Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0277787 (stigma)
 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Research examining pathways to care among African Americans with recent-onset psychosis is limited but suggests that African Americans have more complex and less desirable routes into care compared with whites. Delays in treatment of psychotic illness contribute to increasing rates of hospitalization, lengths of stay, long-term functional disability, and poor outcomes. African Americans may be less likely to seek help than whites, which may be due partly to stigma and beliefs in the African-American community about causes of mental illness as well as to external obstacles, such as involuntary civil commitment. Because African Americans are more likely than whites to seek assistance in primary care, the general practitioner or family physician has a potentially greater role in the identification of psychotic illnesses among African Americans. Further research is necessary to evaluate the role of ethnicity in treatment delays among patients with recent-onset psychotic illnesses.
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PMID:Pathways to care for African Americans with early psychosis. 1681 93

Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.
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PMID:Social anxiety and the shame of psychosis: a study in first episode psychosis. 1700 58

European researchers have observed that schizophrenia is 3 times more frequent in immigrants than in native-born subjects. This increased risk is even higher in dark-skinned immigrants, and the second generation is more affected than the first one. Immigrant status is an important environmental risk factor not only for schizophrenia but also for other psychoses. The explanations proposed to date have been mainly related to epidemiological biases and psychological reasons, such as racism or social defeat, but no biological hypotheses have been tested so far. This article proposes two biological hypotheses related to changes in sun exposure, changes in diet, and stress associated with immigration, which would explain the increased risk for psychosis associated with immigrant status. (1) Vitamin D insufficiency has been proposed as a risk factor for schizophrenia. The main source of vitamin D is through photosynthesis by sun exposure, and dark skins need more sun exposure to maintain adequate blood levels. Vitamin D insufficiency in adulthood could explain why dark-skinned immigrants develop psychosis when moving to high latitude countries, and its insufficiency during pregnancy could explain why the observed risk is higher in the second generation. (2) The second hypothesis is that of epigenetics, with psychosis resulting from modifications in gene expression caused by changes in diet and/or stress related to immigration. The role of homocysteine and the vitamin B-complex, especially folic acid, in these changes in DNA transcription would vary according to the polymorphism of the methylenetetrahydrofolate reductase gene. The vitamin D insufficiency and epigenetics hypotheses are consistent with yet unexplained findings well known in the epidemiology of schizophrenia, such as the increased risk in the urban environment, the excess of winter births, the excess of schizophrenia births after maternal famine, and the shorter interbirth period before a schizophrenia birth. In order to test these hypotheses, epidemiological studies of psychosis and immigration should include objective measures of skin color, which is predicted to be a more important risk factor than ethnicity. They should measure vitamin D, homocysteine and vitamin B-complex status and assess the polymorphisms of the vitamin D receptors and the methylenetetrahydrofolate reductase gene. If confirmed, these hypotheses would lead to effective and inexpensive preventive measures which would markedly decrease the rates of psychosis and schizophrenia, as well as the burden and stigma of these diseases, and greatly improve the mental health of immigrants.
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PMID:Why are immigrants at increased risk for psychosis? Vitamin D insufficiency, epigenetic mechanisms, or both? 1751 23

I used a qualitative approach to explore the sociocultural factors influencing the pattern of the help-seeking pathway of Chinese caregivers with relatives suffering from early psychosis in Hong Kong. Analyses of the interview scripts of 58 caregivers revealed that they required an average of 5 months and 2.14 helpers before their ill relatives could receive formal psychiatric services. Drawing on Lin and Lin's model of the Chinese help-seeking pathway as a basis for discussion, this study finds that family caregivers engaged in intrafamilial coping and expanded in concentric circles to include relatives and friends as helpers in the help-seeking pathway. Contrary to Lin and Lin's view that informal network members might cause a delay in the help-seeking process, it is revealed that informal network members who possessed adequate knowledge of mental illness were able to encourage family caregivers to seek help from formal psychiatric services. The duration leading to extrafamilial coping was shorter than the one implied in Lin and Lin's model. Family caregivers were quite ready to seek help from professionals in the formal psychiatric services despite the fact that the ill relatives were reluctant to seek treatment due to psychiatric stigma. Finally, the findings of this study do not support the existence of the "rejection phase" of the help-seeking process proposed by Lin and Lin.
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PMID:Uncovering sociocultural factors influencing the pathway to care of Chinese caregivers with relatives suffering from early psychosis in Hong Kong. 1718 81

Hospitalization costs are lower in psychiatric hospitals than in psychiatric departments of general hospitals. However, soldiers hospitalized in psychiatric hospitals are subject to the stigma associated with mental illness. The goal of this study was to examine the financial costs of preventing such stigma by hospitalizing soldiers in psychiatric departments of general hospitals, rather than less expensive psychiatric hospitals. Another goal was to find ways to reduce hospitalization costs, taking into consideration the consequences of the stigma for patients and their families. Costs, medical data, and demographic data were gathered from records of soldiers hospitalized for psychiatric illness. The most expensive causes of hospitalization were determined (acute psychotic state and adjustment disorders), and the characteristics of a soldier most likely to encounter psychosis were described. Recommendations include rerouting patients from hospitalization to ambulatory day care, when possible, and from general to psychiatric hospitals. We also recommend adopting a psychiatric diagnosis-related group price list to standardize sums paid per diagnosis and creating a system for considering, on a case-by-case basis, early discharge of soldiers with psychotic disorders during the stressful first half-year of military service.
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PMID:The cost of preventing stigma by hospitalizing soldiers in a general hospital instead of a psychiatric hospital. 1769 79

Patients experiencing a first psychotic episode or early stages of psychosis present with key diagnostic issues for clinicians. At the time of first-episode psychosis presentation, it is crucial that clinicians select the most effective treatment option as immediate intervention offers the best chance for containing the illness. During this period, selecting the best treatment option is also important because functional impairment occurs most rapidly during this early period, which can alter the patient's future prognosis, level of necessary treatment, and affect morbidity. Although research has shown a decrease in brain gray matter for those who develop psychosis along with signs of functional impairment, many patients with psychosis remain untreated for extended periods of time and do not visit a clinician because of denial, fear of stigma, a failure to recognize the problem, or complexities of their care system. Prior studies have shown that when psychosis is left untreated, the patient outcome is worse than for a patient treated earlier in the course of illness. There is a range of treatment options for psychosis treatment, including use of first-generation or second-generation antipsychotic medication. Clinicians should note that both drug types are associated with certain side effects, such as tardive dyskinesia and weight gain, respectively. For both medication types, doses should be lower for patients with a first psychotic episode than for patients with chronic psychosis. Lastly, patients may present with various comorbidities, such as substance abuse, that also may affect treatment. This expert roundtable supplement will address the diagnosis and treatment selection for first-episode psychosis as well as comorbidities related to the condition. The use of first- or second-generation antipsychotics for psychosis treatment, dosing guidelines, and the antipsychotic side-effect profile will also be addressed.
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PMID:First-episode psychosis: a window of opportunity for best practices. 1780 19

Anti-psychotic medications have changed the lives and treatment of persons with mental illness for the better since the social isolation of the 1950s and earlier. Community support programs break down barriers surrounding mental patients, but the stigma and negative attitudes about mental illness continue to block the development of community-based services. Individuals struggling to overcome a mental health issue find themselves facing a constant series of rejections and exclusions. Now that the Mental Health Law and Physically and Mentally Disabled Citizens Protection Act have been amended by The Legislative Yuan, the government will need to review the design of the Mental Health Care Network Project and to promote and facilitate friendly supportive communities for the mentally ill. All of us have to face these challenges to find a new balance between the civil rights of the public and the mentally ill. This paper examines issues concerning the gap between the development of the mental health system and the needs of patients and their families in the last two decades. The system often falls short of meeting needs. To meet the mental health needs of the people and make effective use of resources, changes must be made in the way services are designed, organized and delivered. The process of reforming mental health services, moreover, must not take money away from other services. Instead, changes must be made by reallocating funds. Following the revised Mental Health Law, the government should begin now to develop implementation planning guidelines to establish a comprehensive and integrated mental health services system, especially for the 80?% of patients with mild or moderate mental health problems who live in the community. We will monitor the process carefully, and ensure that patients and their families get the services they need, and help them remain in their communities as far as possible.
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PMID:[Community integrated services for persons with mental illness]. 1793 40

Vitamin B12 deficiency is associated with problems in cognition, mood, psychosis, and less commonly, anxiety. Folate deficiency primarily is associated with problems in mood. Patients who have sickle cell disease, a disease of chronic pain, experience difficulties with depression, anxiety, stigma, and are at risk for substance abuse and dependence. Patients with hemophilia have benefited from advances in treatment; however, their morbidity and mortality were compounded in those who received blood products contaminated with HIV, or hepatitis B and C. Psychiatrists who practice psychosomatic medicine should expect to encounter patients with the above problems, as they are frequently seen in medical settings. Finally, most of the commonly used psychotropic medications have uncommon but potentially important hematologic side effects or may interact with the anticoagulants used in medically ill patients.
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PMID:Hematologic problems in psychosomatic medicine. 1793 43

Each culture influences the perceptions of illness and pathways to health care that its members follow. Non-biomedical beliefs about psychosis and treatment are reported from the developing world. This study explored people's perceptions on psychosis to understand local perceptions of the condition. Focus group discussions were conducted with people who have relatives with psychosis (in five focus groups), with members of the general public (in four focus groups), and with patients who had recovered from psychosis (one group) in Vellore, South India. These discussions were recorded, transcribed and analyzed. Participants recognized psychosis as an illness category, and viewed indigenous healing methods as complementary to allopathic treatments. Multiple and apparently contradictory beliefs on different aspects of psychosis were often simultaneously held by participants. People in the community were more likely to express negative views about mental illness. Relatives of patients with psychosis wanted more support from mental health professionals and community in combating stigma against mental illness. Results of this study reveal the complex nature of illness perspectives among patients with psychosis, their relatives and community. Bio-medical and indigenous beliefs are simultaneously held by a significant number of people who often seek help from both modern and traditional health systems at the same time. The results indicate the need for better understanding of local perceptions of psychosis.
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PMID:Perceptions about psychosis and psychiatric services: a qualitative study from Vellore, India. 1808 Jul 91

Revered in some cultures but persecuted by most others, epilepsy patients have, throughout history, been linked with the divine, demonic, and supernatural. Clinical observations during the past 150 years support an association between religious experiences during (ictal), after (postictal), and in between (interictal) seizures. In addition, epileptic seizures may increase, alter, or decrease religious experience especially in a small group of patients with temporal lobe epilepsy (TLE). Literature surveys have revealed that between .4% and 3.1% of partial epilepsy patients had ictal religious experiences; higher frequencies are found in systematic questionnaires versus spontaneous patient reports. Religious premonitory symptoms or auras were reported by 3.9% of epilepsy patients. Among patients with ictal religious experiences, there is a predominance of patients with right TLE. Postictal and interictal religious experiences occur most often in TLE patients with bilateral seizure foci. Postictal religious experiences occurred in 1.3% of all epilepsy patients and 2.2% of TLE patients. Many of the epilepsy-related religious conversion experiences occurred postictally. Interictal religiosity is more controversial with less consensus among studies. Patients with postictal psychosis may also experience interictal hyper-religiosity, supporting a "pathological" increase in interictal religiosity in some patients. Although psychologic and social factors such as stigma may contribute to religious experiences with epilepsy, a neurologic mechanism most likely plays a large role. The limbic system is also often suggested as the critical site of religious experience due to the association with temporal lobe epilepsy and the emotional nature of the experiences. Neocortical areas also may be involved, suggested by the presence of visual and auditory hallucinations, complex ideation during many religious experiences, and the large expanse of temporal neocortex. In contrast to the role of the temporal lobe in evoking religious experiences, alterations in frontal functions may contribute to increased religious interests as a personality trait. The two main forms of religious experience, the ongoing belief pattern and set of convictions (the religion of the everyday man) versus the ecstatic religious experience, may be predominantly localized to the frontal and temporal regions, respectively, of the right hemisphere.
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PMID:Spirituality and religion in epilepsy. 2545 86


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