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Running head: EFFECTS OF ACTIVITY IN INDIVIDUALS WITH SCHIZOPHRENIA

Effects of Activity in Individuals with Schizophrenia


Ashwajit Kamble
NorQuest College
NFDN 2007: Mental Health
Assignment 2: Research to Practice Report
Carly Legault
February 20, 2015

EFFECTS OF ACTIVITY IN INDIVIDUALS WITH SCHIZOPHRENIA

Schizophrenia is a mental disorder characterized by impairment of thought process,


emotions, and behaviour (Austin & Boyd, 2010). The movie The soloist brings in a great
example of schizophrenia, it is based on a true story of Nathaniel Ayers, who is a musical
prodigy but is restrained to grow and excel due to his mental condition and there comes Steven
Lopez, an infamous writer from The Los Angeles Times, he forms a close relationship with
Nathaniel and this relationship helps Nathaniel in various ways to cope with his disorder. This
paper will mainly focus on the importance of activity and social aspects in the lives of people
suffering from schizophrenia.
Characters Appearance and Behaviour
In the film, Nathanial Ayers appears to be socially awkward around people and likes to be
left alone, he finds solace in the streets where he is not contained in one area and is able to move
rapidly. People with schizophrenia show least amount of interest in personal hygiene and health
(Flammer, Breier, & Steinert, 2009). This is evident in Nathaniels case as well, as he has no
interest in personal hygiene and lives as a homeless. Moreover, he exhibits symptoms such as
auditory hallucinations, when he was to perform in front of a bunch of people and voice comes in
saying everyone is laughing at you and you should not be here and his delusions of Steven
Lopez being his God. These instances indicate clear case of paranoid schizophrenia, where a
person presents auditory/visual hallucinations and delusions (Austin & Boyd, 2010).
Nathanials interest in music completely negates the negative aspects of his disease. To
start with in the beginning of the movie Steven Lopez senses a bit of enthusiasm when he hears
Nathanial talk of Beethoven and other eminent musician. Furthermore, at the second meeting
where Nathanial plays a cello, he loses himself into the symphony. This states that any kind of

EFFECTS OF ACTIVITY IN INDIVIDUALS WITH SCHIZOPHRENIA

activity or personal interest tends to have a positive outcome on the physical and mental health of
individuals with schizophrenia (Soundy et al., 2013).
DSM IV TR
According to the DSM-IV TR, delusions, hallucinations, disorganized speech, grossly
disorganized or catatonic behaviour, and negative symptoms such as flat effect, expression of
little or no emotion, anhedonia (losing interest in pleasure and sexual activities), social
withdrawal and isolation are the main characteristics of schizophrenia. However, a person with
schizophrenia may not possess all the above mentioned symptoms but to meet the criteria he or
she should have at least two above mentioned manifestations (Austin & Boyd, 2010).
In the movie, Nathanial Ayers suffers from auditory hallucinations, delusions, social
withdrawal, rigid thoughts and beliefs. Hence, he shows more than two symptoms and other
manifestations like auditory hallucinations and delusions are consistent with a specific paranoid
subtype of schizophrenia.
Comparison of Nathanials behaviour with characteristics of DSM IV
According to DSM-IV TR, presence of hallucinations with other symptoms for a period
of a month or longer becomes a symptom of schizophrenia (Austin & Boyd, 2010). The major
symptom that Nathanial presented in the movie was the auditory hallucination, it happened twice
in the movie when he was going to play a cello and voice commanded him to leave and the
second hallucination takes place when Nathanial was very young and tries to hurt his sister by
acting on his false suspicions. Moreover, DSM IV TR also states that delusion is another
symptom that should be present in an individual to be diagnosed with schizophrenia (Austin &
Boyd, 2010). Steven Lopez takes special interest in Nathanial, and he tries to help him by getting
him an apartment but Nathanial stays adamant and does not agree to it but when Steven says, I

EFFECTS OF ACTIVITY IN INDIVIDUALS WITH SCHIZOPHRENIA

am your God and you should listen to me then Nathanial moves into the apartment. Hence, this
belief of Steven Lopez being his God is great example of delusion.
According to DSM IV, decreased level of social and occupational activities is also a
requirement for an individual to be diagnosed with schizophrenia (Austin & Boyd, 2010). In the
movie it is quite evident that Nathanial was a recluse, as he lived in the streets away from his
sister and all the people who know him. Coming to his occupation, he never had a job nor did he
try to earn money using unconventional ways (criminal activity). He left his social status when
he left his home at a very young age, so there was no social pressure on him. Decreased sexual
enticement is another characteristic of schizophrenia as the DSM IV suggests (Austin & Boyd,
2010). This symptom is also evident in Nathanials lifestyle, as his reclusiveness suppressed all
his sexual desires making him incompetent of companionship. According to DSM-IV TR
negative signs should persist for at least six months before developing a positive symptom like
hallucination or delusion (Austin & Boyd, 2010). Social withdrawal, rapid speech, loss of
pleasure and interest in world, and deteriorating personal hygiene are some known negative
symptoms that Nathanial exhibits when was young and then he has his first hallucination after
some time where he becomes violent and suspicious when his sister brings him food, and he tries
to hurt her.
Reference of the main article
Soundy, A., Wampers, M., Probst, M., De Hert, ,., Stubbs, B., Vancampfort, D., & ... Strhle, A.
(2013). Physical activity and sedentary behaviour in outpatients with schizophrenia: A
systematic review and meta-analysis... including commentary by Attux C, Leutwyler H,
and Strohle A. International Journal Of Therapy & Rehabilitation, 20(12), 588-596.
Purpose of Research Article

EFFECTS OF ACTIVITY IN INDIVIDUALS WITH SCHIZOPHRENIA

The purpose of this article is to study the effects of activity in the individuals with
schizophrenia. Till now, any kind of activity is considered beneficial for people suffering from
different mental diseases (William & Tinsley, 2011). Furthermore, this article will also compare
the health of patients who are active in their lives with patients who are inactive or sedentary in
their lives.
Type of Study and Study Findings
A systematic review (objective data) was conducted for this study considering research
from the following databases The Cochrane Schizophrenia Group (The Cochrane Library,issue
10), CINAHL (from 1981), EMBASE (from 1974), Medline (from 1946), PEDro (from
1929), PubMed (from 2002), PsychINFO (from 1967), ProQuest (from 1743), ZETOC (the
British library searched on 2 September, 2012); and few selected internet websites (eg. Google
scholar). Two reviewers studied almost 12 different studies with 628 participants involved in it.
They also considered certain factors like age, BMI, gender and a particular stage of
schizophrenia and formed four categories: Sedentary, Light, Moderate and Vigorous activity
They found people coming under sedentary or light activity categories are more prone to
regression of the disease (unable to be calm included as a symptom of schizophrenia). Moreover,
it is also associated with certain metabolic abnormalities among the individuals and depression.
The people coming under moderate/vigorous activities categories are healthier in many forms
like higher metabolism rate and lowered chances of developing regression and depression when
compared to the sedentary people. These findings are just associated with different levels of
activity and participants at that time were not undergoing any medication therapy.
Comparison of the study with Nathanial Ayers

EFFECTS OF ACTIVITY IN INDIVIDUALS WITH SCHIZOPHRENIA

Nathanial was a musical prodigy and he was a homeless. His normal days included
longer periods of walking, as he used to walk to different places to play music. Moreover,
different researchers considered playing computer games as a light activity (Soundy et al., 2013).
Similarly playing music and putting an effort of moving hands rigorously might be considered an
activity of a higher caliber. This overall had a positive outcome on Nathanials mental state, as
his symptoms did not deteriorate to a life threatening extent, and he was still socially available
after a little bit of effort(Steven lopez was able to form a relationship). Playing music may not
only help him stay healthy by keeping his metabolism uptight and prevent regression but also
keep him calm and elevate his mood (sense of happiness when hes listening to music or playing
music) and prevent depression.
Nursing Implications and Impacts on future nursing
In conclusion, the findings clearly state that physical activity has positive outcomes on
patients behaviours. Nurses around the globe should incorporate activity as a valuable
intervention when caring for the patients with schizophrenia, as it not only benefits their mental
state but keeps them healthy generally. Comparing physical activity with other interventions like
medication therapy might be an ideal choice for the nurses who are responsible for the
individuals but the use of medications was not discussed in the article.

References

EFFECTS OF ACTIVITY IN INDIVIDUALS WITH SCHIZOPHRENIA


Austin, W., & Boyd, M. A. (2010). Psychiatric and mental health nursing (2nd ed.).
Philadelphia, PA : Wolters Kluwer/Lippincott Williams & Wilkins.
Flammer, E., Breier, A., & Steinert, T. (2009). Oral health and hygiene among persons with
severe mental illness. Psychiatric Services, 60(10), 1402-1403.
doi:10.1176/appi.ps.60.10.1402
Soundy, A., Wampers, M., Probst, M., De Hert, ,., Stubbs, B., Vancampfort, D., & ... Strhle, A.
(2013). Physical activity and sedentary behaviour in outpatients with schizophrenia: A
systematic review and meta-analysis... including commentary by Attux C, Leutwyler H,
and Strohle A. International Journal Of Therapy & Rehabilitation, 20(12), 588-596.
Williams, A. & Tinsley, T. M., (2011). Mental Health Benefits of Exercise for Adolescents.
Retrieved from http://www.acsm.org/access-publicinformation/articles/2011/10/04/mental-health-benefits-of-exercise-for-adolescents