A Beautiful Mind - John Nash Mental Status Examination (MSE)

The movie “A Beautiful Mind” was based on a true-life story of the brilliant mathematician who suffered from Schizophrenia, a severe mental illness, throughout his lifetime. John Nash, the movie’s main character, shows the multiple symptoms of Schizophrenia, including hallucinations and delusions. As a result of John’s advanced intelligence in math, he was awarded a scholarship to Princeton University and graduated with a Ph. D. in Mathematics.

In 1947, he won the Nobel Prize. For much of the film, John is a mid-aged, married Causation male with a baby boy. John started experiencing his mental illness after he was admitted to the graduate school in Princeton. He is intelligent but awkward socially. He often withdrew from peers and isolated himself, most likely spending his time working on discovering the mathematical equation equivalent to the scientific theory of attraction when he was at Princeton. The first Schizophrenic hallucination consisted of his roommate, Charles, while he was at Princeton. Charles became his best friend and occasionally appeared in other periods of his life looking the same as he did during John’s Princeton days. Five years later, John taught at MIT and helped the government to de-script numbers of Russian codes. The second hallucination developed along with the delusion when John was working as a secret code breaker. He met the government spy, William Parcher, and agreed to work for him. William always praised and appreciated John’s special ability for breaking codes. John also believed that he was a middle of the War and had a special job from the government as a code breaker. In this delusion, his job consisted of collecting codes from magazines and newspapers and obsessively looking for hidden messages in their contents. While John taught at MIT, he fell in love with a young woman, Alicia who would become his wife. The third hallucination developed when John had a stressful time making an important life decision, to ask Alicia to marry him.

In his hallucination, Mercee, Charles’ niece, appeared and supported him emotionally. John continued to struggle with hallucinations and delusions after he married Alicia. He was unable to function adequately at home and work, and his interpersonal relationships suffered due to delusions. He was always busy with collecting and analyzing codes from papers. Alicia started to notice John’s unusual behavior and ended up calling a psychiatric hospital. When John was sent to the hospital, he believed the Russians had taken him due to his mental illness.

Alicia learned that John has schizophrenia and he is dealing with severe hallucinations as well as delusions and needed treatment. John denied his mental disorder and believed everything was true until he underwent electroconvulsive therapy (ECT) - also known as electroshock therapy - and was treated with medicines. John relapsed one year after he was released from the hospital due to stopping the medicines. He stopped taking the medicines because they interfered with his memory and intellectual capacity as well as negatively impacting his interpersonal relationships with his wife and family. However, once he stopped the medications, he started to have hallucinations again. He found a small house to use as an office for his secret job and started working on finding codes from magazines and newspapers again, believing that everything was real. Overall, delusions made it so difficult for John to take care of his family that he almost killed his baby son and hurt his wife. Alicia called the psychiatric hospital again when she found out the small house was cluttered with all kinds of papers for decoding articles and left him. Finally, he recognized that he had been suffering from hallucinations and delusions, and everything was unreal.

Full mental Status Examination

• Appearance and BehaviorJohn looks his age and is dressed appropriately and well groomed. He looks nervous with inconsistent eye contacts, gestures, as well as facial expressions.
• Speech and thought processJohn often speaks loud, fast, and clear. His speech is coherent and monotonous. He is obsessed with mathematics and calculation. He is logical and intelligent. His thought process is coherent and goal-directed. However, he has looseness of associations between reality and imagination.
• Mood and AffectJohn is often anxious and easily gets distracted, agitated, and frustrated. His has blunted and flat affect. His mood is congruent.
• Thought contentJohn is currently experiencing auditory and visual hallucinations from three people: Charles was thought to be his roommate and best friend in college; Charles’ niece Mercee; and William Parcher, a spy. He is also experiencing various paranoid delusions about the role of a code breaker for the U. S. government and Russia. He has no signs of suicidal thoughts, ideation or self-harming.
• CognitionJohn’s memory is intact. He has excellent memory and functioning, as well as advanced knowledge in math. He is alert and oriented to person, place, and time.
• Insight/JudgmentJohn has impaired insight and judgment due to his mental illness. He almost killed his baby son and hurt his wife due to the mental illness.
• Mini-mental Status exam: John has no cognitive impairment with scoring 30. DSM-5 DiagnosisJohn meets diagnostic criteria for DSM-5 which is Schizophrenia (259. 90). He shows at least two symptoms on DSM-5 psychological diagnostic criteria (A) including hallucinations and delusions for a long period of time. His mental illness which is Schizophrenia increases functional impairment in occupation and interpersonal relations. In fact, he was unable to maintain an interpersonal relationship with his wife and to function as a father as he put his son in danger and almost killed him. John’s score of Global Assessment of Functions Scale (GAF) is between from 30 to 40 since his mind and behaviors are constantly influenced by hallucinations and delusions. Overall, John has difficulty in social and occupational functioning, as well as maintaining interpersonal relationships due to the severe symptoms of Schizophrenia.

A Preliminary intervention Plan Medication

Antipsychotic medications will reduce John’s Schizophrenic symptoms and allow him to function efficiently and effectively on a daily basis. He will keep taking antipsychotic medication daily to relieve the psychotic symptoms including hallucinations and delusions. He will also take antidepressants and anti-anxiety medications to manage the symptoms that come with the mental disorder. Cognitive Behavior Therapy (CBT)CBT will help John to increase healthier and accurate thought processes and patterns. Throughout the therapy sessions, John will be able to accurately perceive reality and the symptoms of mental illness. CBT will allow John to learn and develop coping and problem-solving skills and help him to self-manage his illness. Moreover, CBT will reduce his psychotic symptoms, as well as mood-related symptoms such as depression and anxiety as result. John will receive CBT treatment twice a week for 6 months to help him improve his social functioning and social cognition abilities.