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

The appearance of mammalian follicles at the time of ovulation has been described by numerous observers. Importance features to which attention has been directed are: changes in the vascularization of the follicle, the appearance of an avascular area known as the macula pellucida or stigma, the formation of small blood clots near the stigma and some extravasation of blood, and the rupture of the follicle at the stigma and exist of the oocyte and follicular fluid. The first major advance beyond this descriptive stage came with the demonstration that antral pressure does not increase prior to follicle rupture. This observation eliminated a number of hypotheses concerning ovulation and focused attention on the deterioration and weakening of the follicle wall at the stigma. That the follicle wall weakness prior to rupture is established beyond doubt by gross observations of its increased fragility during various manipulative procedures, by stress-strain measurements in vivo and in vitro, and by histological observations. Progressive weakening of the stigma region by thinning and degeneration is a fundamental aspect of the preovulatory maturation of follicles, and it would appear to be a necessary prerequisite to rupture.
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PMID:Rupture of ovarian follicles at ovulation. 17 4

The ultra-orthodox (haredi) community is a sizable proportion of the population of North Jerusalem. They are proportionately underrepresented among new referrals to the Community Mental Health services, tend to drop out of treatment early, and only present with severe psychopathology. Fear of stigma, contact with the irreligious world, "yihud" with opposite sex therapists, suspicion of irreligious healers of the Jewish "nefesh", and seeing such a need as a sign of weakness of faith all serve to deter the religious patient from seeking help. The therapist's anti-religious sentiments, his feelings of being belittled and used, and lack of attention to these feelings help diminish the therapist's changes of a successful outcome. Differences in communication style, language, concepts and interests affect the prospects of establishing a therapeutic alliance. The views of two Rabbis involved in the field of mental health are presented. Their views portray the structure of the ultra-orthodox society, and its expectations and misgivings concerning psychiatry, psychotherapy and therapists. Ten suggestions are proposed for improving communication between the Community Mental Health services and the ultra-orthodox community.
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PMID:Is psychotherapy possible with unbelievers?: The care of the ultra-orthodox community. 152 51

Although female circumcision is a health condition unfamiliar to most Western obstetrician-gynecologists, immigrants from parts of the world where this procedure is routinely practiced may be encountered. Such women pose unique management problems during labor and delivery. Presented is the case of a 36-year-old Sudanese woman who had undergone pharaonic circumcision, with substantial vulvar scarring, as a young girl in her country of origin. After emigration to the US, she had 2 Cesarean section deliveries. When she presented to the University of New Mexico with a 3rd pregnancy, she requested vaginal birth (to overcome the stigma of moral weakness her family associated with cesarean section) and a female obstetrician familiar with female circumcision. The patient had spontaneous membrane rupture at 39 weeks' gestation. Epidural anesthesia was necessary to examine the patient without severe discomfort. The external genitalia were missing the labia minora, and the clitoral area and external urinary meatus were obscured by bands of scar tissue that had to be cut. The major obstetric problem associated with this profile is prolongation of the 2nd stage of labor due to scar or soft tissue dystocia and the consequent need for deinfibulation. Women who labor unattended with an obstructed introitus are at risk of vesicovaginal and rectovaginal fistulas, laceration of scar tissue with hemorrhage, and fetal asphyxia or death. Incision of the fibrous tissue in this patient allowed sufficient widening of the introitus for expulsion of the fetal head. Delivery was uneventful and occurred after 19 hours. Although some women may desire reinfibulation, this patient sought less discomfort in future vaginal examinations, so the vulvar scars were not reapproximated. The raw surfaces were oversewn loosely after delivery.
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PMID:Female circumcision: obstetric issues. 794 93

We have tried to show, first, that there exists a wide divergence between the interests of psychiatry and clients: none of the three major models underpinning society's trust in psychiatrists justify confidence that the interests of psychiatry and its clients converge enough to warrant psychiatrists' speaking and acting for clients in the development of the mental health system and its policies. Second, the distribution of power between psychiatrists and clients is highly unequal: the voices of clients have been co-opted or submerged by those of other groups, particularly organized psychiatry and family-dominated advocacy organizations. Our argument is not based on any particular conception of what the "needs" of clients are--we have not claimed to know what they are, nor, indeed, that they are determinable. However, our point is that the mental health system remains with no good theory to support a proposition that needs will be met, leaving no basis upon which to evaluate the system's success. Therefore, insofar as the "purpose" of this system is to meet client needs, we consider the system to be irrational. The numbers of clients and their presumed intensity of interest in mental health policy should have guaranteed them a place of importance in the political processes shaping the mental health system. There are several structural reasons why this has not been the case: client passivity due to the medical model therapeutic context; hesitancy to engage in public action due to the enduring stigma of mental illness; incapacities caused by psychological distress as well as by iatrogenic dysfunction; organizational weakness due to the free-rider problem of voluntary client groups compared with the ability of psychiatry to encourage contributions to its lobbying efforts; marked client disadvantages in obtaining external funding. If we judge one of the positive features of a liberal democracy to be its stability (in that individuals and groups do not need to resort to violence in order to get a fair allocation of society's goods and costs), we need to be watchful. A political system that systematically disadvantages significant segments of society risks alienating them. While such a situation may (temporarily) benefit a small powerful minority, society as a whole will suffer. Goodwin (1989, p. 47) noted that "over the post-war period the state has consistently sought to recognize greater levels of mental illness in the community."
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PMID:Extremely unbalanced: interest divergence and power disparities between clients and psychiatry. 892 56

About forty million Americans will experience a major depressive illness sometime during their lives. However, many will not seek treatment because of the social stigma attached to the disorder--depression is a sign of weakness or failure. For those that do seek treatment, many alternatives are available. The first generation of antidepressants, dubbed tricyclics (TCAs), provide relief from depression, but produce severe side effects. Monoamine oxidase inhibitors (MAOIs) allow more norepinephrine, dopamine, and serotonin to be produced--neurotransmitters linked to moods and sleep. They also exhibit many side effects. The newest drugs, selective serotonin reuptake inhibitors (SSRIs), relieve depression similar to the TCAs and MAOIs, but have a lower rate of unpleasant side effects. Prozac, within the SSRI family, is the most popular and most studied drug for the treatment of depression. Discovered by pharmaceutical company Eli Lilly and approved by the Food and Drug Administration (FDA) in 1987, prozac has been shown to work against obsessive-compulsive disorder, suicidal thoughts, and aggressive behavior--all of which can be symptoms of depression.
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PMID:Generation prozac. 1136 74

Depression is a serious illness of which I and other patients should not be ashamed but this is hard to avoid. The stigma of depression is different from that of other mental illnesses and largely due to the negative nature of the illness that makes depressives seem unattractive and unreliable. Self stigmatisation makes patients shameful and secretive and can prevent proper treatment. It may also cause somatisation. A major contributing factor is that depression for those who have not had it is very hard to understand and so can be seen as a sign of weakness. Openness by depressives and education in schools could help.
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PMID:Stigma of depression--a personal view. 1171 20

Malawi has a population of 9 million people with AIDS the leading cause of death in the 20-40 age group. The HIV positive prevalence rate, estimated at 23% in urban areas and 8% in rural areas, is one of the highest in the world (AIDSEC, 1994:1). Evaluation of counselling practices showed poor results with counsellors feeling ineffective and inadequate. Patients are mostly tested on medical indication but patients who do not see the benefit of knowing their HIV status increasingly refuse testing. The counselling practise as it is known in the Western world is a foreign concept for patients living in rural Malawi. The high stigma of AIDS complicates support of the patients. The goal of the research study was to describe a model of counselling that would meet the needs of an AIDS patient in rural community in Malawi. A qualitative research design that was explorative, descriptive and contextually specific to rural Malawi was used for the study. In order to describe a counselling model it was important to understand the illness experience of HIV reactive patients. The patients are seen in group context congruent with the African culture and therefore the experience of the primary care giver of AIDS patients is explored as the other major factor in the phenomenon examined. One phase of the research is described in this article namely exploring and describing the experience of the HIV reactive patient in rural Malawi. Results show that patients are in an advanced stage of AIDS when they are diagnosed and complain of weakness and an inability to do work, including an inability to do their daily chores. This causes a feeling of desperateness that is worsened by the perception that support systems are inadequate. Support systems are mostly identified as parents, partners and siblings to assist mainly with the physical care and financial support. Despite the fact that the family is very important to patients there is a reluctance to acknowledge their HIV status. Patients fear being rejected once it is known that they have AIDS--not only because AIDS is a sexually transmitted disease, but also because it is perceived that financial and other support will be withheld if it is known that patients have AIDS and will therefore die and not be able to return the support provided. Patients feel they have no future once a diagnosis of AIDS has been made which results in refusal of testing, as they do not see the benefit of knowing their HIV status. Assessing the coping ability of the patient within the household as part of an overall assessment is one proposed strategy that could be taken. Secondly the patient is encouraged to take a more active role in the counselling process, which could be achieved by narration. The family should be incorporated into the counselling process as early as possible.
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PMID:The experience of HIV reactive patients in rural Malawi--Part I. 1197 4

This paper examines Japanese mind-body concepts and attempts to tease out some of the ways this philosophical orientation influences the Japanese view of mental illness. An analysis of key Japanese words will demonstrate that traditionally the Japanese have viewed the mind and body as inextricably intertwined and that this interconnectedness extends to the Japanese self conceptualization. It is argued that this Japanese value orientation sheds light on the stigma associated with mental illness and equally helps to explain the Japanese tendency to somatisize psychological distress. Because "mental" illness is perceived as a character weakness, "somatic talk" becomes a culturally coded idiom of distress providing the Japanese with a culturally acceptable way to influence the behavior of others while at the same time avoiding being labeled with a psychiatric disorder. Somatization in Japan, then, can be understood as an inherently ethical event that has more to do with morals than medicine.
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PMID:Mind-body concepts and mental illness: a study of Japanese values. 1457 85

Almost 19 million Americans require treatment for an "alcohol problem"; however, only 2.4 million have been diagnosed and just 139,000 receive medication to treat it. Chronic heavy drinking contributes to cardiovascular illnesses, liver disease, cancer, and psychiatric disorders. Imaging studies demonstrate structural changes in the human brain with prolonged exposure to alcohol. Alcoholism can thus be described as an acquired brain dysfunction with specific neurochemical and neuroanatomic pathways. There is a need to intervene early because the average age of alcohol experimentation is 11-13 years--delaying onset reduces the rate of alcoholism. A survey sponsored by the Community Anti-Drug Coalitions of America (CADCA) set out to measure the attitudes and misperceptions of 1000 adults from the general population plus 300 physicians and 503 individuals in recovery from alcohol use disorder (AUD) to better understand approaches toward alcohol treatment. In these surveys, 74% of the general public indicated that alcoholism affects their daily lives, with 41% reporting having to encourage a loved one to seek help for an alcohol problem. The vast majority (= 80%) indicated a stigma toward alcoholics. Denial or refusal to admit severity and fear of social embarrassment were the top 2 reasons for not seeking help. The majority of the general population believes that alcoholism is caused partly by moral weakness. The survey revealed that most Americans are open to medications to treat alcoholism if physician-recommended and if it could reduce alcohol cravings and maintain abstinence. In the past 55 years, only 3 medications (disulfiram, naltrexone, and acamprosate) have been US Food and Drug Administration (FDA)-approved for the treatment of AUD, each with unique mechanisms of action.
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PMID:Alcoholism and pathways to recovery: new survey results on views and treatment options. 1691 32

We present an instructive case of a 47-year-old female patient with tethered cord syndrome, discovered before arthroscopy was to be performed under routine spinal anesthesia for right knee arthritis. The patient had no symptoms except for right knee-joint pain, but weakness in the left dorsiflexors and decreased range of motion in the left ankle and toe joints were found on preoperative physical examination. In addition, clawfoot deformity was discovered in the left foot. A small stigma was observed on the skin in the sacral region. A magnetic resonance imaging scan showed the spinal cord tethered to an intrathecal mass in the sacral region. Therefore, we avoided spinal anesthesia. The arthroscopy proceeded uneventfully with the patient under general anesthesia.
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PMID:Tethered cord syndrome discovered in preoperative examination. 1745 59


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