Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach

OBJECTIVE: Many anti-stigma programmes use the 'mental illness is an illness like any other' approach. This review evaluates the effectiveness of this approach in relation to schizophrenia. METHOD: The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes. RESULTS: The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as 'illness', are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance. CONCLUSION: An evidence-based approach to reducing discrimination would seek a range of alternatives to the 'mental illness is an illness like any other' approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.     

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.     

Stigmatizing Attitudes About Mental Illness and Allocation of Resources to Mental Health Services

This study tests a social psychological model (Skitka & Tetlock, 1992). Journal of Experimental Social Psychology, 28, 491-522; [1993]. Journal of Personality & Social Psychology, 65, 1205-1223 stating that policy maker decisions regarding the allocation of resources to mental health services are influenced by their attitudes towards people with mental illness and treatment efficacy. Fifty four individuals participated in a larger study of education about mental health stigma. Participants completed various measures of resource allocation preferences for mandated treatment and rehabilitation services, attributions about people with mental illness, and factors that influence allocation preferences including perceived treatment efficacy. Results showed significant attitudinal correlates with resource allocation preferences for mandated treatment, but no correlates to rehabilitation services. In particular, people who pity people with mental illness as well as those that endorse coercive and segregated treatments, were more likely to rate resource allocation to mandated care as important. Perceived treatment efficacy was also positively associated with resource allocation preferences for mandated treatment. A separate behavioral measure that involved donating money to NAMI was found to be inversely associated with blaming people for their mental illness and not being willing to help them. Implications of these findings on strategies that seek to increase resources for mental health programs are discussed.     

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.     

Using clinical data bases to study schizophrenia

Studying psycho-pathology using clinical registries enables a birds-eye view of all mental illness, and allows researchers to look at each illness in the context of other mental illnesses. The papers presented in this issue indicate that at least some of the symptoms commonly present in schizophrenia are actually present in other mental disorders and may even be present in individuals without diagnosed psychiatric disorders. Although there are some disadvantages to research based on clinical registries, this method enables study designs not be possible with conventional research paradigms.     

Stigmatization of People with Schizophrenia: Perspectives of Graduate Students in Various Healthcare Fields

Healthcare professionals exhibit stigmatization toward people with schizophrenia, which is an internationally recognized problem. This can negatively impact healthcare of people with schizophrenia. Research has shown that nursing and medical students also have stigmatizing attitudes toward individuals with schizophrenia. However, there has been little research examining graduate students in other healthcare professions. These students are important to assess because they are likely to encounter individuals with schizophrenia in their work. This study examined 113 graduate students in psychology, physical therapy, and occupational therapy programs. Students completed the Depression Anxiety Stress Scale, General Self-Efficacy Scale, and Satisfaction with Life Scale, both about themselves and what they believed a person in a narrative with schizophrenia might experience. Students from all programs engaged in stereotyping behavior. Students studying psychology, however, exhibited lower stigmatization compared to other students. This may be due to psychology students’ increased education and experience with people with schizophrenia.     

精神疾病病耻感量表维吾尔文版在维吾尔族精神分裂症患者中信度和效度的研究

目的:检测精神疾病病耻感量表维吾尔(维)文版(SSMI-U)在新疆维吾尔(维)族精神分裂症患者的信度及效度。方法:对中文版精神疾病病耻感量表进行翻译并修订成维文版;随机选取118例门诊及住院维族精神分裂症患者评估;2周后随机抽取其中60例患者进行重测。结果:SSMI-U克朗巴赫α系数为0.801,评定者一致性组内相关系数(r)=0.995(95%CI:0.949~0.990);重测信度r=0.750(P0.001)。结论:SSMI-U在新疆维族精神分裂症患者具有良好的信度与效度。     

Attitudes of Brazilian psychiatrists toward people with epilepsy

The purpose of this survey was to evaluate the experience of Brazilian psychiatrists in treatment, formal training, attitudes, and knowledge with respect to epilepsy (and associated mental disorders). One hundred fifty-seven Brazilian psychiatrists completed a specially developed questionnaire. Most (95%) had previously treated patients with epilepsy and mental disorders. About one-third (35%) admitted a lack of any formal training in epilepsy, and only 46% confirmed having received some formal training in mental disorders related to epilepsy. Eighty percent were dissatisfied with their knowledge. Three knowledge-based questions were answered correctly by only 10%. Almost half (48%) admitted that among psychiatrists, prejudice exists toward patients with epilepsy. Difficulties with treatment (50%) and lack of knowledge of epilepsy (50%) were considered the main causes of such prejudice. These data indicate an urgent need for improvement in education on epilepsy and associated mental disorders, as well as inclusion of formal epilepsy training in psychiatry residency programs.     

精神疾病内在病耻感调查表在精神分裂症患者中的信度和效度

目的:评价精神疾病内在病耻感调查表(internalized stigma of mental illness inventory,ISMI)在精神分裂症患者中的信度和效度。方法:选择慢性稳定期精神分裂症患者191例,自行完成ISMI量表及病耻感总体评价,随机抽取42例患者于2周后复测ISMI。使用SPSS软件对量表的信度、效度进行分析。结果:被试者ISMI总分平均为(65.12±12.86)分;复测信度相关性系数为0.87;分半信度系数为0.85;所有29条目Cronbach α系数为0.94。平行效度相关系数为0.66;结构效度采用因子分析法,经方差最大旋转后结果揭示主成分累计贡献率57.80%。结论:ISMI量表对评定精神分裂症患者的病耻感有较好的信度和效度。     

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.     

Attitudes of patients with schizophrenia toward placebo-controlled clinical trials

BACKGROUND: Despite the fact that the efficacy of antipsychotic treatment in patients with schizophrenia has been demonstrated in numerous double-blind studies, placebo-controlled studies are still commonly performed. Although much is known about the opinions of professionals concerning this issue, so far nothing is known about the opinions of patients who are most affected by the realization of placebo-controlled clinical trials. METHOD: In a cross-sectional study from June 2000 to January 2001, 100 inpatients and outpatients with ICD-10 schizophrenia or schizophreniform disorder were investigated by using a questionnaire specifically developed to survey patients' attitudes concerning possible participation in placebo-controlled clinical trials. Psychopathology and side effects were physician-rated. RESULTS: 56% of patients would not be willing to participate in a placebo-controlled clinical trial. On the other hand, only about 16% of the patients are against clinical trials in principle. Gender, treatment, severity of psychopathology (Positive and Negative Syndrome Scale), adverse events (UKU Side Effect Rating Scale), and attitude toward medication (Drug Attitude Inventory) had no statistically significant influence on the decision. Most of the patients (76%) stated that they would not lose trust in their physician if asked to participate in a placebo-controlled clinical trial. CONCLUSION: The opinions and fears of patients who are most affected by the debate need to be considered when deciding whether a placebo-controlled clinical trial is necessary.     

Attitudes toward electroconvulsive therapy in Romanian psychiatrists

Use of electroconvulsive therapy (ECT) is influenced by the attitudes of the psychiatrists. The aim of this pilot survey was to assess the knowledge about and attitudes toward ECT in Romanian psychiatrists. Participants of a scientific meeting were requested to fill a 29-item questionnaire. Answers reflecting false concepts or negative attitudes toward ECT were more than 20% in 15 of 21 items, which highlights the urgent need to improve psychiatrists' education and training about ECT in Romania.     

精神分裂症患者认知功能与精神症状相关性研究

目的：探讨精神分裂症患者认知功能与精神症状的相关性。方法：对40例精神分裂症患者于治疗前、治疗12周末分别进行韦氏成人智力量表（WAIS-R）、韦氏记忆量表（WMS）、H—R神经心理成套测验（HRB）中的连线测验A、威斯康星卡片分类测验（WCST）及言语流利性测验及简明精神病评定量表（BPRS）评定。结果：治疗前焦虑抑郁因子分与总记忆商数（MQ）分显著相关,迟滞因子分与WCST完成类别数、智力显著相关;治疗12周末焦虑抑郁因子分与总智商（IQ）显著相关,迟滞因子分与WCST持续反应数、言语IQ、操作IQ显著相关,猜疑因子分与WCST持续反应数显著相关。结论：精神分裂症患者部分认知功能与精神症状显著相关。     

The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy

OBJECTIVE: (a) To explore burden related to caregiving and support received from professionals and social network in relatives of patients with schizophrenia in Northern, Central and Southern Italy; and (b) to test whether a higher level of family burden is associated with a lower level of professional and social network support. METHOD: Seven hundred and nine patients with schizophrenia and their key-relatives were consecutively recruited in 30 Italian mental health departments. Data were collected on: (a) patients' clinical status and levels of disability; (b) relatives' burden, social and professional support; (c) interventions received by patients and their families. RESULTS: Family burden was found lower in Northern Italy. However, after controlling for psychosocial interventions, differences in family burden among the three geographical areas disappeared. Family burden was associated with patients' levels of disability and manic/hostility symptoms, and with professional and social network support received by the family. CONCLUSION: Professional and social network support represent crucial resources to reduce family burden in schizophrenia.