Stigma and Stigmatization

Stigma and Stigmatization

• Stigma, from the Greek word for mark or brand, refers to the attribution of negative traits and characteristics
• Stigmatization describes a societal process where certain groups are devalued based on prejudices

Forms of Stigmatization

• Self-stigmatization involves an affected individual adopting negative attributions, leading to resignation
• Public stigmatization involves negative reactions from the social environment, stemming from prejudices
• Structural stigmatization involves institutional discrimination, leading to unequal treatment in healthcare

Problem Areas of Stigmatization

• Insufficient knowledge about mental illness
• Negative attitudes towards those affected
• Avoidance of mentally ill individuals
• Fear of mental illness

Development of Mental Illness

• Risk factors include biological causes like genetic predisposition and neurotransmitter disorders
• Familial circumstances such as strained relationships and neglect are also risk factors
• Stressful life events like trauma, stress, and social isolation can contribute
• Vulnerability-stress model: few risk factors equates to low vulnerability, several risk factors equate to moderate vulnerability, many risk factors equates to high susceptibility to mental illnesses

Affective Disorders

• Affect is a short-term emotional reaction characterized by mood changes
• Affective disorders are mental illnesses marked by considerable changes in mood, drive, and thinking
• Emotional states, drive, and thought processes are abnormally increased or decreased
• The disorders involve a morbid change in mood that persists for a prolonged amount of time, impairing functionality
• Observation criteria for include basic mood, situational appropriateness, emotional stability, and emotional range
• Types of progression are unipolar, bipolar, or with or without psychotic symptoms
• Progression can be phasic, marked by time-defined episodes of illness with healthy intervals

Phases of Episodes

• 1/3 experience a single disease episode with no recurrence
• 1/3 experience several disease episodes with few recurrences
• 1/3 experience frequent disease episodes with many recurrences

Depression

• Defined as an affective disorder characterized by a pathologically depressed mood and various psychological and physical symptoms
• Cardinal symptoms include depressed mood, loss of interest or pleasure, reduced drive, and increased fatigability
• Additional symptoms include impaired concentration, feelings of guilt, suicidal thoughts, sleep disorders, diminished self-esteem/confidence, negative future prospects, and reduced appetite

Types of Episodes

• Mild episodes involve two cardinal and two secondary symptoms, with minor impairments
• Moderate episodes involve two primary and three secondary symptoms, with considerable impairments
• Severe episodes involve all primary and at least four secondary symptoms, with everyday functions severely restricted
• Depression with psychotic symptoms involves severe depression in addition to delusions of guilt, persecution, impoverishment, or hypochondria
• Seasonally dependent depression follows a pattern, is linked to autumn and winter months, has increased sleep requirements, and increased appetite

Etiology

• Etiology may include neurotransmitter dysfunction
• Familial burden
• Early childhood burdens
• Life events
• Chronic stress
• Psychosocial care for severe depression addresses the lack of all social resources

Rebuilding

• Focuses on re-establishing friendships
• Re-establishing relationships
• Financial stability
• Securing employment
• Securing housing
• Interventions involve pharmacological treatments like antidepressants, mood stabilizers, St. John's Wort, neuroleptics, or benzodiazepines

Non-Pharmacological Therapy

• These therapies include light therapy
• Sleep deprivation therapy
• Psychotherapy
• Occupational therapy
• Physiotherapy
• Sociotherapy.

Care

• The principle is to strike a balance between activating measures and overexertion
• Providing too much attention is something that may be seen as putting someone under pressure
• Providing too little attention reinforces existing feelings of inadequacy

Mania

• Affective disorder characterized by a pathologically elevated mood, increased drive, and heightened personal efficacy
• Those affected often experience euphoria, are excessively active, and have a reduced need for sleep
• Cardinal symptoms include elevated or inappropriately elevated mood, increased productivity and talkativeness, reduced need for sleep, impulsiveness and concentration problems, disinhibition, increased risk-taking, irritability, and rapid mood swings
• Additional symptoms are irritability, excessive sociability, increased libido, concentration problems, recklessness, and reduced awareness of illness

Types of Mania

• Hypomania is a mild form of mania with increased activity and euphoria
• It doesn't have any significant impairments to daily life and increased productivity and creativity
• Mood is abnormally elevated or irritable
• Manic episode with at least three cardinal symptoms lasting over a week; severe impairment of lifestyle

Attributes Of A Manic Episode

• Involves a lack of insight into the illness and possible social and professional consequences
• Mania with psychotic symptoms: delusions or hallucinations occur in addition to manic symptoms
• Typical symptoms include delusions of grandeur, persecution, and excessive self-esteem
• Etiology: neurotransmitter imbalance where norepinephrine and dopamine play a role
• Factors such as genetics, stress, psychological strain, and sleep deprivation can trigger manic episode
• Drug use like stimulants, can trigger or worsen mania

Intervention Options

• Hospitalization may be necessary to minimize harm
• Treatment often uses a combination of up to three different groups of medications: antipsychotics, mood stabilizers, and benzodiazepines
• Psychotherapy is often difficult due to restlessness and is focused on establishing relationships
• This is done by encouraging compliance and psychoeducation
• Other therapies include occupational, sports, and music therapy
• Electroconvulsive therapy (ECT)
• Care requires clearly communicating limits and rules; not restricting an excessive urge to move too strongly; promoting peace of mind

Goals To Help With Mania

• To avoid reinforcing cheerfulness
• To create a low-stimulus environment
• Don't let yourself be provoked, and provide protection from destructive actions
• Also monitor weight

Schizophrenia

• A severe mental disorder marked by characteristic changes in thinking, feeling, and perception
• Etiology includes genetic factors where the risk increases due to family history
• Early childhood damage like oxygen deficiency at birth and infections, alcohol, and substance abuse
• Possible factors also are neurotransmitter changes where imbalance of dopamine and norepinephrine, brain substance reduction, social factors: trauma, stress, drug abuse, and overwork

Symptoms of Schizophrenia

• Positive symptoms include hallucinations, thought disorders, delusions and ego disturbances
• Negative symptoms include loss of drive, flattened affect, social isolation, reduced content of speech, apathy, and impaired performance
• Thought disorders include rumination, thought insertion, delusional ideas, and compulsions
• Management: impossible to talk someone out of delusions; addressing the delusion does not cause someone to give up the delusion

Important Nursing Practices

• Take the patient seriously, give attentive, interested, neutral hearing
• Reinforce healthy aspects of the patient
• Provide a stable daily Structure and avoid stress and excessive demands put on the patient
• Use simple and unambiguous communication while providing opportunities for withdrawal
• Forms of schizophrenia: paranoid schizophrenia: dominance of delusions and hallucinations and ego-disturbances (most common type)

Types of Schizophrenia

• Catatonic schizophrenia can be traced back to neurological disorders in 25% of cases
• It involves movement disorders, stupor, catalepsy, mutism, negativism, long maintenance of awkward postures, and dreamlike states
• Schizophrenia simplex is primarily characterized by negative symptoms and an insidious course, and strange behavior; social requirements can no longer be met, and performance declines
• Post-schizophrenic depression is a depressive episode after a psychotic phase, with negative or positive symptoms in the background and a greatly increased risk of suicide

Addiction Disorders

• Definition: Uncontrollable craving for a substance or behavior despite negative consequences, dose escalation, and withdrawal symptoms during abstinence

Addiction Criteria

• Craving: A strong wish or desire to consume substances
• Impaired control: regarding the start, end, and amount of consumption
• Physical withdrawal symptoms: occurs during reduction or abstinence (DSM5, 2022)
• Addiction criteria: tolerance development: tendency to escalate the dose
• Narrowing behavioral patterns to substance use: increased time commitment, shifting priorities, neglect of other interests
• Continued substance use despite its harmfulness: despite evidence of ongoing late effects, continued consumption
• Negative social and health consequences

Diagnoses

• Diagnosis includes the occurrence of at least three addiction criteria within one month or repeated occurrence of at least three addiction criteria within one year
• Diagnostic assessments include somatic, psychic, and social assessments
• Somatic assessments include circulatory disorders, tremors, sweating, calf cramps, paraesthesia, nausea, loss of appetite, and impotence
• Psychic assessments of abnormal is drinking habits like hidden and morning drinking, dissimulation, sleep disorders, film tears, and concentration disorders
• Social work assessments include professional difficulties and an interest loss

Additional Attributes of Addiction

• Mangelnde Hygiene
• Common behaviors are trivialization, denial, belittling, dissimulation, concealment, low frustration tolerance, reduced self-esteem, social withdrawal, blame shifting
• Harmful use definition: demonstrable damage to health, traceable to consumption, has existed for at least one month or repeatedly within one year, addiction criteria are not met
• Substance dependencies: Alcohol: consequences, liver damage, neuropathies, memory disorders, alcohol withdrawal syndrome: tremors, restlessness, seizures

Additional Substances Of Abuse

• THC (Cannabis): positive: relaxation, euphoria, negative: anxiety, hallucinations
• Amphetamines (Speed, MDMA): increases blood pressure and performance, leads to withdrawal symptoms
• Opioids (Heroin, Morphine): high addiction rate, extreme euphoria, severe withdrawal symptoms
• Hallucinogens (LSD, Psilocybin): altered state of consciousness, risk of psychosis
• Consequences and complications: alcohol withdrawal syndrome (tremor, insomnia, restlessness, seizures, etc.); Wernicke encephalopathy (fever, gastrointestinal disorders, ataxia, oculomotor disorders, impaired consciousness)
• Amnestic syndrome (memory loss, reduced comprehension, disorientation and lack of initiative)

Suicidality

• Defined as all thoughts and actions aimed at ending one's own life
• Causes include genetic/biological factors like metabolic changes in the brain, psychosocial factors, and societal factors
• Stressful life events are also a potential cause
• Risk factors include previous suicide attempts, hopelessness, chronic pain, mental illnesses, impulsivity, and access to lethal means
• Warning signs include talking about death, withdrawal, giving away personal items, and sudden calm after prolonged depression
• Presuicidal syndrome characteristics which include narrowing, aggression, and escapism
• Care and intervention: take suicidal thoughts seriously and listen

More Care Points

• Have a direct conversation and give psychosocial support
• Attempt to form relationship support to the patient and to stand by them and help them overcome the crisis
• Try to eliminate psychological as well as social stressors
• Don't trivialize their feelings
• Try to take away any emotional pressure