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UNIT 3 ■ Care of Patients With Psychiatric Disorders
Diffusion tensor imaging studies have identified widespread white matter abnormalities in schizo- phrenia (Viher et al., 2016). These abnormalities in white matter microstructure appear to be primarily associated with negative symptoms and psychomotor behavior abnormalities. Long-term studies of patients with schizophrenia have noted brain volume reduction, particularly in the temporal and preventricular areas (Veijola et al., 2014). It has been postulated that long-term antipsy- chotic medication use may contribute to this reduc- tion, but the implications are unclear. Veijola and associates found that symptom severity, level of func- tional ability, and decline in cognitive abilities were not correlated with this reduction in brain volume. Electrophysiology Several studies have evaluated 40 Hz auditory steady- state response, a measure of electrical activity in the brain, and identified neural circuit dysfunctions in people with schizophrenia. A recent meta-analysis (Thunè et al., 2016) of these studies demonstrates robust evidence of such dysfunction in schizophre- nia. The meaning of these circuit dysfunctions is not well understood but may indicate another biomarker for identifying risk or illness. Physical Conditions Several medical conditions are known to cause acute psychotic episodes, including Huntington’s disease, hyperthyroidism or hypothyroidism, hypoglycemia, calcium imbalances, temporal lobe epilepsy, Wilson’s disease, central nervous system (CNS) neoplasms, encephalitis, meningitis, neurosyphilis, and stroke (Mathews et al., 2013). See Box 15–3 for a list of many medical conditions associated with psychosis. Psychological Factors Early conceptualizations of schizophrenia focused on family relationship factors as major influences in the development of the illness, probably in light of the con- spicuous absence of information related to a biologi- cal connection. These early theories implicated poor parent-child relationships, particularly condemn- ing the mother as “schizophrenogenic” (inducing schizophrenia in her child) related to a troublesome communication style known as double bind communi- cation. This theory is no longer considered credible. Researchers now focus on schizophrenia as a brain disorder. Although family relationships are not the cause of the illness, the symptoms in schizophrenia can contribute to significant disruption in communi- cation and relationships among family members, so
BOX 15–3 General Medical Conditions That May Cause Psychotic Symptoms Acute intermittent porphyria Brain abscesses Cerebrovascular disease CNS infections CNS trauma Cushing’s syndrome Deafness Encephalitis Fluid or electrolyte imbalances Hepatic disease
Herpes encephalitis Huntington’s disease Hypoadrenocorticism Hypo- or hyperparathyroidism Hypo- or hyperthyroidism Meningitis Metabolic conditions (e.g., hypoxia; hypercarbia; hypoglycemia) Migraine headache Neoplasms Neurosyphilis NMDA glutamate receptor autoimmune encephalopathy Normal pressure hydrocephalus Renal disease Systemic lupus erythematosus Temporal lobe epilepsy Vitamin deficiency (e.g., B 12 ) Wilson’s disease
Sources: Compiled from APA (2022); Freudenreich (2010); Boland & Verduin (2022).
psychosocial factors should always be part of a com- prehensive assessment. Furthermore, evidence sug- gests that childhood traumas, particularly multiple traumatizations, are associated (among many other influences) with the development of schizophrenia in vulnerable individuals (Álvarez et al., 2015; Davis et al., 2016; Matheson et al., 2014). Trauma-informed care is an important part of comprehensive assess- ment and intervention for this client. Environmental Influences Sociocultural Factors Many studies have attempted to link schizophrenia to social class. Epidemiological statistics have shown
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