The role of weight bias and role-modeling in medical students’ patient-centered communication with higher weight standardized patients

ObjectivePatients with obesity may experience less patient-centered care. We assessed whether medical students’ implicit/explicit weight-related attitudes and perceptions of normative attitudes are associated with patient-centered care for patients with obesity.MethodsThird and fourth year medical students (N = 111) at one medical school completed a survey and participated in a patient care scenario with a standardized patient with obesity. Encounters were coded for patient-centered behavior. Predictors of patient-centered behaviors were assessed.ResultsStudent perceptions that negative attitudes about patients with obesity are normative in medical school were significantly associated with poorer patient-centered behaviors, including lower attentiveness (b=?0.19, p = 0.01), friendliness (b=?0.28, p < 0.001), responsiveness (b=?0.21, p = 0.002), respectfulness (b=?0.17, p = 0.003), interactivity (b=?0.22, p = 0.003), likelihood of being recommended by observers (b=?0.34, p < 0.001), and patient-centeredness index scores (b=?0.16, p = 0.002). Student reported faculty role-modeling of discrimination against patients with obesity predicted lower friendliness (b=?0.16, p = 0.03), recommendation likelihood (b=?0.22, p = 0.04), and patient-centeredness index score (b=?0.12, p = 0.03).ConclusionsNegative normative attitudes and behaviors regarding obesity in the medical school environment may adversely influence the quality of patient-centered behaviors provided to patients with obesity.Practice implicationsEfforts to improve patient-centered communication quality among medical trainees may benefit from intervention to improve group normative attitudes about patients with obesity.     

恢复期精神分裂症加用帕罗西汀的社会功能研究

目的探讨利培酮加用小剂量的帕罗西汀对恢复期精神分裂症患者阴性症状、情绪表达、社会功能的影响。方法将71例恢复期精神分裂症患者随机分为干预组(36例)和对照组(35例)。对干预组给予利培酮加用帕罗西汀;对照组单用利陪酮。临床疗效采用阳性与阴性症状量表(PANSS)、个人和社会功能量表(PSP)作为评价指标。结果在加药后12周时,干预组的PANSS总分低于对照组(t=-5.801,P<0.001)。阳性量表分低于对照组(P<0.01);在PSP评分中,干预组的评分大于对照组评分(t=7.08,P<0.001)。组间比较,差异有显著性(P<0.01)。结论利培酮合用帕罗西汀可改善恢复期精神分裂症患者的情绪表达,减轻病耻感、焦虑情绪、增加生活动力,促进患者社会功能的恢复。     

青年癫痫患者经历病耻感真实体验的质性研究

目的了解青年患者发生癫痫后经历病耻感的真实体验,为临床护理人员对其进行针对性护理干预提供理论依据。方法采用目的性抽样法,于2019年9月—2020年4月选取上海某三级甲等医院神经科的青年癫痫患者12例为研究对象。采用描述性质性研究设计,通过半结构式访谈提纲对患者进行深度访谈。采用主题分析法分析资料。结果提炼出3个主题,即病耻感体验(羞耻感、被歧视感、绝望感)、病耻感危害(社交恐惧、自杀倾向、婚姻关系较差、工作消极)及病耻感应对。结论青年癫痫患者存在较强烈的病耻感且病耻感对他们造成了较大的危害,但他们却无法应对病耻感,因此需要临床护理人员充分关注青年癫痫患者的病耻感,及时为其提供护理干预。     

阅读疗法对轻中度抑郁症患者病耻感及主观幸福感的影响

目的 探讨阅读疗法对轻中度抑郁症患者病耻感及主观幸福感的影响。方法 选取2018年10月-2019年6月在我院住院的轻中度抑郁症患者104例,采用随机数字表法将其分为观察组和对照组。对照组给予常规治疗和护理,观察组在对照组基础上实施阅读疗法。在阅读疗法实施前和实施4周、8周后采用Link病耻感量表和纽芬兰纪念大学幸福度量表(MUNSH)对阅读疗法的效果进行评定。 结果 2组Link病耻感量表、MUNSH得分在时间、组间、交互效应上比较,差异均有统计学意义(P<0.05 )。 结论 阅读疗法能够有效缓解轻中度抑郁症患者的病耻感,并增强其积极体验和应对能力,提升患者的主观幸福感。     

Psychiatric-mental health education with integrated role-play and real-world contact can reduce the stigma of nursing students towards people with mental illness

Stigma and negative attitudes towards people with mental illness are frequently found among nursing students. Interventions targeting mental illness stigma are the critical elements in altering the status. The aim of the present study was to examine the effects of the psychiatric-mental health education with role-play and real-world contact on stigma of nursing students towards people with mental illness in China. A single group pretest and posttest study design was adopted and total 373 students were recruited whilst 343 completed the course. We integrated the role-play and contact with patients in the routine psychiatric-mental health education. After the education was completed, the students' stigma towards people with mental illness were positively changed (pretest mean score of stigma: 53.77, posttest mean score of stigma: 49.01, 95% CI: 2.63–6.87) and their willingness to care for the people with mental illness was also significantly increased (pretest mean score of willingness: 5.45, posttest mean score of willingness: 7.38, 95% CI: −2.22–−1.65). The psychiatric-mental health education especially with integrated role-play and real-world contact is an effective way to reduce nursing students’ stigma and negative attitudes towards people with mental illness and increases their willingness to care for people with mental illness.     

Stigma of Mental Illnesses as Perceived by North Korean Defectors Living in South Korea

Objective

This study aims to provide the information of the stigmas of mental illness such as psychosis, alcoholism, attempt suicide, and depression among North Korean defectors.

Methods

We examined stigma for the mental illnesses of 639 North Korean defectors aged 19 to 65 years who live in the Settlement Support Center for North Korean Refugees. The stigmas of mental illnesses were assessed using the Perceived Devaluation-Discrimination Scale We directly compared the stigma level between North Korean defectors and the general population of South Korea.

Results

North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Perceived stigma associated with attempted suicide was similar for North Korean defectors and South Koreans. Only marital status in sociodemographic variables had associations with higher perceived stigma of psychosis, alcoholism, and depression in the North Korean defectors. North Korean defectors, who spent more than one year in transit country, had associations with lower perceived stigma of psychosis and alcoholism. North Korean defectors, who had the experience of compulsory repatriation to North Korea or North Korean family in South Korea, had an association with higher perceived stigma of depression.

Conclusion

North Korean defectors had higher perceived stigmas of psychosis and alcoholism and lower perceived stigmas of depression than South Koreans. Further studies are needed to document serial changes in stigmas for mental illnesses associated with the receipt of education at the Settlement Support Center for North Korean defectors.     

Psychosocial impact of COVID-19

BackgroundAlong with its high infectivity and fatality rates, the 2019 Corona Virus Disease (COVID-19) has caused universal psychosocial impact by causing mass hysteria, economic burden and financial losses. Mass fear of COVID-19, termed as “coronaphobia”, has generated a plethora of psychiatric manifestations across the different strata of the society. So, this review has been undertaken to define psychosocial impact of COVID-19.MethodsPubmed and GoogleScholar are searched with the following key terms- “COVID-19”, “SARS-CoV2”, “Pandemic”, “Psychology”, “Psychosocial”, “Psychitry”, “marginalized”, “telemedicine”, “mental health”, “quarantine”, “infodemic”, “social media” and” “internet”. Few news paper reports related to COVID-19 and psychosocial impacts have also been added as per context.ResultsDisease itself multiplied by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. These have been fueled by an “infodemic” spread via different platforms of social media. Outbursts of racism, stigmatization, and xenophobia against particular communities are also being widely reported. Nevertheless, frontline healthcare workers are at higher-risk of contracting the disease as well as experiencing adverse psychological outcomes in form of burnout, anxiety, fear of transmitting infection, feeling of incompatibility, depression, increased substance-dependence, and PTSD. Community-based mitigation programs to combat COVID-19 will disrupt children’s usual lifestyle and may cause florid mental distress. The psychosocial aspects of older people, their caregivers, psychiatric patients and marginalized communities are affected by this pandemic in different ways and need special attention.ConclusionFor better dealing with these psychosocial issues of different strata of the society, psychosocial crisis prevention and intervention models should be urgently developed by the government, health care personnel and other stakeholders. Apt application of internet services, technology and social media to curb both pandemic and infodemic needs to be instigated. Psychosocial preparedness by setting up mental organizations specific for future pandemics is certainly necessary.     

男男性行为人群HIV感染者/AIDS病人耻辱感的影响因素

目的了解北京市男男性行为人群(MSM)艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人耻辱感现状,分析影响因素,探索降低耻辱感的科学方法。方法通过方便抽样选取262名MSM人群HIV感染者/AIDS病人,进行一般情况和耻辱感的问卷调查。结果耻辱量表四个维度得分分别为个人耻辱(53.22±8.13)分、担心公开(33.20±3.73)分、负面自我形象(35.84±6.40)分、关注公众态度(61.31±8.44)分。耻辱感随着感染情况告知家人、好友的人数增多而降低(P<0.05),在婚者的耻辱感低于离异/丧偶者。结论如何获得家人和周围好友的情感支持,是降低HIV感染者/AIDS病人耻辱感的关键因素。     

Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia,depression and alcohol dependence

Separation is a central step in the process of stigmatizing persons with mental disorders. We examine whether belief in a continuum of symptoms from mental health to mental illness is associated with less stigmatizing attitudes. In a representative population survey in Germany (n=3642), using case-vignettes of persons suffering from schizophrenia, depression or alcohol dependence, we measured belief in a continuity of symptoms, emotional reactions and desire for social distance related to the person described in the vignette. While 42% of respondents agreed in symptom continuity for depression, this percentage was 26% for schizophrenia and 27% for alcohol dependence. Continuum beliefs were associated in general with more positive emotional reactions and less desire for social distance. This relationship was strongest for schizophrenia, followed by alcohol dependence. Continuum beliefs thus seem to be associated with less stigmatizing attitudes, particularly regarding schizophrenia and alcohol dependence. Educational information on the continuous nature of most psychopathological phenomena could usefully be integrated in anti-stigma messages.     

Discrimination in health care against people with mental illness

This paper discusses factors associated with low rates of help-seeking and poorer quality of physical healthcare among people with mental illnesses. Evidence is reviewed on the associations between low rates of mental health literacy, negative attitudes towards people with mental illness, and reluctance to seek help by people who consider that they may have a mental disorder. People with mental illness often report encountering negative attitudes among mental health staff about their prognosis, associated in part with ‘physician bias’. ‘Diagnostic overshadowing’ appears to be common in general health care settings, meaning the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions.