Stigmatization of schizophrenia as perceived by nurses, medical doctors, medical students and patients.

Stigmatization of schizophrenia is widespread and its genetic explanation may potentially increase the stigma. The present study investigated whether seeing schizophrenia as a genetic or environmental disorder might influence perceived beliefs towards people with schizophrenia and whether social stigmatizing attitudes were differently perceived the 202 subjects who were recruited. Perceived social stigmatizing attitudes were compared among participants who read two vignettes depicting a person with schizophrenia. Then, the Standardized Stigmatization Questionnaire (SSQ) was administered. A genetic explanation of schizophrenia was more frequently associated with stigmatizing attitudes. Also, there were higher levels of perceived stigmatization in medical students and medical doctors than in other groups based on their social experience or background. However, the sample size was small and this was a non-experimental design; also the SSQ would benefit from more cross-validation. About half of the participants perceived stigmatizing social attitudes. Finally, considering schizophrenia as a genetic disorder influenced participants perception of other people's beliefs about dangerousness and unpredictability and people's desire for social distance.

A unitary theory of stigmatisation: pursuit of self-interest and routes to destigmatisation.

BACKGROUND: Stigmatisation is of increasing importance in relation to racism, ageism and sexism but also as an impediment to treating patients. AIMS: To develop a theoretical foundation to help comprehend the core meaning of stigmatisation and to guide practical anti-stigmatisation measures. METHOD: Personal reflection; re-interpretation of stigmatisation and reformulation of the relevant concepts. RESULTS: Emergence of a unitary theory of stigmatisation. CONCLUSIONS: Based on the structure of stigmatisation one could explore six levels of intervention in anti-stigmatisation campaigns: the cognitive level - educational intervention; the affective level - psychological intervention; the discrimination level - legislative intervention; the denial level - linguistic intervention; the economic origin - political intervention; the evolutionary origin - intellectual and cultural intervention. As destigmatisation has to challenge fundamental human tendencies, anti-stigmatisation campaigns have to be continuous, non-stop, open-ended projects aiming at keeping alive thought processes that moderate and humanise the pursuit of self-interest and the urge to survive in a competitive world.

Schizophrenia: breaking down the barriers.

This paper reviews the key issues presented during the Fourth International Conference on Schizophrenia, which was held in October 1996 in Vancouver, Canada. The main emphasis was placed on the problem of stigma, loneliness and work as well as on the necessity to further elucidate the physiopathology of schizophrenia. Some of the barriers discussed are unlikely to disappear from human societies in the short term with any possible cure for schizophrenia as they are part of any major long-term illness, of which there is a long and ever increasing list.

Lifelong development of risk of recurrence in depressive disorders.

This article reviews studies performed over the last half-century on the lifelong development of risk of recurrence in depressive disorders. It mainly examines the question of the development of the frequency of recurrence, in other words, whether consecutive intervals between depressive episodes lengthen or shorten as episodes continue to recur. Methodological issues have been discussed and recommendations are made for future research.

Polycythaemia and agoraphobia.

Using single photon emission computerized tomography (SPECT), we demonstrated that in patient A, a 20-year-old male with polycythaemia, the cerebral blood flow was decreased (presumably as a result of increased viscosity and or microemboli), probably leading to frightening visual distortions (dysmorphopsia) associated with scintillating specks of bright colors (Teichopsia). This had presumably precipitated agoraphobia. After hospitalization, when the patient had not responded to efforts at systematic desensitization, he improved through a combination of multiple venesections and antiplatelet aggregation therapy (aspirin 75 mg o.d.) over 3 months combined with systematic desensitization. A subsequent SPECT demonstrated an increase in cerebral blood flow to normal levels, which coincided with improvement of agoraphobic symptoms and disappearance of visual distortions on further follow-up. This paper depicts another yet undocumented example of an alarming physical symptom probably leading to a cognitively-based panic sufficient to cause agoraphobia by classical conditioning. It also suggests that prior treatment of such physical symptoms is likely to facilitate the process of systematic desensitization.

Cultural sensitivity: ICD-10 versus DSM-III-R.

This article is the outcome of a comparison of the ICD-10 (International Classification of Diseases, 10th Revision) and DSM-III-R (Diagnostic and Statistical Manual, Third Edition, Revised). The study indicates that the ICD-10 has made great progress in widening the international scope of contemporary systems of classification in psychiatry and that the inclusion of certain cultural elements into a classificatory system could enrich its worldwide perspective.