mr. Nash will need counseling to help develop independence and autonomy in his life. This can be a great benefit to help him understand his value and self-concept.
Psychosocial approaches like Family therapy, social skills training, and Cognitive Behavioral Therapy might be a great place to start with Mr. Nash in his treatment. Family Therapy is more of a family intervention program to help Mr. Nash not experience relapse and know that he has true natural supports in his daily battle with his delusions and hallucinations. I think even going outside of the family and having the employer (University) understand the struggles to which Mr. Nash goes through on a daily bases could improve his work environment. Social skills training for Mr. Nash could provide him with forming friendships, finding and keeping a job or living independently. These skills could also help Mr. Nash develop functional skills such as relationship skills, self-care skills, and skills to manage medications, or symptoms. A Cognitive Behavioral Therapy (CBT) approach could be beneficial for Mr. Nash. The CBT approach will help Mr. Nash with mood or anxiety outburst that he is experiencing in his day to day life. The goal of this treatment is to decrease the intensity of the positive symptoms, reduce relapse, and decrease social disability. This is accomplished by a therapist and Mr. Nash exploring the nature of the delusions and hallucinations by examining the veracity or veridicality and subject delusional beliefs to reality testing.
Overall, Mr. Nash has been diagnosed with Schizophrenia with multiple episodes, Continues disorder. He has done a great job with his ability to handle his hallucinations and delusions but still suffers from forms of social awkwardness. Together I and Mr. Nash have developed a treatment plan for any crisis that he may experience. His involvement has allowed him to take ownership of his progress and realization that he has a support system. It is very important that in counseling sessions to remind Mr. Nash to stay in compliance with his treatment plan. Mr. Nash desires to have control over his life and learn how to handle his disorder to be functional for his family and career.
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