[Stigmatization in mental health care. Research among clients and care providers]. / Stigmatisering binnen de ggz; onderzoek onder cliënten en hulpverleners.

BACKGROUND: In addition to impediments to social and social functioning, people with severe mental illness also experience the negative consequences of prejudice and stigmatization. Stigmatization also occurs in mental health care, including addiction care. AIM: To describe the occurrence and manifestations of stigmatization by care providers, from the perspective of clients and care providers. METHOD: Digital surveys among clients of the panel Psychisch Gezien (n = 628) and among care providers (n = 471). RESULTS: More than half (54%) of the panel members had experienced stigmatization by mental health care providers in the past two years. They experienced this mainly through a distant attitude (22%) and the language used by care providers (20%). Two-fifths (40%) of the care providers indicated that stigmatization occured regularly or often in their own team. Both clients and counselors emphasized the importance of normalizing mental health problems, reluctant use of psychiatric labels and recovery-oriented work to reduce stigma. CONCLUSION: Stigmatization by mental health care providers is manifested in many ways, making it a complex and ambiguous problem. Although there is no ‘one size fits all’ solution, normalization of mental problems is an important starting point.

Blocking AMPA receptor signalling by caroverine infusion does not affect counter-regulation of hypoglycaemia in healthy men.

AIMS/HYPOTHESIS: Glutamatergic pathways are assumed to play a critical role in the hormonal stress response to hypoglycaemia. In rats, glutamate signalling at the amino-3-hydroxy-5-methyl-4-isoxazol propionate (AMPA) receptor contributes to hormone release induced by behavioural stressors. We hypothesised that blocking the AMPA receptor by caroverine in healthy men would impair their perception of neuroglycopenia and thereby diminish hormonal counter-regulation as well as symptoms of hypoglycaemia, as a model of stress. METHODS: In a balanced double-blind study, two hypoglycaemic clamp sessions (mean blood glucose 2.4 mmol/l for 50 min) were performed in ten healthy men during intravenous administration of 80 mg caroverine or placebo. We assessed concentrations of counter-regulatory hormones as well as subjective symptoms related to hypoglycaemia. RESULTS: AMPA receptor antagonisation by caroverine did not influence the perception of neuroglycopenic and autonomic hypoglycaemia-associated symptoms (p > 0.39 for all). Notwithstanding, caroverine did increase basal and counter-regulatory glucagon secretion (p < 0.002) and slightly enhanced counter-regulatory growth hormone concentrations (p = 0.07). Counter-regulatory release of ACTH, cortisol, adrenaline (epinephrine) and noradrenaline (norepinephrine) did not differ between conditions (p > 0.11 for all). CONCLUSIONS/INTERPRETATION: Antagonising AMPA receptor signalling by caroverine infusion failed to diminish and even slightly amplified counter-regulatory hormone release during hypoglycaemia in healthy men. The discrepancy with previous findings in rats may be due to different dosages or administration routes and calls for further investigations on the role of AMPA receptor signalling in hypoglycaemia counter-regulation in humans.