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

Consultation-liaison (C-L) psychiatry a subspecialty in psychiatry is referred to as the guardian of the psychological and holistic approach to patient. It has been undergoing rapid changes especially in the developed countries but its practice is strongly affected by stigma and negative attitude by professional colleagues. In this review, it is recommended that C-L psychiatry must not be restricted to conspicuous acute psychiatric disorders alone but must have impact across the whole of medical care. C-L psychiatrists ever than before must not only concentrate on managing psychotic patients but must strive to maintain intellectual and clinical leadership for the psychological system in its entirety. There is yet more to be done in the area of research and campaign against stigmatization.
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PMID:Consultation-liaison psychiatry: the past and the present. 1839 57

The aim is to analyze the stigma associated with severe and persistent mental illness in the general population of the community of Madrid, Spain, as a first step to promote strategies to fight against it. Participants (n = 439) showed adequate general knowledge about mental illness, but a high degree of confusion with mental retardation. Stigmatizing attitudes focusing mainly on the disposition to help and on pity. Moreover, there were some perception of contamination and pity toward other family members. Psychosis seems to shows more stigma attitudes than cancer and depression, but less than cocaine addiction and AIDS.
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PMID:Descriptive study of stigma associated with severe and persistent mental illness among the general population of Madrid (Spain). 1843 69

Kraepelin's dichotomy, manic-depressive insanity and dementia praecox, are contrasting and true endogenous disease entities which affect excitability, the fundamental property of the CNS. Kraepelin wanted to establish a valid classification and hit the extremes in brain structure and function at a time when we had no knowledge of brain dysfunction in "functional" psychoses. The aetiology is now known: the psychoses are part of human growth and maturation and might be classified according to their brain dysfunction, which is exactly what Kraepelin wanted. However, presumably to reduce the stigma attached to the word "psychosis", there is currently a strong initiative to eliminate the concept. But knowledge of what is happening in the brain in a psychosis might be more helpful in reducing stigma. It is suggested that psychosis is due to an affection of the supplementary motor area (SMA), located at the centre of the Medial Frontal Lobe network. The SMA is one of the rare universally connected areas of the brain, as should be the case for such a key structure that makes decisions as to the right moment for action. This important network, which partly has continuous neurogenesis, has sufficiently widespread connections. The SMA, a premotor area located on the medial side of the frontal lobes, is one of the last regions to reach a concurrence of synaptogenesis. An affection of the SMA, a deficient or abolished Delayed Response Task, seriously disturbs our relation and adaptation to the surroundings. We usually master the Delayed Response Task around the age of 7 months, a time at which the second CNS regressive event takes place, which proceeds from the posterior to the anterior of the brain. In very late maturation, a persistent affection of the SMA might occur. We experience a chronic psychosis: infantile autism (IA), a chronic inability to act consciously, which contrasts with the episodic SMA affection post-puberty, when excitation is reduced due to excessive pruning of excitatory synapses. Silent spots are the result of insufficient fill-in mechanisms following a breakdown of circuitry. They may affect the SMA in the case of very late puberty. An acute reduction in excitation and concomitantly a marked increase in silent spots might lead to an acute psychosis. A frontal preference is likely, given that a reduction might occur anywhere in the cortex, but particularly in the areas maturing latest. The varying localisations probably explain the difficulty in accepting schizophrenia as a disease entity. The multifactorial inheritance of the dichotomy implies that the genetics are not fate, a psychotic development might be prevented given enough epigenetic factors: brain food (omega 3). Might the present dietary adversity, with its lack of brain food, be responsible for a rising incidence in psychosis? A psychosis is an understandable and preventable dysfunction of the brain, and its mechanisms are known. Primarily a disorder of reduced excitation in an attenuated CNS, this explains why all the neuroleptics are convulsants, raising excitation, in contrast to all antidepressives, which are anti-epileptic.
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PMID:What is a psychosis and where is it located? 1851 23

Stigma of mental illness is a major obstacle to its diagnosis and treatment and may be worse among Asians than Caucasians. This study compared the stigma of depression in 50 Chinese Americans (CA) and 50 Caucasian Americans (WA). Subjects were asked to read 5 case vignettes in the following order: diabetes mellitus (DB), major depressive disorder (MDD), somatoform depression (SD), psychotic depression (PD), and fever of unknown origin (HA). Diagnosis of each case was not revealed. Subjects then rated their response to each case, on a Likert scale from "strongly disagree" to "strongly agree," to 25 statements that contained 6 stigma factors: fear, shame, cognitive distortion, social consensus, discrimination, and sanction. Composite scores constructed from ratings of each factor were used to calculate the severity of stigma. Stigma of all 5 cases was worse in CA than WA. Both groups ranked DB and HA to be least and PD to be most stigmatizing. CA rated SD to be less stigmatizing than MDD but not WA. We concluded that stigma formation and severity were determined by fear, shame, cognitive distortion, social communication, consensus, and sanction. Mental symptoms, particularly psychotic symptoms, were more stigmatizing than physical symptoms, especially for CA. Belief that depression was like a physical illness did not diminish its stigma.
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PMID:Stigma of depression is more severe in Chinese Americans than Caucasian Americans. 1883 72

The rise of the early intervention paradigm in psychotic disorders represents a maturing of the therapeutic approach in psychiatry, as it embraces practical preventive strategies which are firmly established in mainstream health care. Early intervention means better access and systematic early delivery of existing and incremental improvements in knowledge rather than necessarily requiring dramatic and elusive breakthroughs. A clinical staging model has proven useful and may have wider utility in psychiatry. The earliest clinical stages of psychotic disorder are non-specific and multidimensional and overlap phenotypically with the initial stages of other disorders. This implies that treatment should proceed in a stepwise fashion depending upon safety, response and progression. Withholding treatment until severe and less reversible symptomatic and functional impairment have become entrenched represents a failure of care. While early intervention in psychosis has developed strongly in recent years, many countries have made no progress at all, and others have achieved only sparse coverage. The reform process has been substantially evidence-based, arguably more so than other system reforms in mental health. However, while evidence is necessary, it is insufficient. It is also a by-product as well as a catalyst of reform. In early psychosis, we have also seen the evidence-based paradigm misused to frustrate overdue reform. Mental disorders are the chronic diseases of the young, with their onset and maximum impact in late adolescence and early adult life. A broader focus for early intervention would solve many of the second order issues raised by the early psychosis reform process, such as diagnostic uncertainty despite a clear-cut need for care, stigma and engagement, and should be more effective in mobilizing community support. Early intervention represents a vital and challenging project for early adopters in global psychiatry to consider.
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PMID:Early intervention in psychosis: concepts, evidence and future directions. 1883 82

Psychiatric disorders can be identified in 25-50% of patients with epilepsy, with higher prevalence among patients with poorly controlled seizures. These disturbances include depression, anxiety, psychotic disorders, cognitive, and personality changes occurring in the interictal or ictal/postictal states. In this chapter, we describe four areas of focus in women with epilepsy: comorbid primary psychiatric processes, integrated symptoms secondary to epilepsy, stigma and psychosocial consequences of epilepsy, and nonepileptic seizures.
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PMID:Psychiatric comorbidities in epilepsy. 1892 92

In this article, we identify an array of creative strategies used by persons diagnosed with schizophrenia-related illness to deflect and resist social stigma, and address the lived experience of deploying these strategies in the intersubjective context of everyday life. The data are derived from anthropological interviews and ethnographic observations of ninety persons who received treatment at community mental health facilities in an urban North American locale. Nearly all were keenly aware of stigma that permeated their lives. Their predicament is contradictory: on the one hand, they have recovered relative to previous states of psychosis; on the other hand, their subjectivity is saturated by intense awareness of social stigma that seems intractable in relation to temporal or functional criteria. Ironically, these lives can be characterized as fraught with stigma despite recovery. The strategies generated to resist the impact of stigma highlight the fact that persons with these illnesses are often not only exceedingly socially aware but also strategically skilled in response to social assaults on their personhood and survival. We examine these strategies in terms of (1) the social characteristics of each afflicted person, (2) the situational characteristics of managing stigma, (3) the cultural context of recovery, and (4) the illness-specific characteristics of schizophrenia.
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PMID:Stigma despite recovery: strategies for living in the aftermath of psychosis. 1918 24

The aims of the study were twofold. First, the study examined the extent to which there are gender differences in the experience of caring in a sample of relatives of patients with serious mental illness. Secondly, the study examined the association of self-reports of health and functioning with the experience of burden among relatives of patients with serious mental illness. A total of 50 relatives of 32 patients receiving psychiatric treatment for their bipolar or psychotic condition completed the Experience of Caregiving Inventory (ECI) and COOP-WONCA (a self-report measure of general state of health and functioning). The study revealed that female relatives had a higher score on eight of 10 ECI subscores, and in both ECI negative and ECI positive. Additionally, the study revealed significant correlations between a higher score on the COOP-WONCA feeling subscore and the following ECI subscores: stigma (r = 0.304, p < 0.05), problem with services (r = 0.348, p < 0.05), need to back up (r = 0.335, p < 0.05), loss (r = 0.293, p < 0.05) and the total ECI negative subscore (r = 0.343, p < 0.05). We also found a significant correlation between a higher score on the overall health subscore (COOP-WONCA) and a higher score on problems with services (r = 0.290, p < 0.05). Gender was the strongest predictor of the ECI negative subscore. Neither the COOP-WONCA subscore physical health, daily activities or social activities correlated significantly with any of the ECI subscores. Our results showed strong associations between poor mental well-being and caregiver burden. We also found a higher association with gender and the feelings subscore (COOP-WONCA) on ECI negative than we had expected.
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PMID:The experience of caring in relatives to patients with serious mental illness: gender differences, health and functioning. 1919 43

Although psychiatric stigma in China is particularly pervasive and damaging, rates of high expressed emotion ("EE" or family members' emotional attitudes that predict relapse) are generally lower than rates found in Western countries. In light of this seemingly incongruous juxtaposition and because Chinese comprise approximately one-fifth of the world's mentally ill, we examine how one of the most widely held causal beliefs of schizophrenia--excessive thinking (xiang tai duo)--may powerfully shape how those exhibiting psychotic symptoms pass from "normal" status to stigmatized "other." Using a framework by which stigma threatens an actor's capacity to participate in core everyday engagements, we examine how expressions of excessive thinking intersect with psychotic symptoms and how this idiom reduces stigma by preserving essential moral standing. Four focus groups with family members (n = 34 total) of schizophrenia outpatients, who had participated in psychoeducation, were conducted in Beijing. Open coding was conducted by 2 bilingual coders achieving high interrater agreement. Common expressions of excessive thinking--taking things too hard that is perceived as a causal factor and unwarranted suspicion that is used to benignly interpret paranoid symptoms encapsulated disruptive behaviors that closely overlapped with psychotic symptoms. Because excessive thinking is understood to occur universally, this idiom encourages socially accommodating behavior that signifies acceptance of these individuals as full-status community members. In contrast, due to beliefs implying moral contamination, those labeled mentally ill are threatened with both subtle and outright social exclusion. We discuss implications of this idiom for EE and the detection of schizophrenia "prodrome" in China.
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PMID:"Excessive thinking" as explanatory model for schizophrenia: impacts on stigma and "moral" status in Mainland China. 1919 42

Received wisdom and a substantial body of epidemiological work indicate that early psychosis bodes ill for matrimonial prospects. Using follow-up data from ISoS, the WHO-Collaborative International Study of Schizophrenia, we confirm an earlier local finding that marital success, 15 years after first-break psychosis, is quite favourable in India: 74% for women, 71% for men, compared with elsewhere: 48% for women, 28% for men. This comparative advantage applies to both marriages contracted after onset of psychosis as well as those that survive it, and is the more remarkable for occurring in a culture where the stigma attached to mental illness with regard to marriage is especially heavy. The presence of children and availability of household assistance both appear to enhance odds of successful marriage. That expressed worries about marriage proved so poor a guide to actual performance (and, indeed, survive living proof to the contrary in the families reporting the stigma) suggests that inquiries into stigma should be reworked as larger inquiries into local moral economies of worth. In the dharma-governed world of Hindu India resistance to the cultural opprobrium attached to madness is not a strategic assault on a structured source of shame and discrimination, but a tactical manoeuvre in the name of a higher cultural good - family, the lineage and the social order. Restoring this social basis of self-respect repairs what would otherwise be a disabling breach in the normal maturation process; developmental continuity, in turn, may help explain India's favourable rates of recovery from psychotic disorder. By the same token, the lack of coordinate processes in cultures where transitions to adulthood are poorly marked and post-hospital expectations are low may help to explain the common experience of 'social defeat', and poor outcome, in the lives of former psychiatric patients in the West.
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PMID:To have and to hold: a cross-cultural inquiry into marital prospects after psychosis. 1928 27


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