Case study writing assignment; client: chris pratt

The sinema The Lookout (2007) demonstrates the mental disorder and the process of treatment for Major Neurocognitive Disorder based on the biographical account of an admire high school hockey player with a bright future and being selected a victim to rob the bank, Chris Pratt. The sinema shows the results of devastating car accident. While he is driving his car headlights off down a country highway to show his girlfriend, Kelly, and another friends the swarms of fireflies illuminated in the summer night, he crashes into a combine stalled on the road. Two couples of the car are killed while Chris and his girlfriend survive. However, the crash leaves Chris with lasting mental impairment and along with some anger management issues. In the sinema Chris is presented as a worker who cleans a small-town bank at night. He has a substantial impairment in his cognitive performance. Chris’s loss of cognitive abilities such as executive function, memory and learning are quickly observed by others. Furthermore, he has problems to think logically and manage his anger. This interferes significantly with his independence in daily life. He is in classes to learn new skill which include the simple sequencing of daily tasks to compensate for his inability to remember. He attempts to cope with a tough case manager to build a life despite his injuries. In order to reduce symptoms of mental illness, he keeps notes to himself in a small notebook to remember his daily tasks. He is emotionally supported by his roommate who is a blind man named Lewis, but receives only financial support from his wealthy family. In the light of the above information, the sinema demonstrates typical symptoms of Major Neurocognitive Disorder and its treatment.

After traumatic brain injury, Chris is not himself. Damage to his frontal lobe creates changes in his personality, limited facial expressions, and difficulty in interpreting his environment, such as not being able to adequately assess risk and danger. His injuries also affect his short term memory in the form similar to anterograde amnesia, along with challenging anger management. Before the accident, he is talkative, sociable, outgoing and friendly. He is a successful hockey player and likes to spend time with his friends. However, after the accident, he is sullen and chronically irritable. He also shows some introverted personality traits such as being more quiet, and reserved. He just has a close friend which is his roommate, a blind man named Lewis. He sometimes found himself in unwanted crying. Moreover, he has sorun to recall the simple sequencing of daily tasks to do. Accordingly, he puts small note all over the household goods to remember how to use them. Because he always forgets his car key on the car, he keeps a spare car key in his shoe. Furthermore, he talks without thinking because he gets a severe damage from his frontal lobe which is responsible executive functions such as judgment and decision-making skills and inhibition. For example, in a scene of the movie, he experiences one of the symptoms of these. He meets his therapist who is a female model and also has brain injury before working as a therapist. She is responsible for observing Chris’s behavior and evaluating his mental improvement. When she is asking his relationship with girls, he avoids answering and mentions his emotion about her. He says that he always dreams about having sexual intercourse with her and then he apologizes to saying this due to his uncontrollable speaking after damage his frontal lobe. He says this out loud in the public place. This shows that he has difficulty to manage his speaking to fit socially acceptable norms. Because of this, he prefers to avoid being involved in friendship and stay alone. On the other hand, he wants to be like before the accident. He is unhappy with his life due to not having sociable life and skills like before.

To compensate, he keeps notes in a small notebook to enable him to remember what he is to do. He learns this during engaging in classes which is provided by Independent Life Skills Center. Also, he gets new skills which include the simple sequencing of daily errands to do for his inability to recall. Even though he does the same simple sequencing of daily tasks, he cannot success in sequencing them during exam he takes in the Center. When he talks about this his friend called Lewis, he gets anger not to remember list of typical errands in daily life. Lewis suggests him to remember tasks from the end to the beginning. For example, remembering a short story, first recall what happens at the end of the story and then listing events towards the end to the beginning. Furthermore, he reports that he has problems to recall colors and smells, and confusion over differentiation between fruits and vegetables such as lemon and tomato.

With this in mind, he is obviously unable to have meaningful work. As a result of this, he works as a night cleaning man in a small town bank with regular visitation from Ted who is a sheriff. Ted is his only friend aside from Lewis and delivers doughnuts to Chris in order to check in on him regularly. Because of his mental incapacitation, he comes under the scrutiny of a gang planning to rob the bank. The gang leader named Gary befriends him and gets him involved with a young woman who further reels him in their group. After they get close and after reeling in with his own failures, the bank plan unfolds. Gary manipulates his by promising to get back his life which he lives before the accident with power of money. He tells Chris that the more money you have the more power you get. Also, he reminds Chris about the limitations of his life since the accident. He says that nobody believes you in doing something alone. He wants to learn this by calling his father to ask for money, but his demand does not meet. Besides, his ambitions to be a teller are underestimated by the bank manager. Accordingly, he gets anger and confused because his thoughts and emotions are manipulated by the gang leader. However, he is not aware of this situation because damage to his frontal lobe decreases his ability to analyze or evaluate risk and danger associated with actions. This enables Gary to easily persuade him to aid their bank robbery plan. Therefore, due to wanting to escape his current existence, Chris initially goes along with the bank robbery. After, his frustrations trickle downs into confrontation with his friends, Lewis and Ted, he realizes that he is used and attempts to stop the robbery. He tells gangs members to change his mind, but it is too late. He is forced to empty the bank vault at gunpoint.

The sinema The Lookout shows the symptoms and complications of the mental illness major neurocognitive disorder also known dementia, however also the promise for recruitment and return to society whereby proper treatment. The sinema introduces the typical symptoms of major neurocognitive disorder caused by traumatic brain injury and introduces a timeline of the different treatment methods. Not all brain injuries can be considered potentially causative of neurocognitive disorder. The diagnostic criteria for neurocognitive disorder due to traumatic brain injury require that the traumatic brain injury should be associated with at least one of four features: loss of consciousness, posttraumatic amnesia, disorientation and confusion, or neurological signs, such as neuroimaging findings, seizures, and visual field cuts. Moreover, the neurocognitive disorder must have its onset either immediately after the traumatic brain injury or after recovery of consciousness and must persist past the acute postinjury period (Simpson, 2014). In DSM-5, a major neurocognitive disorder is characterized by a number of cognitive deficits. The DSM-5 criteria for major neurocognitive disorder require that a person has significant cognitive decline from a previous level of performance in one or more cognitive domains such as complex attention, executive function, learning memory, language, perceptual-motor or social cognition. Besides, these cognitive deficits interfere with individuals’ independence in everyday activities such as requiring with complex instrumental activities of daily living. Also, these cognitive deficits do not occur exclusively in context of a delirium and are not better explained by another mental disorder such as major depressive disorder and schizophrenia (Grohol, 2014). Chris’s symptoms are characteristic of people with traumatic brain injury. As mention above, he shows changes both in his cognitive abilities and in his usual emotional and personality functioning. Because Chris also meets the criteria of neurocognitive disorder, he is diagnosed with major neurocognitive disorder. As demonstrated above, after the accident, he experiences dramatically decline in his mental abilities such as learning new things, executive function and complex attention. He lives with roommate named Lewis so that he can decrease the effect of the cognitive deficits on his independence in everyday activity.

There are two classes of drugs are approved for treatment of the cognitive symptoms of major neurocognitive disorder. To begin with, cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) help prevent the breakdown of the neurotransmitter acetylcholine. However, like all the other medicines, these drugs have a few side effects which include nausea, diarrhea, and anorexia. The second class is drugs such as memantine (Namenda) that regulate the activity of the neurotransmitter glutamate, that plays an important role in learning and memory. Also, behavioral therapies can be helpful in controlling patients’ angry outbursts and emotional instability. Cognitive therapy focuses on the cognitive remediation in order to help an individual acquire tools and strategies necessary to improve thinking, executive functioning, time management, and decision-making. Occupational therapy is another treatment option. This therapy focuses on teaching the patient strategies to minimize the effect that cognitive impairment has on day to day living (Nolen-Hoeksema, 2014).

Even though drugs help reduce the cognitive symptoms of major neurocognitive disorder and enable patients to manage anger and agitation, a few research shows that occupational therapy treatment has a significant effect on improvement of patient with major neurocognitive disorder. According to Park et al. (2015), occupational therapy services improve the quality of life for the rest of the lives of people with severe dementia and their caregivers. Similarly, occupational therapists implement multi-sensory environment interventions for individuals with dementia. These interventions emphasize client-centered deva, which facilitates neural changes and promotes emotional connection (Crowe et al, 2014)

In the movie, Chris gets occupational therapy treatment. He engages in classes in Independent Skills Center to learn new skills, including the simple sequencing of daily tasks to compensate for his inability to recall. This therapy works in Chris treatment progress. In the end of the movie, Chris looks at his notebook and realize that he was involved in the bank robbery and Gary was killed him after getting money. Chris successes to make a plan by using his new sequencing skills in order to save his friend who was took hostage by the gang leader. He successfully follows the sequences of his plan and saves the live of his friend.

In conclusion, the treatment history of major neurocognitive disorder is illustrated via The Lookout movie. The sinema demonstrates typical symptoms of dementia caused by traumatic brain disorder by analyzing Chris’ illness. His symptoms occurred after devastating car accident. He had the withdrawal and experienced problems in executive function, learning memory and anger management. There are few treatment used to his symptoms such as pharmaceutical drug treatment and occupational therapy. As mentioned above, occupational therapy is more useful treatment of major neurocognitive disorder. In the movie, Chris was able to think critically and made a plan by using his new skills thanks to occupational therapy.

Reference Lists

Crowe, J. (2014). Professional reasoning and occupational therapist’s use of a multi-sensory

environment for clients with dementia.Physical & Occupational Therapy In

Geriatrics, 32(3), 198-209. doi:10.3109/02703181.2014.927947

Grohol, J. (2014). Symptoms of Major Neurocognitive Disorder. Psych Central. Retrieved on

December 21, 2015, from http://psychcentral.com/disorders/symptoms-of-major-

neurocognitive-disorder/

Nolen-Hoeksema, N. (2014). Abnormal psychology (6th ed ). New York: McGraw-Hill.

Park, J., Lee, J., & Kim, Y. (2015). Occupational therapy services for elderly with severe

dementia. In I. Söderback, I. Söderback (Eds.), International handbook of

occupational therapy interventions (2nd ed.) (pp. 451-461). Cham, Switzerland: Springer International Publishing.

Simpson, J. R. (2014). DSM-5 and neurocognitive disorders. Journal Of The American

Academy Of Psychiatry And The Law, 42(2), 159-164.