Attitudes of psychiatrists toward patients with schizophrenia

A questionnaire was distributed to psychiatrists to investigate their attitudes toward patients with schizophrenia. A total of 42.7% of 60 respondents never informed patients of the diagnosis of schizophrenia and 40.7% informed on a case-by-case basis. The reason that psychiatrists gave for avoiding informing the patients/family members of the diagnosis was the idea that they would not understand the meaning (32.6%) and that they would drop-out from treatment (28.3%). A total of 88.4% of respondents thought the term 'schizophrenia' was used in a pejorative manner in public. The findings revealed that stigmatizing attitudes of society are also shared by some psychiatrists.     

Anticipated discrimination among people with schizophrenia

Üçok A, Brohan E, Rose D, Sartorius N, Leese M, Yoon CK, Plooy A, Ertekin BA, Milev R, Thornicroft G, the INDIGO Study Group. Anticipated discrimination among people with schizophrenia. Objective: The aim of this study was to evaluate the level of anticipated discrimination in people with schizophrenia (n = 732) from 27 countries in the International Study of Discrimination and Stigma Outcomes (INDIGO). Method: Anticipated discrimination was assessed through four questions of Discrimination and Stigma Scale. Twenty‐five individuals were identified at each site who were reasonably representative of all such treated cases within the local area. Results: Sixty‐four per cent of the participants reported that they had stopped themselves from applying for work, training or education because of anticipated discrimination. Seventy‐two per cent of them reported that they felt the need to conceal their diagnosis. Expecting to be avoided by others who know about their diagnosis was highly associated with decisions to conceal their diagnosis. Those who concealed their diagnosis were younger and more educated. The participants who perceived discrimination by others were more likely to stop themselves from looking for a close relationship. Anticipated discrimination in finding and keeping work was more common in the absence than in the presence of experienced discrimination, and the similar findings applied to intimate relationships. Conclusion: This study shows that anticipated discrimination among people with schizophrenia is common, but is not necessarily associated with experienced discrimination.     

A survey of burnout among Australian mental health occupational therapists and social workers

Abstract. Background: This study investigated the extent to which occupational therapists and social workers employed in Australian mental health settings are affected by burnout. Method: Questionnaires were sent to occupational therapists and social workers who had indicated that they were interested in participating in the study. An overall response rate of 76.6% (n = 304) was achieved. The outcome measure was the Maslach Burnout Inventory (comprising emotional exhaustion, depersonalisation and personal accomplishment scales). Results: There were no significant differences, with respect to any of the three burnout scales, between occupational therapists and social workers. Both groups experienced high emotional exhaustion, moderate depersonalisation, and high personal accomplishment. Levels of burnout were not significantly different between inpatient and community staff. Conclusions: These results suggested that, while occupational therapists and social workers reported emotional exhaustion, there was less evidence of depersonalisation and they reported very high personal accomplishment in their work. Results are congruent with those of previous studies and it is argued that the focus of future research should be on identifying characteristics of mental health work that contribute to emotional exhaustion.     

Patterns of social distance towards people suffering from schizophrenia in Austria: a comparison between the general public, relatives and mental health staff

OBJECTIVE: The aims of this study were to identify the different aspects of the attitudes towards people suffering from schizophrenia and to find factors influencing these attitudes -- especially the willingness to contact people suffering from schizophrenia -- as well as to obtain information on how to reduce stigma and discrimination. METHOD: We conducted a study to investigate these attitudes in Austria. A representative sample of the general public, different professional groups working in the field and relatives of mentally ill people were interviewed. The public, relatives and people working in the mental health field were asked a number of the same questions, to allow for comparisons between groups. RESULTS: We found great differences in key dimensions of the attitude towards people suffering from schizophrenia between groups: these included different causal attributions to schizophrenia, different attitudes concerning the perceived success of the treatment of schizophrenia, different fears concerning perceived dangerousness and a different willingness to interact voluntarily with schizophrenia patients. CONCLUSION: The factors influencing the distance towards people suffering from schizophrenia differ between groups. Our findings should help to optimize campaigns fighting against stigma and discrimination.     

National mental health registry for schizophrenia in Malaysia: A preliminary assessment on service utilization

The National Mental Health Registry for Schizophrenia (NMHRS) was established in Malaysia in 2003. Data includes patients who are now receiving treatment in all different facilities in the country and at all levels, including primary care. A subset of data from the registry was analyzed to assess how people with schizophrenia in Malaysia utilize the service. A total of 276 patients with schizophrenia from the NMHRS who were still being followed up after 1 year of treatment at the same facility were included in the assessment. About 13% (n=36) of the patients were seen at an emergency department, 17% (n=46) had psychiatric rehospitalization, 2% (n=6) were transferred to a mental institution, 89.1% (n=246) were on regular follow‐up, 3% (n=9) abused a substance, 22% (n=6) attempted self harm, 4% (n=10) had been in contact with or arrested by police, 10% (n=27) utilized community mental health services and 14% (n=38) continued to seek alternative treatment. Apart from being useful in assisting policy planners, administrators, and clinicians to further improve the mental health services, the present study can also suggest areas of future service research for people with schizophrenia in Malaysia.     

Effects of an antistigma program on medical students' attitudes towards people with schizophrenia

People with schizophrenia are amongst the most stigmatized of those with mental illnesses. The purpose of this study was to examine whether an antistigma program which consists of education, contact, and viewing a film that depicts an individual with schizophrenia, can change attitudes towards people with schizophrenia. The antistigma program was carried out with first-year medical students (n=25). Students' attitudes towards people with schizophrenia were assessed before and after the program. In parallel, a control group of first-year medical students were questioned (n=35). Assessment was repeated after 1 month. Favorable attitudinal changes were observed in terms of 'belief about the etiology of schizophrenia', 'social distance to people with schizophrenia', and 'care and management of people with schizophrenia'. In contrast, no significant change was observed in the control group. Attitude changes tended to decrease at the 1-month follow up. These results suggest that attitudes towards schizophrenia could be changed favorably with this program. To sustain changed attitudes towards people with schizophrenia, antistigma programs should be offered on a regular basis.     

Different dimensions of social support for the caregivers of patients with schizophrenia: main effect and stress-buffering models

The aims of this study were: (i) to assess the impact of caring for patients with schizophrenia on the mental health status of the caregivers; and (ii) to examine the direct and buffer effects of social support on the mental health status of these caregivers. A total of 61 key caregivers of patients with schizophrenia were administered the Chinese Health Questionnaire (CHQ) and the Measure of Support Function (MSF) self-report questionnaire to assess their mental health and social support status. The MSF questionnaire constitutes four subscales, including: (i) the perceived crisis support (PCS); (ii) the perceived routine support (PRS); (iii) the received crisis support (RCS); and (iv) the received routine support (RRS) subscale. The Positive and Negative Syndrome Scale (PANSS) was used to assess the psychopathology severity of the patients they cared for. Then the authors used the hierarchical multiple regression model to analyze the relationship between these variables. The psychopathology severity of the patients reflected by the PANSS scores correlated inversely with the caregivers' CHQ scores. Besides, the PCS subscale scores correlated positively with the caregivers' CHQ scores. Moreover, the interaction between the RCS subscale scores and the PANSS scores was significant. Significant positive correlation between the RCS and CHQ exists only in the higher PANSS subgroup, but not in the lower PANSS subgroup. The psychopathological severity of the patients has a negative impact on their caregivers' mental health. PCS has a direct effect, and RCS has a buffer effect on the mental health status of these caregivers.     

Impairments of social cues recognition and social functioning in Chinese people with schizophrenia

Previous studies have suggested that social cognition deficits, and impaired social functioning, were associated with schizophrenia. However, specificity of the relationships between social cues recognition and social functioning remain largely undefined. The authors speculated that the two were related, and further that recognition of verbal and non-verbal social cues were impaired in people with schizophrenia. A total of 71 people (40 schizophrenia patients and 31 matched normal controls) voluntarily participated in this study. Social cues recognition abilities were measured by the eye gaze discrimination task and the faux pas recognition task. Social functioning was assessed using the Social Functioning Scale. Correlation analysis revealed a significant association between faux pas and, in particular, the social functioning subscales of the Social Functioning Scale (independence and employment) in patients with schizophrenia. Furthermore, the authors also observed that clinical participants performed significantly worse in both the eye gaze discrimination and faux pas recognition tasks than their healthy counterparts. These findings suggested that impaired social cues recognition in people with schizophrenia may be a possible explanation for their impaired social functioning.     

Spiritual belief, social support, physical functioning and depression among older people in Bulgaria and Romania

Objectives: An exploratory investigation is reported into the role of spirituality and religious practice in protecting against depression among older people living in rural villages in Bulgaria and Romania, two neighbouring countries with similar cultural, political and religious histories, but with differing levels of current religiosity.

Methods: In both countries, interviews were conducted with samples of 160 persons of 60 years and over in villages of similar socio-economic status. The Hospital Anxiety and Depression-D scale and the Royal Free Interview for Religious and Spiritual Beliefs were used to assess depression and spiritual belief and practice respectively. In addition social support, physical functioning and the presence of chronic diseases were assessed. One year later, follow-up interviews were conducted with 58 of the original sample in Bulgaria, in which additional measures of depression and of spiritual belief and practice were also included.

Results: The study demonstrates, as expected, significantly lower levels of spiritual belief in the Bulgarian sample (Bulgarian mean 29.7 (SD?=?19.1), Romanian mean 47.6 (SD?=?11.2), t?=?10.2, p?t?=?9.3, p?

Conclusions: Much of Eastern Europe displays high rates of depression among its older population and provides opportunities for investigation of the role of religious belief and practice in preventing and coping with depression. Further research is encouraged in populations of diverse religiosity.     

Stigma associated with schizophrenia: Cultural comparison of social distance in Japan and China

Aims:  The aim of the present study was to investigate social attitudes toward schizophrenia in Japan and China in view of social distance and knowledge of psychiatry, as well as sociocultural aspects.
Methods:  Two self-rating scales were used to compare social distance and knowledge regarding schizophrenia in 352 Japanese subjects and 347 Chinese subjects. The Social Distance Scale–Japanese version was used to measure social distance from schizophrenia subjects in Japan. This scale consists of eight questions graded using a 4-point Likert scale (0–3 points), with higher scores representing increased social distance. A translation of the SDSJ into Chinese was used to assess social distance in China. The Knowledge of Illness and Drugs Inventory was used to determine participant knowledge of mental illness and its treatment (medication) through 20 questions (responses are graded as correct or incorrect, with higher scores indicating greater knowledge). A Chinese version of this questionnaire was also created.
Results:  Total scores of both scales were significantly higher in Japanese subjects than in Chinese subjects.
Conclusions:  Social distance associated with schizophrenia is large in both Beijing and Fukuoka, but the features of social distance differ between countries. It is important to determine the features of stigma associated with schizophrenia and develop anti-stigma programs based on trans-cultural considerations.     

Medical students' beliefs and attitudes towards schizophrenia before and after undergraduate psychiatric training in Greece

Aims: The aim of the present study was to explore medical students' beliefs and attitudes towards people with schizophrenia (PwS) prior to receiving any training in psychiatry and to assess the impact of the psychiatric placement on changing them. Methods: A questionnaire addressing beliefs, attitudes and desired social distance from PwS was distributed to all final year medical students before the beginning of their 4‐week undergraduate psychiatric placement and upon its completion. Results: Students did not endorse stereotypes commonly attached to PwS, such as being dangerous, lazy or of lower intelligence, but they held the view that PwS are unpredictable and suffer from split personality. Furthermore, the baseline level of desired social distance was found to increase as the intimacy of the interaction increased, and the only variable associated with it was personal experience of serious mental illness. Moreover, the placement was found to have either no influence at all or in a negative direction. Upon its completion more students were found to believe that PwS cannot recover, have no insight into their condition, cannot make reasonable decisions, cannot work in regular jobs and are dangerous to the public. No difference was recorded in social distance scores. Conclusions: A close and critical examination of the various elements of the undergraduate placement in psychiatry is needed in order to develop an evidence‐based, fully rounded education with an anti‐stigma orientation.     

Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders

Research has paradoxically linked awareness of illness to both better function outcomes and lesser hope and self-esteem. One possible explanation for these findings is that acceptance of having schizophrenia may impact outcomes differently depending on the meanings the person attaches to this acceptance, particularly whether he or she accepts stigmatizing beliefs about mental illness. To explore this possibility we performed a cluster analysis of 75 persons with schizophrenia spectrum disorders based on single measures of insight using the Positive and Negative Syndrome Scale, internalized stigma using the Internalized Stigma of Mental Illness Scale, and compared groups on concurrent assessments of hope and self-esteem. Three groups were produced by the cluster analyses: low in sight/mild stigma (n = 23), high insight/minimal stigma (n = 25), and high insight/moderate stigma (n = 27). As predicted, analysis of variance-comparing groups revealed that the high insight/moderate stigma group had significantly the lowest levels of hope on the Beck Hopelessness Scale and self-esteem using the Multidimensional Self-esteem Inventory. As predicted, the high insight/minimal stigma group also had significantly less impaired social function than the other groups. Implications for assisting persons to come to cope with awareness of illness and stigma are discussed.     

Occupation and social experience: Factors influencing attitude towards people with schizophrenia

The purpose of the present study was to examine the role of occupation and social experience as factors determining the attitude of psychiatric care workers and other workers from various backgrounds toward people with schizophrenia. To measure the attitude of 786 subjects from six occupational groups toward people with schizophrenia, the evaluation scale applying semantic differential technique and the modified Social Rejection Scale were used, which assess two aspects of the attitude: affective acceptance and social distancing, respectively. The results of the two scales from the six groups were similar on the whole. Public health nurses showed the most accepting attitude in both scales. Psychiatric nurses and local welfare commissioners were the second and the third groups in affective acceptance, and the third and the second in socially accepting behavior, respectively. There was no significant difference in attitude among the rest of the groups (non-psychiatric care workers, professional probation officers and non-care workers). These results can be understood in terms of the workers' experience of contact with people with schizophrenia, and education and other support opportunities. The importance of positive contact experiences and the means for facilitation of an accepting attitude in psychiatric care workers and other workers need to be stressed.     

Attitudes toward standardized assessment tools and their use among clinicians in a public mental health service

Abstract

The aim of the present study was to investigate the use and attitudes toward standardized assessment tools among clinicians in a public mental health service in Norway. A total of 606 clinicians provided feedback on their use and attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone using the Attitudes toward Standardized Assessment (ASA) Scales. Clinicians working in the adult mental health field scored significantly higher on use of diagnostic interviews, pre–post evaluations, and ongoing evaluations, whereas clinicians working in the child/adolescent mental health field scored significantly higher on use of screening instruments and held more positive attitudes towards using standardized assessment tools. Attitudes toward standardized assessment tools predicted use of such tools, and results were found to be similar to a study on US clinicians. Whereas the US study only found attitudes regarding the practicality of using such instrument as an independent predictor of assessment use, the current study found that attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone were independent predictors of use.     

Perceptions of problems and needs for service among middle-aged and elderly outpatients with schizophrenia and related psychotic disorders

We examined the perceived problems and needs for services among 72 middle-aged and elderly outpatients with schizophrenia and related psychotic disorders. The survey questionnaire included 50 Likert scaled items involving everyday functioning skills, health, clinical symptoms, and social skills. Subjects assigned the highest priority to physical health and memory. Other areas of high priority were: social functioning, education about their own mental illness, and improvements in sleep and mood. Reducing frequency of psychiatric hospitalization, and drug or alcohol rehabilitation received low priority. Focused interventions targeting health-related and social issues are needed in older patients with schizophrenia.     

A systematic review of the Soteria paradigm for the treatment of people diagnosed with schizophrenia

BACKGROUND: The "Soteria paradigm" attempts to support people diagnosed with schizophrenia spectrum disorders using a minimal medication approach. Interest in this approach is growing in the United Kingdom, several European countries, North America, and Australasia. AIMS: To summarize the findings from all controlled trials that have assessed the efficacy of the Soteria paradigm for the treatment of people diagnosed with schizophrenia spectrum disorders. METHODS: A systematic search strategy was used to identify controlled studies (randomized, pseudorandomized, and nonrandomized) employing the Soteria paradigm to treat adults and adolescents meeting the criteria for schizophrenia spectrum disorders according to International Classification of Diseases and Diagnostic and Statistical Manual for Mental Disorders criteria. RESULTS: We identified 3 controlled trials involving a total of 223 participants diagnosed with first- or second-episode schizophrenia spectrum disorders. There were few major significant differences between the experimental and control groups in any of the trials across a range of outcome measures at 2-year follow-up, though there were some benefits in specific areas. CONCLUSIONS: The studies included in this review suggest that the Soteria paradigm yields equal, and in certain specific areas, better results in the treatment of people diagnosed with first- or second-episode schizophrenia spectrum disorders (achieving this with considerably lower use of medication) when compared with conventional, medication-based approaches. Further research is urgently required to evaluate this approach more rigorously because it may offer an alternative treatment for people diagnosed with schizophrenia spectrum disorders.     

Evaluating community attitudes to people with schizophrenia and mental disorders using a case vignette method

Utilizing the case vignette method, community attitudes about people with schizophrenia and mental disorders, and perceived causes of and images regarding schizophrenia were investigated. Participants comprised 1596 respondents living in the area covered by the K health center in N prefecture. The survey utilized the Mental Disorder Prejudice Scale, a case vignette, and other basic attributes. The case vignette survey yielded the following results: when asked about a landlord refusing to rent an apartment to the vignette subject, approximately 80% of respondents agreed with the landlord's decision. However, when asked about necessary conditions for the vignette subject to live in an apartment independently, only 2.4% of respondents chose 'difficult under any circumstance'. Approximately half of the respondents chose the following conditions: 'periodic visits to the hospital', 'availability of a system where people can discuss and address any problems that might arise' and 'attending a sheltered workshop or making attempts to rehabilitate'. Regarding acceptance as a neighbor after meeting the listed conditions, most respondents stated they would 'treat him just like any other neighbor' (47.3%), followed by 'help as much as possible in times of need' (36.3%). In other words, approximately 80.0% of respondents were willing to have the vignette subject as their neighbor. In addition, many respondents thought that schizophrenia is caused by problems in interpersonal relationships (64.8%) and represents an unstable disease (69.9%). When asked about having the subject as a neighbor, respondents were more willing to accept him as a neighbor after clarifying conditions for living arrangements.     

Veteran identity as a protective factor: A grounded theory comparison of perceptions of self,illness, and treatment among veterans and non-veterans with schizophrenia

For individuals with severe mental illness, relatively little is known about the impact of a veteran role identity. Consequently, this article investigates whether veterans (n?=?20) and non-veterans (n?=?26) with schizophrenia differ in their perceptions of self, illness, or treatment. Participants completed an audiotaped, semistructured interview that was transcribed and coded using modified grounded theory. Veterans were more likely than non-veterans to discuss the following themes: (1) wanting to be “normal,” (2) having a military mindset, (3) being optimistic toward the future, (4) resisting stigma, and (5) having active treatment attitudes. Findings support the theory that identifying as a veteran has several protective factors that might help shape self-perception and thereby responses to stigma, attitudes toward treatment, and hope for the future.