John Nash

Dr. Nash

• White, male, 30
• Tenured professor at MIT
• Homeless, committed involuntarily by wife
• Several incidences in mid to late 20s

History

• 3rd time hospitalized
• Previous diagnosis of psychosis
• Stablized with antipsychotics
• No family history

Presenting Problem

• Cx claims he is being chased
• Part of an organization
• Nonsensical writings
• Man of great religious importance

CLient Presentation

• Appears irritated
• Flat affect
• Disoriented
• Thought process shows paranoia

CLient Presentation

• Cx lost interest in self-care
• Frequently changes topics
• Hard to follow thought pattern

Cluster of Symptoms

• Persecutory delusions
• Referential delusions
• Visual & auditory hallucinations

Cluster of Symptoms

• Disorganized thinking
• Dysphoric mood
• Diminished emotional expression

Principle Diagnosis

• Schizophrenia (F20.9) no specifier
• Duration is less than 1 year
• No provisional diagnosis

Other Conditions

• Child Affected by Parental Relationship Distress
• Relationship Distress with Spouse
• Uncomplicated Bereavment
• Academic or Educational Problems
• Homelessness
• Phase of Life Problem

Rule out

• Bipolar Disorder
• Delusional Disorder
• Schizoaffective Disorder

Treatment Plan

• Reduce or remove symptoms
• Reduce the need to stay in the hospital
• Achieve and maintain relief from symptoms so that they no longer have a negative effect on client’s life

Long-term Prognosis

• No known cure
• Antipsychotic medications can reduce symptoms
• Symptoms seem to improve in 20% of Cxs
• Psychotic episodes tend to decrease with age

Theory

• CBT--shorter and more flexible
• Mindfulness, metacognition, compassionate mind training
• Different ways to interact with cognitions Cxs exposed to

Role of Counselor

• Evolve over time
• Cx needs to be treated with medication
• Advocate
• Psychoeducational

Chronic Illness

• Role of counselor will include support and education for family
• Plan of action that includes family (support system) is crucial
• Couple's counseling

Staffing

• Create timeline
• Be sure to assess affect, mood, and orientation to person, place and time
• Rule outs

Karie Cappiello
Webster University
Dr. Decker

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