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David Baxter

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Stigma worsens schizophrenia symptoms and social function
30 January 2007
Psychiatry Res 2007; 149: 89?95

Stigma experienced by patients with schizophrenia may impact on their symptoms and social function, researchers report.

Paul Lysaker (Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA) and colleagues found that patients reporting more internalized stigma had higher levels of positive symptoms, more emotional discomfort, and fewer social relationships than those with less stigma.

These associations were seen at baseline and 6 months later, the investigators note.

Positive schizophrenic symptoms were a risk factor for increased stigma 6 months later, while high levels of stigma were a risk factor for increased emotional discomfort at 6 months.

The study involved 36 people with schizophrenia who completed the Internalized Stigma of Mental Illness Scale, the Positive and Negative Syndrome Scale, and the Quality of Life Scale.

Reporting in the journal Psychiatry Research, the team notes that examination of each of the individual stigma scales suggested that "alienation, or feeling devalued as a member of society, was most strongly related to symptoms 6 months later."

Lysaker and co-workers suggest that positive symptoms may attract attention and be misunderstood as signs of danger or incompetence by others, resulting in social distance, discrimination, and self-stigmatization.

In turn, stigma may predict emotional distress because negative beliefs lead to a cycle of self-fulfilling failure and suffering.

The researchers were surprised to find that negative symptoms were not associated with stigma. They speculate that such symptoms do not attract attention and can be more easily explained by behavior and traits than positive symptoms. Moreover, in patients adhering to treatment, negative symptoms are less likely to emerge than positive symptoms.

Lysaker et al say that their results suggest "internalized stigma is linked with social function and symptoms."

They conclude: "Positive symptoms may make some persons with schizophrenia more vulnerable to ongoing stigma experience."

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