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Query: UMLS:C0277787 (stigma)
 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article describes the descent into psychosis of the author and his recovery, both mental and cognitive. It discusses the problems of stigma that the author overcame as he searched for a new identity as a person given a label. In discussing recovery, the article contrasts traditional mental health services with the PACT model described by Allness and Knoedler (1998). Finally the article argues for the validity of the Peer Specialist as part of a professional mental health team.
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PMID:How I quit being a "mental patient" and became a whole person with a neurochemical imbalance: conceptual and functional recovery from a psychotic episode. 1560 57

Given the morbidity and difficulty of treating psychotic disorders, including schizophrenia, there has been a move toward identifying and treating adolescents and young adults who appear to be clinically at risk or "prodromal" to psychosis. The field now has greater specificity in identification, with rates of 40-50% conversion to frank psychosis within 1-2 years. There is further evidence that medications and other treatments may have some efficacy for "prodromal" patients, though with variable side effects. However, controversy remains about some of the inherent risks in prodromal research, such as medication exposure and stigma among false-positives. In this paper, we add to this discussion through an analysis of ethics in prodromal research from the more established field of predictive genetic testing. Issues are raised about the effects of information on patients, families, and institutions, as well as future insurability, the limits of confidentiality (as it relies on discretion of patients and families), the autonomy of minors with psychiatric symptoms, and even the risks for the true-positive patient.
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PMID:Prodromal interventions for schizophrenia vulnerability: the risks of being "at risk". 1565 60

Psychiatric stigma is a concept that is often used uncritically by policy-makers to explain the underutilization of professional psychiatric services in non-Western societies. Stigma, however, is a multi-determined process manifestations and effects of which cannot be viewed separately from the larger social and cultural context. The present paper presents the results of a qualitative study of psychiatric stigma in Egypt from the perspective of lay respondents. A vignette method was used to elicit judgments of social distance and qualitative responses to stories depicting psychosis, depression, alcohol abuse and a 'possession state' from 208 respondents recruited through their places of work. The results indicated that while stigma does exist in Egypt, the form that it takes must be understood with reference to Egyptian notions of selfhood that locate behavioral disturbances in the intersubjective rather than intrapsychic realm. On the one hand, individual blame is diffused as responsibility for the illness and its cure is placed in the social, not personal (or biological) realm. On the other, behavioral disorders that threaten the social fabric of society are particularly stigmatized and often met with social rejection.
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PMID:Selfhood and social distance: toward a cultural understanding of psychiatric stigma in Egypt. 1595 96

This pilot study examined associations between three central constructs of the theory of planned behavior and the length of treatment delay among patients hospitalized for a first episode of nonaffective psychosis. The sample consisted of 21 relatives directly involved in initiating hospitalization for 14 first-episode patients. Spearman correlation coefficients were calculated to test associations between length of treatment delay and the hypothesized predictors. One of the 3 theory of planned behavior constructs, perceived behavioral control (PBC), was significantly inversely correlated with treatment delay (p = -0.44, P = .04). The other 2 theory constructs were not significant correlates. Perceived stigma was significantly inversely correlated with PBC (p = -0.51, P = .02). There has been no prior research using health behavior theories to study potential predictors of treatment delay or the duration of untreated psychosis. Findings from this pilot study indicate that some health behavior theory constructs, including PBC, may be useful in future early intervention efforts.
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PMID:Treatment delay in first-episode nonaffective psychosis: a pilot study with African American family members and the theory of planned behavior. 1617 61

This paper examines descriptive statistics for the primary payer, length of stay, and admission source of an acute care hospitalization of Hispanic children--pre-adolescents, and adolescents with a primary psychiatric Diagnostic Related Group (DRG)--and relates these variables to the concept of stigma. This paper was a secondary analysis that used data from the National Inpatient Sample database. Psychosis was the most frequent diagnosis of Hispanic youth who were hospitalized. More Hispanic pre-adolescents had a psychiatric DRG than any other ethnic group but fewer Hispanic adolescents were diagnosed with a psychiatric DRG than any other ethnic group. For Hispanic pre-adolescents and adolescents, the primary payer was Medicaid versus private insurance for White pre-adolescents and adolescents. The length of stay was approximately the same for all ethnic groups. The admission source differed for Hispanic pre-adolescents and adolescents with the majority of pre-adolescents being admitted routinely and the majority of Hispanic adolescents being admitted through emergency departments. Recommendations are made for future research, clinical practice, and public policy related to the stigmatization of Hispanic children and adolescents with mental illness.
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PMID:Stigmatization of Hispanic children, pre-adolescents, and adolescents with mental illness: exploration using a national database. 1628 97

African Americans purportedly have a higher prevalence of mental illnesses but are often misdiagnosed and less likely to seek treatment. Delayed treatment has been associated with the stigma related to these disorders. The demographic characteristics, length of stay, most prevalent psychiatric diagnoses, and hospital admissions of African Americans were compared to other U.S. populations using a nationwide sample (N = 4,474,732). African American participants were younger, had significantly longer lengths of stay, and were admitted more often through the emergency room than the other groups in this sample. Psychosis, alcohol/drug dependence, and depressive neurosis were the most prevalent psychiatric diagnoses reported for African American participants. Research is needed to explain these results so that strategies can be instituted to improve the poor mental health outcomes often observed in African American populations.
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PMID:Length of stay, admission types, psychiatric diagnoses, and the implications of stigma in African Americans in the nationwide inpatient sample. 1628 98

Programs for the early detection of psychosis are currently underway in most developed countries. Their aim is to improve the outcome of subjects with psychotic disorders, but neither their feasibility nor their usefulness was assessed before their implementation. The postulate underlying these programs - that early treatment improves the prognosis of psychosis - has not yet been demonstrated. The absence of effective and adequately specific screening tests implies that a substantial number of the subjects evaluated may be incorrectly diagnosed with and treated for psychoses (false positives). Development of facilities specializing in the assessment and care of subjects with early psychosis often implies a decrease in funding for facilities caring for patients with chronic psychoses. Educational and information campaigns aimed at the general public and health professionals, on the other hand, may help reduce the stigma associated with psychosis and improve access to care for subjects in early stages of psychosis. Risk/benefit and cost/benefit analyses of programs for the early detection of psychosis must be evaluated before promoting their development.
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PMID:[Screening programs for early detection of psychosis?]. 1655 Jan 42

The current psychiatric diagnostic system, the diagnostic statistic manual, has recently come under increasing criticism. The major reason for the shortcomings of the current psychiatric diagnosis is the lack of a scientific brain-related etiological knowledge about mental disorders. The advancement toward such knowledge is further hampered by the lack of a theoretical framework or "language" that translates clinical findings of mental disorders to brain disturbances and insufficiencies. Here such a theoretical construct is proposed based on insights from neuroscience and neural-computation models. Correlates between clinical manifestations and presumed neuronal network disturbances are proposed in the form of a practical diagnostic system titled "Brain Profiling". Three dimensions make-up brain profiling, "neural complexity disorders", "neuronal resilience insufficiency", and "context-sensitive processing decline". The first dimension relates to disturbances occurring to fast neuronal activations in the millisecond range, it incorporates connectivity and hierarchical imbalances appertaining typically to psychotic and schizophrenic clinical manifestations. The second dimension relates to disturbances that alter slower changes namely long-term synaptic modulations, and incorporates disturbances to optimization and constraint satisfactions within relevant neuronal circuitry. Finally, the level of internal representations related to personality disorders is presented by a "context-sensitive process decline" as the third dimension. For practical use of brain profiling diagnosis a consensual list of psychiatric clinical manifestations provides a "diagnostic input vector", clinical findings are coded 1 for "detection" and 0 for "non-detection", 0.5 is coded for "questionable". The entries are clustered according to their presumed neuronal dynamic relationships and coefficients determine their relevance to the specific related brain disturbance. Relevant equations calculate and normalize the different values attributed to relevant brain disturbances culminating in a three-digit estimation representing the three diagnostic dimensions. brain profiling has the promise for a future brain-related diagnosis. It offers testable predictions about the etiology of mental disorders because being brain-related it lends readily to brain imaging investigations. Being presented also as a one-point representation in a three-dimensional space, multiple follow-up diagnoses trace a trajectory representing an easy-to-see clinical history of the patient. Additional, more immediate, advantages involve reduced stigma because it relaters the disorder to the brain not the person, in addition the three-digit diagnostic code is clinically informative unlike the DSM codes that have no clinical relevance. To conclude, brain profiling diagnosis of mental disorders could be a bold new step toward a "clinical-neuroscience" substituting "psychiatry".
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PMID:Brain profiling and clinical-neuroscience. 1669 89

This article is a qualitative investigation of the subjective experience of recovery from the perspective of persons living with schizophrenia-related disorders. An NIMH-sponsored ethnographic study of community outpatient clinics was completed for 90 persons taking second-generation antipsychotic medications. Research diagnostic criteria and clinical ratings were obtained in tandem with an anthropologically developed Subjective Experience of Medication Interview (SEMI) that elicits narrative data on everyday life and activities, medication and treatment, management of symptoms, expectations concerning recovery, and stigma. Ethnographic observations from diverse settings (clinics, public transportation, restaurants, homes) were also obtained. The primary findings are that recovery was experienced in relation to low levels of symptoms, the need to take medications to avoid hospitalization or psychotic episodes, and personal agency to struggle against the effects of illness. The majority of participants articulated their sense of illness recovery and expectation that their lives would improve. Improvement and recovery is an incremental, yet definitively discernable subjective process. Several problems were identified as part of this process surrounding cultural conflicts that generate the experience of ambivalence analyzed here as the "paradox of recovery without cure," irreconcilable "catch-22" dilemmas involving sacrifice (e.g., one must be "fat" or be "crazy"), and substantial stigma despite improvement in illness and everyday life experience.
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PMID:The new paradigm of recovery from schizophrenia: cultural conundrums of improvement without cure. 1677 57

The biography of a social-worker shows a positive development in her professional life in spite of several severe episodes of psychotic illness. The author knows her personally over three decades, partly as her psychiatrist. Whether to hide or reveal her psychotic illness as a stigma in professional life is discussed with her own examples. Her "management of the secret" is shown as a combination of hiding and revealing. A slow process of taking again the "risk of trust" with a few friends and within the therapeutic process helps her gain back selfconfidence and trust in others. This process is discussed with Luhmanns approach to trust and the current literature as a way to overcome the inner process of stigmatisation.
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PMID:[To hide and to reveal - how to manage the stigma of mental illness]. 1680 64


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