Question:
Discuss about the Mental Health Nursing for Schizophrenia Disorder.
The Birdy movie is about two friends, Birdy and Al Columbato. Birdy had a fascination for birds and flying and he had also built a new aviary in his bed. Due to certain life experiences, he always wanted to escape from reality and expressed his desire to be born as a bird. After the Vietnam war, Birdy was emotionally scarred and confined to mental hospital. He was almost in comatose state. However, his friend Al made several attempts to reduce his dissociative behavior. In the end, Birdy escaped to another level of the roof as he was found jumping off the roof of the hospital just like a bird (Birdy, 2017). . Considering this storyline of the movie Birdy, the essay provides a detailed insight into the mental illness depicted in the movie and discusses in detail about the symptoms, impact of the mental illness, nursing interventions and treatment options available for the mental illness.
After the analysis of the main character of the movie Birdy, it has been found that the mental illness of schizophrenia was depicted in the movie. Schizophrenia is a chronic mental disorder that has an impact on a person’s feeling, thinking and behavior. It is often characterized by episodes when patients cannot make differentiate between real and unreal experience. Birdy was also found to display bizarre behavior in the movie such as always imagining himself as a bird and flying. They lose touch with reality and the brain disorder is often associated with symptoms like hallucination, delusion, impaired memory, poor executive and motor functioning, disorganized speech and disruptions in normal emotions and behavior (Frith, 2014). Similar symptoms were also found in the Birdy as he often wanted to escape reality and had delusions. He imagined himself as a bird.
The symptoms of schizophrenia are characterized into four categories such as positive psychotic symptoms, negative symptoms, disorganization symptoms and impaired cognition. The positive symptoms include distorted thoughts and beliefs, paranoid delusion and hearing voices. It is called positive symptoms because this feelings did not existed in patient before they were ill, however it get added to people’s psyche after the diagnosis of schizophrenia. On the other hand, symptoms like losing the ability to speak, develop plans and find pleasure in life is regarded as negative symptoms. It is named so because these symptoms exist in patients before the diagnosis of the mental illness. Confused thinking and speech are examples of disorganization symptoms and problem with attention and memory are example of impaired cognition (Fusar-Poli et al., 2014). Positive symptoms like paranoid delusion were observed in Birdy in the beginning before he went to the Vietnam War. However, other three symptoms was found after he returned from Vietnam War and placed in mental hospital.
The Birdy has correctly depicted the sufferings and burden of schizophrenia on patients and their immediate family members. Currently the prevalence of schizophrenia is also rising worldwide. It is a devastating disorder which creates both health and cost burden for families and community. The prevalence of schizophrenia worldwide is about 1.1% of the population above 18 years (Schizophrenia Symptoms, Patterns and Statistics and Patterns, 2017). This means at least 51 million people worldwide are affected by schizophrenia. In case of UAE, it has been found that about 50, 000 people suffer from schizophrenia. This means almost 1% of the UAE population is affected by the mental disorder (Saberi, 2017). The stigma associated with schizophrenia often exacerbates the sufferings of affected people.
Schizophrenia is regarded as a devastating mental disorder as it has psychological, socio-cultural and spiritual impact on patients, their family members and the workplace of patients. The diagnosis of schizophrenia is associated with great psychological impact as it leads to cognitive dysfunction in patient. The deficits in attention, memory and executive functioning have an impact on patient’s capability to perform daily life activities and such patients are prone to many risks in their life (Hofer et al., 2017). Hence, they rely on family members and clinical staffs to perform work as well as basis living skills. In addition, certain functional deficits in patient affect socio-cultural life of people too. This can be said because people with schizophrenia tend to have overlapping symptoms of depressive disorder. Impaired cognitive, functional disability and poor ability to concentrate reduces self-esteem and confidence of people. They often remained distressed contributing to the risk of depression (Balci et al., 2016). They fail to cope with demands of social life and fail to fulfill interpersonal relationship with partners or work staffs. They capability for full-time is affected and they lose sexual desire too. Hence, stable relationship in social life does not exist and severely ill patients often enter into social isolation. There are even more serious impact of social isolation and if this is not addressed, patients starts developing suicide ideation too (Baek, 2014). Religion and spirituality also has an impact on the life of schizophrenia patient. The relation between spirituality and schizophrenia has influence on help seeking behavior, psychopathology as well as treatment outcome for patient (Grover, Davuluri & Chakrabarti, 2014).
Based on the analysis of mental illness symptoms in the movie, two nursing diagnoses have been identified. Firstly, the Birdy was found to have unreal thought process, delusion and impaired thinking pattern evident from his continuous thoughts about birds and his wish to fly like birds. He also wanted to escape from harsh realities of life. Another nursing diagnosis is that Birdy has impaired social interaction evident from the fact he failed to enter into any close relationship, had no sexual desire and has only friend.
In relation to the nursing diagnosis of delusional thought pattern in Birdy, two important nursing interventions for Birdy includes active listening and communication with patient to understand the intensity and duration of such behavior and use distractive methods to prevent Birdy from focusing on delusion. Distraction strategies would serve to relax patient and reinforce positive behavior to help him concentrate. While talking and listening to patient, it will be necessary to give no judgment and just listen to identify thinking patterns and level of disorder thinking in patient.
To address impaired social interaction in patient, social and coping skills nursing intervention will be necessary for Birdy. The nurse can help the client to facilitate contact with other people by developing good rapport with patient and helping him to identify alterative course of action that would reduce his suffering. In order to encourage patient to increase social contact, he will also be referred to any role model and encouraged to take part in group activities. Schizophrenia patient also tend to enter into social isolation because they lack coping skills and develop anxiety in social place. Hence, nurse can help to strengthen coping skill in Birdy by entering into empathetic communication with him and providing chance to express his fear or any expectation. On the basis of this communication, the patient can be encouraged to recognize his strength and develop their self-esteem (Jung et al., 2016). This will help Birdy to interact confidently in social group.
As schizophrenia is mainly cognitive disorder, two forms of treatment are available for such patient. First treatment option is the pharmacological treatment option by providing anti-psychotic medication to patient. This is necessary for acute and long term management of schizophrenia (Leucht et al., 2013). Another treatment option is the use of cognitive therapy to treat psychosis in schizophrenia patient. Cognitive therapy is recognized as specific and effective intervention for schizophrenia patients because it mainly use cognitive rehabilitation or social skills training to reduce psychotic symptoms and modify dysfunctional beliefs of patient (Gould et al., 2015).
The above two treatment options are associated with different side effects in managing schizophrenia too. Firstly, the use of anti-psychotic medications for schizophrenia patient is associated with many side effects such as dizziness, weight gain, tremors and restlessness. Hence, such side effects may further increase the issues for patients and there is a need to consider the need for medication in individual patient. In addition, the side effect or adverse impact of cognitive therapy on schizophrenia patient is that some patients may get more disturbed and their symptoms may relapse. This will increase the need for re-hospitalization of patient.
Considering the above discussion on impact of schizophrenia on patients, two recommendations for clients to manage their illness includes increasing their resilience skills and taking time out to engage in other activities that distract their mind from delusions. Focusing on resilience and coping skill will help client to get back their lost motivation and emotions in activities. Engaging in extra activities will help them to come out from unreal thought pattern.
The essay gave insight into the Birdy movie which effectively depicted the plight and sufferings of people suffering from dementia. Through the character of Birdy, one can easily relate to types of disorder thinking experienced by people with dementia. The adverse impact of mental disorder on psychological, socio-cultural and spiritual life of people is also clearly understood from the essay. The essay also gives insight into possible nursing interventions, treatment options and self-management strategies for client to treat the patients.
Reference
Baek, S. B. (2014). Psychopathology of social isolation. Journal of exercise rehabilitation, 10(3), 143.
Balci, G., Oter, G. B., Akdag, H. A., Bekki, A., Kisa, C., & Goka, E. (2016). Factors associated with depression in patients with schizophrenia. Journal of Mood Disorders, 6(2), 54.
Birdy. (2017). Rcpsych.ac.uk. Retrieved 23 November 2017, from https://www.rcpsych.ac.uk/discoverpsychiatry/blogzone/mindsonfilmblog/birdy.aspx
Frith, C. D. (2014). The cognitive neuropsychology of schizophrenia. Psychology Press.
Fusar-Poli, P., Papanastasiou, E., Stahl, D., Rocchetti, M., Carpenter, W., Shergill, S., & McGuire, P. (2014). Treatments of negative symptoms in schizophrenia: meta-analysis of 168 randomized placebo-controlled trials. Schizophrenia bulletin, 41(4), 892-899.
Gould, R. A., Mueser, K. T., Bolton, E., Mays, V., & Goff, D. (2015). Cognitive therapy for psychosis in schizophrenia: an effect size analysis. Focus.
Grover, S., Davuluri, T., & Chakrabarti, S. (2014). Religion, spirituality, and schizophrenia: a review. Indian journal of psychological medicine, 36(2), 119.
Hofer, A., Mizuno, Y., Wartelsteiner, F., Fleischhacker, W. W., Frajo-Apor, B., Kemmler, G., … & Welte, A. (2017). Quality of life in schizophrenia and bipolar disorder: The impact of symptomatic remission and resilience. European Psychiatry, 46, 42-47.
Jung, E., Wiesjahn, M., Wendt, H., Bock, T., Rief, W., & Lincoln, T. M. (2016). Symptoms, functioning and coping strategies in individuals with schizophrenia spectrum disorders who do not take antipsychotic medication: a comparative interview study. Psychological medicine, 46(10), 2179-2188.
Leucht, S., Heres, S., Kissling, W., & Davis, J. M. (2013). Pharmacological treatment of schizophrenia. Fortschritte der Neurologie· Psychiatrie, 81(05), e1-e13.
Saberi, M. (2017). About 50,000 people suffer from schizophrenia in the UAE. GulfNews. Retrieved 23 November 2017, from https://gulfnews.com/about-50-000-people-suffer-from-schizophrenia-in-the-uae-1.520741
Schizophrenia Symptoms, Patterns and Statistics and Patterns. (2017). Mentalhelp.net. Retrieved 23 November 2017, from https://www.mentalhelp.net/articles/schizophrenia-symptoms-patterns-and-statistics-and-patterns/
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