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Jäckel D, Willert A, Brose A, Leopold K, Nischk D, Senner S, Pogarell O, Sachenbacher S, Lambert M, Rohenkohl A, Kling-Lourenco P, Rüsch N, Bermpohl F, Schouler-Ocak M, Disselhof V, Skorupa U, Bechdolf A. Correction: Enhancing educational and vocational recovery in adolescents and young adults with early psychosis through Supported Employment and Education (SEEearly): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:476. [PMID: 37491354 PMCID: PMC10369747 DOI: 10.1186/s13063-023-07524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- D Jäckel
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - A Willert
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany.
| | - A Brose
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - K Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - D Nischk
- Department of Social Psychiatry, Zentrum Für Psychiatrie, Reichenau, Germany
| | - S Senner
- Department of Social Psychiatry, Zentrum Für Psychiatrie, Reichenau, Germany
| | - O Pogarell
- Department of Psychiatry and Psychother- Apy, University Hospital, LMU Munich, Munich, Germany
| | - S Sachenbacher
- Department of Psychiatry and Psychother- Apy, University Hospital, LMU Munich, Munich, Germany
| | - M Lambert
- Department of Psy- Chiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rohenkohl
- Department of Psy- Chiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Kling-Lourenco
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - N Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - M Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - V Disselhof
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - U Skorupa
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité UniversitätsmedizinBerlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum Am Urban and Vivantes Klinikum Im Friedrichshain, Berlin, Germany
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Jäckel D, Willert A, Brose A, Leopold K, Nischk D, Senner S, Pogarell O, Sachenbacher S, Lambert M, Rohenkohl A, Kling-Lourenco P, Rüsch N, Bermpohl F, Schouler-Ocak M, Disselhoff V, Skorupa U, Bechdolf A. Enhancing educational and vocational recovery in adolescents and young adults with early psychosis through Supported Employment and Education (SEEearly): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:440. [PMID: 37400899 PMCID: PMC10316586 DOI: 10.1186/s13063-023-07462-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Psychotic disorders often develop a chronic course with devastating consequences for individuals, families, and societies. Early intervention programs for people in the first 5 years after the initial psychotic episode (early psychosis) can significantly improve the outcome and are therefore strongly recommended in national and international guidelines. However, most early intervention programs still focus on improving symptoms and relapse prevention, rather than targeting educational and vocational recovery. The aim of the present study is to explore the effects of Supported Employment and Education (SEE) following the Individual Placement and Support (IPS) model in people with early psychosis. METHODS The SEEearly trial compares treatment as usual (TAU) plus SEE to TAU alone in outpatient psychiatric settings. The study is a six-site, two-arm, single-blinded, superiority randomized controlled trial (RCT). Participants are randomly assigned (1:1) to the intervention or control group. Aiming to recruit 184 participants, with an assumed drop-out rate of 22%, we will be able to detect a 24% difference in the main outcome of employment/education with 90% power. We make assessments at baseline and at 6- and 12-month follow-ups. Outcome data on employment/education, medication, and current psychiatric treatment is obtained monthly through phone based short assessments. The primary outcome is steady participation for at least 50% of the 12-month follow-up in competitive employment and/or mainstream education. Secondary employment outcomes capture length of employment/education, time to first employment/education, monthly wages/educational attainment, and social return on investment (SROI). Secondary non-employment outcomes include subjective quality of life, psychopathology, substance use, relapse, hospitalization, and functional impairment. To be eligible, participants must be between 16 and 35 years, fulfill diagnostic criteria for early psychosis, and be interested in competitive employment and/or mainstream education. DISCUSSION In SEEearly, we hypothesize that participants with psychosis, who receive TAU plus SEE, present with better primary and secondary outcomes than participants, who receive TAU alone. Positive results of this study will justify SEE as an evidence-based strategy for clinical routine treatment in people with early psychosis. TRIAL REGISTRATION SEEearly was registered nationally and internationally in the German Clinical Trials Register (DRKS; identifier: DRKS00029660) on October 14, 2022.
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Affiliation(s)
- D Jäckel
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - A Willert
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany.
| | - A Brose
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - K Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - D Nischk
- Department of Social Psychiatry, Zentrum für Psychiatrie, Reichenau, Germany
| | - S Senner
- Department of Social Psychiatry, Zentrum für Psychiatrie, Reichenau, Germany
| | - O Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - S Sachenbacher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Kling-Lourenco
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - N Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - M Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - V Disselhoff
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - U Skorupa
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Abstract
In many societies suicide was and is an extremely controversial topic. This review article outlines the historical background of social condemnation of suicidal thoughts and actions in the western world. It summarizes current research results about the consequences of suicide stigma for affected persons and its relevance for suicide prevention. Finally, the next steps in research and prevention are discussed. Over time and in different cultures, the societal judgement of suicide has greatly varied. During antiquity, some philosophers viewed suicide negatively and by the fifth century AD suicide was widely condemned by societies across the western world. Until today suicide remains a taboo topic in Germany and other countries. Current research showed that the social condemnation of suicidal thoughts and behavior (i.e. suicide stigma) is an additional stressor among persons who experience or have experienced suicidality and their relatives. Furthermore, suicide stigma is considered to be a central barrier to seeking help for and disclosure of suicidality. Despite its relevance for suicide prevention, only a few interventions to reduce suicide stigma among members of the general public and to support affected persons in dealing with suicide stigma exist.
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Affiliation(s)
- N Oexle
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Deutschland. .,Sektion Public Mental Health, Klinik für Psychiatrie und Psychotherapie II der Universität Ulm am Bezirkskrankenhaus Günzburg, Parkstraße 11, 89073, Ulm, Deutschland.
| | - L Mayer
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
| | - N Rüsch
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm am Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
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Evans-Lacko S, Courtin E, Fiorillo A, Knapp M, Luciano M, Park AL, Brunn M, Byford S, Chevreul K, Forsman A, Gulacsi L, Haro J, Kennelly B, Knappe S, Lai T, Lasalvia A, Miret M, O'Sullivan C, Obradors-Tarragó C, Rüsch N, Sartorius N, Švab V, van Weeghel J, Van Audenhove C, Wahlbeck K, Zlati A, McDaid D, Thornicroft G. The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature. Eur Psychiatry 2020; 29:381-9. [DOI: 10.1016/j.eurpsy.2014.02.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractStigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe—primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.
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Abstract
BACKGROUND Suicide is a major global public health issue. Mental illness is a risk factor for suicide, but as many individuals with a diagnosed mental health problem do not experience suicidal ideation or attempt suicide, other individual and societal factors must be considered. Mental illness-related discrimination is one potential risk factor. METHOD Using mixed methods, the influence of discrimination on suicidality amongst 194 individuals diagnosed with depression, bipolar or schizophrenia spectrum disorders was investigated. Qualitative interviews with a sub-sample of 58 individuals who reported a link between experience of discrimination and suicidality were analysed using framework analysis. Quantitative methods were used to examine the model derived from qualitative analyses. RESULTS Results indicate that the experience of discrimination led 38% of the overall sample of 194 participants, to suicidal feelings and 20% reported that it contributed to making a suicide attempt. The qualitative model derived from interviews with a sub-sample of 58 participants suggested that the experience of discrimination is experienced as a stressor that exceeds coping resources, leading to a negative self-image and a perception of decreased supportive networks/social structure. The anticipation of further negative events and treatment, and the perception of a lack of supportive networks led individuals in this study to feelings of hopelessness and suicidality. Quantitative analyses provided support for the model. CONCLUSIONS These data suggest that both psychological therapies aimed at improving coping skills and population-level anti-stigma interventions that reduce the occurrence of discrimination may provide some protection against suicide amongst individuals with mental health problems.
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Affiliation(s)
- S Farrelly
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - D Jeffery
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - N Rüsch
- Department of Psychiatry II,University of Ulm and BKH Günzburg,Germany
| | - P Williams
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - G Thornicroft
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
| | - S Clement
- Health Service and Population Research Department,Kings College London, Institute of Psychiatry,London,UK
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Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JSL, Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med 2015; 45:11-27. [PMID: 24569086 DOI: 10.1017/s0033291714000129] [Citation(s) in RCA: 1348] [Impact Index Per Article: 149.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking? METHOD Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted. RESULTS The review identified 144 studies with 90,189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = - 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma. CONCLUSIONS Stigma has a small- to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.
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Affiliation(s)
- S Clement
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - O Schauman
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - T Graham
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - F Maggioni
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - S Evans-Lacko
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - N Bezborodovs
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - C Morgan
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
| | - N Rüsch
- Department of Psychiatry II,University of Ulm,Germany
| | - J S L Brown
- Department of Psychology, Institute of Psychiatry,King's College London,UK
| | - G Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry,King's College London,UK
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Rüsch N, Corrigan P, Todd A, Bodenhausen G. PW01-209 - Implicit self-stigma in people with mental illness. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rüsch N, Corrigan P, Todd A, Bodenhausen G. P03-186 - Automatic stereotyping and prejudice against people with mental illness. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Rüsch N, Todd A, Bodenhausen G, Corrigan P. P03-187 - Biogenetic models of psychopathology, implicit guilt, and mental illness stigma. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rüsch N, Todd A, Bodenhausen G, Corrigan P. P03-184 - Mental illness stigma in a just world: implicit and explicit findings. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71238-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rüsch N, Corrigan P. P03-185 - Self-stigma, group identification and perceived legitimacy of discrimination as predictors of mental health service use: a longitudinal study. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rüsch N, Corrigan PW, Wassel A, Michaels P, Olschewski M, Wilkniss S, Batia K. Ingroup perception and responses to stigma among persons with mental illness. Acta Psychiatr Scand 2009; 120:320-8. [PMID: 19485961 DOI: 10.1111/j.1600-0447.2009.01403.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Mental illness stigma is common, but it is unclear why it affects some individuals more than others. We tested the hypothesis that the way persons with mental illness perceive their ingroup (people with mental illness) in terms of group value, group identification and entitativity (perception of the ingroup as a coherent unit) shapes their reaction to stigma. METHOD Ingroup perceptions, perceived legitimacy of discrimination and reactions to stigma (educating or helping others, social performance, secrecy, social distance, hopelessness) were assessed among 85 people with mental illness using questionnaires and a standardized role-play test. RESULTS Controlling for depression and perceived discrimination, high group value and low perceived legitimacy of discrimination predicted positive reactions to stigma. High group identification and entitativity predicted positive reactions only in the context of high group value or low perceived legitimacy of discrimination. CONCLUSION Group value and perceived legitimacy of discrimination may be useful targets to help people with mental illness to better cope with stigma.
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Affiliation(s)
- N Rüsch
- Illinois Institute of Technology, Chicago, IL 60616, USA.
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Tebartz van Elst L, Valerius G, Büchert M, Thiel T, Rüsch N, Bubl E, Hennig J, Ebert D, Olbrich HM. Increased prefrontal and hippocampal glutamate concentration in first episode paranoid-hallucinatory schizophrenia: evidence from a magnetic resonance spectroscopy study. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-991789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Orfei MD, Robinson RG, Prigatano GP, Starkstein S, Rüsch N, Bria P, Caltagirone C, Spalletta G. Anosognosia for hemiplegia after stroke is a multifaceted phenomenon: a systematic review of the literature. Brain 2007; 130:3075-90. [PMID: 17533170 DOI: 10.1093/brain/awm106] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Anosognosia is the lack of awareness or the underestimation of a specific deficit in sensory, perceptual, motor, affective or cognitive functioning due to a brain lesion. This self-awareness deficit has been studied mainly in stroke hemiplegic patients, who may report no deficit, overestimate their abilities or deny that they are unable to move a paretic limb. In this review, a detailed search of the literature was conducted to illustrate clinical manifestations, pathogenetic models, diagnostic procedures and unresolved issues in anosognosia for motor impairment after stroke. English and French language papers spanning the period January 1990-January 2007 were selected using PubMed Services and utilizing research words stroke, anosognosia, awareness, denial, unawareness, hemiplegia. Papers reporting sign-based definitions, neurological and neuropsychological data and the results of clinical trials or historical trends in diagnosis were chosen. As a result, a very complex and multifaceted phenomenon emerges, whose variable behavioural manifestations often produce uncertainties in conceptual definitions and diagnostic procedures. Although a number of questionnaires and diagnostic methods have been developed to assess anosognosia following stroke in the last 30 years, they are often limited by insufficient discriminative power or a narrow focus on specific deficits. As a consequence, epidemiological estimates are variable and incidence rates have ranged from 7 to 77% in stroke. In addition, the pathogenesis of anosognosia is widely debated. The most recent neuropsychological models have suggested a defect in the feedforward system, while neuro-anatomical studies have consistently reported on the involvement of the right cerebral hemisphere, particularly the prefrontal and parieto-temporal cortex, as well as insula and thalamus. We highlight the need for a multidimensional assessment procedure and suggest some potentially productive directions for future research about unawareness of illness.
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Affiliation(s)
- M D Orfei
- IRCCS Santa Lucia Foundation, Laboratory of Clinical and Behavioural Neurology, Rome, Italy
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Tebartz van Elst L, Ludaescher P, Thiel T, Büchert M, Hesslinger B, Bohus M, Rüsch N, Hennig J, Ebert D, Lieb K. Evidence of disturbed amygdalar energy metabolism in patients with borderline personality disorder. Neurosci Lett 2007; 417:36-41. [PMID: 17397999 DOI: 10.1016/j.neulet.2007.02.071] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 02/06/2007] [Accepted: 02/12/2007] [Indexed: 11/17/2022]
Abstract
In order to detect possible links between structural and neurochemical brain abnormalities we applied high resolution morphometric imaging and short-echo time absolute-quantification magnetic resonance spectroscopy (MRS) at the left hand side to the amygdala in 12 patients with borderline personality disorder (BPD) and 10 group-matched healthy controls. Confirming earlier reports we found a significant 11-17% reduction of amygdalar volumes in patients with BPD. In addition there was a significant 17% increase of left amygdalar creatine concentrations in BPD patients. Left amygdalar creatine concentration correlated positively with measures of anxiety and negatively with amygdalar volume. This pilot study of simultaneous amygdalar morphometry and spectroscopy in BPD reveals a possible link between amygdalar volume loss, psychopathology and neurochemical abnormalities in terms of creatine signals.
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Affiliation(s)
- L Tebartz van Elst
- South German Brain Imaging Center, and Department of Psychiatry and Psychotherapy, Medical School, Albert-Ludwigs-University Freiburg, Hauptstrasse 5, 79104 Freiburg, Germany.
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Lieb K, Jacob G, Rüsch N, Tebartz van Elst L. Disturbed fronto-limbic brain circuits in borderline personality disorder. Pharmacopsychiatry 2005. [DOI: 10.1055/s-2005-918767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rüsch N, van Elst LT, Ludaescher P, Wilke M, Huppertz HJ, Thiel T, Schmahl C, Bohus M, Lieb K, Hesslinger B, Hennig J, Ebert D. A voxel-based morphometric MRI study in female patients with borderline personality disorder. Neuroimage 2003; 20:385-92. [PMID: 14527598 DOI: 10.1016/s1053-8119(03)00297-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Subtle prefrontal and limbic structural abnormalities have been reported in borderline personality disorder (BPD). In order to further validate the previously reported findings and to more precisely describe the nature of the structural change we performed a voxel-based morphometric (VBM) study in patients with BPD. Twenty female patients with BPD and 21 female healthy controls were investigated. High-resolution 3-D datasets were acquired and analyzed following an optimized protocol of VBM in the framework of statistical parametric mapping (SPM99). Gray matter volume loss was found in the left amygdala. No other differences in gray or white matter volume or density were found anywhere else in the brain. Our findings support the hypothesis that temporolimbic abnormalities play a role in the pathophysiology of BPD. Prefrontal structural alterations in BPD were not observed in this study.
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Affiliation(s)
- N Rüsch
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
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Trimble MR, Rüsch N, Betts T, Crawford PM. Psychiatric symptoms after therapy with new antiepileptic drugs: psychopathological and seizure related variables. Seizure 2000; 9:249-54. [PMID: 10880283 DOI: 10.1053/seiz.2000.0405] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this paper is to understand the association between antiepileptic drugs (AEDs), patient characteristics, changes in seizure pattern and emergent psychiatric disorder, i.e. psychosis or affective disorder. To this end we carried out a retrospective casenote study on 89 patients who developed psychiatric symptoms during treatment with topiramate, vigabatrin or tiagabine. The psychiatric problem was either an affective or a psychotic disorder (not including affective psychoses). It was discovered that 99% of the patients suffered from complex partial seizures with or without secondary generalization. More than half were on polytherapy with two or more other AEDs. Nearly two-thirds had a previous psychiatric history. There was a strong association between the type of previous psychiatric illness and the type of emerging psychiatric problem, both for psychoses and for affective disorders. Patients on vigabatrin had an earlier onset of epilepsy and more neurological abnormalities than those on topiramate. Those patients on lower doses had a shorter interval between the start of the AED therapy and the onset of the psychiatric problem. A seizure-free period was observed in more than half of the patients before they developed the psychiatric symptoms, and of these more were likely to develop a psychosis rather than an affective disorder. There seemed to be an association of suppression of right-sided seizures and the onset of the psychiatric problem. The conclusions drawn were that patients with a previous history of psychosis or affective disorder tended to develop the same psychiatric problem with new AEDs. Those with a seizure-free period before the onset of the psychiatric problem were more likely to develop a psychosis than an affective disorder.
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Affiliation(s)
- M R Trimble
- Institute of Neurology, Queen Square, London WC1N 3BG, UK.
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