Spanish validation of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and factors associated with physician burnout

OBJECTIVES

The aim of this study was to investigate the psychometric properties of the Spanish version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and the factors associated with Physician Burnout in Paraguay.

METHODS

Participants included 747 Paraguayan healthcare workers, aged 24-77 years old, of both sexes. SOSS-D was translated into Spanish and validated through an exploratory and confirmatory factor analysis. Participants were also scored with the Oldenburg Burnout Inventory (OLBI), the CAGE questionnaire, and the stigma subscale of the Perceived Barriers to Psychological Treatment (PBPT) measure.

RESULTS

Three factors had a raw eigenvalue greater than 1, and explained 61.7% of total variance. The confirmatory analysis confirmed that the scale is three-dimensional. The model adjustment was good, according to all fit indices. OLBI results indicate clinically significant disengagement in 85.9% and clinically significant exhaustion in 91.6% of participants. Of the 747 participants, 57.6% reported alcoholic beverage consumption and among those, 19.3% had problematic alcohol consumption according to the CAGE questionnaire. The correlation between SOSS-D and the stigma subscale of the PBPT was statistically significant (r = 0.245, p < 0.001).

CONCLUSIONS

The Spanish version of the SOSS-D was found to have good psychometric properties and adequately reproduces the three-dimensional model of the original English version.

Kleptomania as a neglected disorder in psychiatry

Kleptomania is an impulse control disorder characterized by the irresistible urge to steal not for monetary gain. Since its conceptualization, this categorical diagnosis has been conflated with common beliefs regarding the social class and gender such as the idea that women are intrinsically fragile and that people in the middle class were unlikely to commit theft. Also, its use has been controversial in the medical and forensic fields. This presentation will provide a historical excursus through the definitions of the syndrome and summarize the available pharmacological and psychotherapeutic options for its treatment. Currently, there is a lack of systematic studies regarding the clinical characteristics of kleptomania and its treatment options for practical standardized approaches.

Religion, Psychiatry, and Alternate Sexuality

Religious institutions tend to display a conservative view towards individuals with alternate sexuality or identity. For managing patients with alternate sexuality, it is imperative that clinicians understand and take into account religious views and its effects on a person's mental health. We review the literature on religion, alternate sexuality, and psychiatry to ascertain their interaction and impact on the mental health of individuals with alternate sexuality or identity. Differing but overlapping perspectives on alternate sexuality persist across world religions. Individuals with conflict between religious and sexual identities are prone to have adverse mental health outcomes; adequate social supports result in more positive mental health outcomes. Education on lesbian, gay, bisexual, transgender, queer, and intersex-related topics in mental health professionals leads to better recognition of the issue and provision of respectful, effective mental health care within the context of socio-religious identity and background.

Sexuality in the 21st Century: Sexual Fluidity

Sexuality is a vital component of human life. Sexuality deals with procreation and pleasure. Sexual behaviours and orientations vary and may be related to mental health. Some sexual orientations may be discriminated or censored by religious or political beliefs, and this has a big impact on sexual variations. Frequently, sexual variations are considered to be pathological and need to be medically treated. However, it should be accepted that sexuality includes a continuum of behaviours, thoughts, fantasies, acts, and attractions that are beyond procreation. Modern sexology introduced the concept of gender identity and sexual fluidity to describe how gender and sexual orientation vary and are flexible over time. Healthcare professionals and policy makers should be aware of these new definitions in order to meet health needs of sexually variant people and prevent sexuality discrimination.

Attitude of Medical Students in Paraguay Towards Homosexuality

INTRODUCTION

The attitude of medical students towards homosexuality may affect the quality of care for homosexual patients. This study aimed to describe the attitude of medical students at the National University of Asuncion, Paraguay towards homosexuality.

METHODS

This observational, cross-sectional study was conducted in June 2016 in consecutive medical students from the National University of Asunción (Santa Rosa del Aguaray branch), Paraguay. The 10-item attitude towards homosexuality scale (EAH-10) was used to assess participants' acceptance/ rejection of homosexuals as individuals, homosexuality as a sexual orientation, and public manifestations of homosexuality.

RESULTS

A total of 48 female and 29 male participants (mean age, 21 ± 2 years) were included. Most were Catholic (71.4%), followed by non-Catholic Christian (10.4%), agnostic (9.1%), atheist (2.6%), and other (6.5%). 71.4% reported having at least one homosexual friend. The mean EAH-10 score was 27.23 ± 9.379. 42.9% of participants were indifferent or undecided in their attitude towards homosexuality and 28.6% were discriminatory. Having homosexual friends was associated with a lower EAH-10 score (t = -3.447 [75], p = 0.001).

CONCLUSION

Education about health issues of homosexuals is needed for medical students in Paraguay.

Attitude of Indian Medical Students Towards Homosexuality

INTRODUCTION

It is important to understand the attitude of medical students towards homosexuality, as this may affect patient care.

METHODS

Year 2 and 3 students at Calcutta National Medical College, Kolkata, India were asked to selfadminister an 18-item questionnaire anonymously. Internal consistency of the questionnaire statements was high (Cronbach's alpha of 0.91). There were five responses for each statement: strongly agree, generally agree, unsure, generally disagree, and strongly disagree.

RESULTS

Of 290 students, 270 (93.1%) [148 males and 122 females] completed the questionnaire and were included in the analysis. Overall, 55.6% strongly disagreed that homosexuality was an illness; 70.8% agreed that homosexuals were capable of forming stable relationships. Only 31.1% believed that homosexual doctors would better understand homosexual patients. About 71.8% reported that talking about homosexuality did not embarrass them, and 81.8% believed that problems associated with homosexuality could be reduced if society was more liberal. Nonetheless, negative attitudes were reflected in the stereotypical image of homosexuality. About 15.9% of respondents believed that homosexuality was an illness; 24.8% considered homosexuals neurotic, 28.1% considered homosexuals promiscuous; and 8.2% thought that they posed a danger to children.

CONCLUSION

Although the overall attitude of Indian medical students towards homosexuality is positive, the percentage of students with negative attitudes remains quite high. Further work on the medical curriculum is needed to change these negative attitudes so that patients receive appropriate care.

Correlations between medical students’ specialty choice and different attitudes towards mental illness

Introduction

Discrimination and stigmatization cause an important burden for people suffering from psychiatric disorders. The medical doctors, those who should be important reference points for psychiatric patients, are instead one of the categories that contribute to their stigmatization.

Objectives

It is extremely important to study and to know the attitudes of undergraduate medical students towards psychiatric disorders, since these individuals will be involved in the care of these patients throughout their careers.

Aims

The present study analyzes the attitudes of a group of Italian medical students towards mental illness, highlighting the differences between the students who would choose surgical specialties from those who prefer medical ones.

Methods

A total of 339 medical students of different medical schools, in Rome and Foggia (Italy), completed a cross-sectional survey. The Italian version of community attitude towards the mentally Ill test (CAMI) was used to evaluate the students’ attitudes.

Results

The students that would choose medical specialties reported less stigmatizing responses in 11 CAMI items (including five items with P < 0.01), in benevolence and community mental health ideology subscales (P = 0.003) and in the total score (P = 0.003).

Conclusions

It is evident that the students that prefer the surgical specialties have more stigmatizing attitudes towards psychiatric patients. Negative feedbacks on Psychiatry from non-psychiatrist colleagues may have a fundamental role in stigmatizing mental disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Differences in empathy in Italian university students: Are medical students more or less empathetic?

Introduction

Empathy is the capacity to understand or feel what another person is experiencing. It is an important quality in the medical profession, since it is fundamental in interpersonal relationships with patients. Nevertheless, many studies have found that over time medical students (MS) become less empathic and more detached from patients.

Objectives and aims

To determine MS loss of empathy and to study the differences in empathy between MS and other university students who are not involved in healthcare.

Methods

We enrolled 244 MS (120 of the 1st year and 124 of the last year) and 125 other university students not involved in healthcare, in different universities in Rome and Foggia (Italy). They anonymously and voluntarily completed a socio-demographic questionnaire and Baron Cohen's empathy quotient test (EQ).

Results

We found no differences regarding EQ total score between MS and other students, however there are few differences considering individual EQ items. In particular, MS really like taking care of others (P = 0.005) and they are sometimes considered to be rude, even if only they are only blunt (P = 0.006). We found no differences in empathy between first year and last year MS.

Conclusions

In our sample of Italian students, we have not found MS to be more or less empathetic than other university students, but there are some peculiar differences in empathy that make them better suited to the chosen course of study. Moreover, we found no differences between the different years of medical school.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Relationship between affective temperaments, traits of schizotypal Personality and early diagnosis in a sample of Italian healthy subjects

Introduction

Akiskal et al. [1] examined the relationship between affective temperaments and characteristics of schizotypal personality disorder. Schizotypal personality disorder is becoming increasingly important both in itself as a significant personality disorder and as a condition that can provide important insights into the origins of schizophrenia. Perceptual and interpersonal cognitive disorders, behavior and disorganized speech do the schizotypal personality disorder a kind of mild form of schizophrenia, a premorbid or prodromal phase of this serious disorder.

Aims

To analyze, in an Italian sample of healthy subjects, the correlation between affective temperaments and schizotypal traits.

Methods

We recruited 173 healthy subjects aged between 18 and 65 years who have completed the following tests:

– BIS-11;

– SPQ;

– SDS;

– SAS;

– HCL-32;

– TEMPS-A.

Results

At linear regression analysis between TEMPS-A scores and other rating scales are observed highly significant associations between increasing scores of cyclothymic and depressive temperament, subjective anxiety and depression with scores pertaining to the schizotypal personality disorder.

Conclusions

Clinically, a better understanding of the mechanisms that lead to a schizotypal personality could lead to the development of effective preventive and curative treatments in an early stage of symptoms in addition to the identification of subgroups at risk for the development of schizophrenic pathology.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Early-life stress and psychiatric disorders: epidemiology, neurobiology and innovative pharmacological targets

The modern concept of stress is based on responses to events or factors ("stressors") experienced as aversive, threatening or excessive for maintaining physiological equilibrium of an organism. Prolonged exposure to stressors, particularly during early life, is strongly associated with later psychiatric disorders. Underlying mechanistic connections between stress responses and development of psychiatric illnesses remain uncertain and typically appear to be nonspecific. Relevant candidate mechanisms are likely to include the hypothalamic-pituitary-adrenal (HPA) axis, marked by sustained excessive release of cortisol from the adrenal cortex. In turn, this process is influenced by and alters various central neurotransmitter and other molecular signaling systems that include glutamate, dopamine, serotonin, and neurotrophic peptides. Additional manifestations of stress include altered neurogenesis and neuroplasticity, as well as oxidative neuron-damaging effects. The complex molecular systems involved in these processes present many opportunities for innovative pharmacological interventions that may have preventive or therapeutic benefits regarding mental illnesses arising from stress.

Perceived insecurity, mental health and urbanization: Results from a multicentric study

AIMS

This article aims to (1) explore the levels of perceived insecurity in a sample of patients with mood or anxiety disorders and (2) assess whether living in 'big cities' can influence the levels of patients' perceived insecurity and social contacts compared to living in a non-urbanized context.

METHODS

A total of 24 Italian mental health centers (MHCs) have been invited to participate. Twenty patients consecutively accessing the MHC have been recruited. All patients have been assessed using validated assessment tools.

RESULTS

The sample consisted of 426 patients, mostly female, with a mean age of 45 years. Globally, 52.2% of patients had a diagnosis of mood disorders, and 37.8% had anxiety disorders. Half of the sample declared that the main feeling toward life is uncertainty; higher levels of pessimistic views toward life have been detected in patients living in urban areas. A positive association between negative attitudes toward life and higher levels of depressive and anxiety symptoms, poor social functioning and higher levels of perceived psychological distress has been found.

CONCLUSION

Our findings confirm the presence of a common sense of perceived uncertainty among our sample. Such attitude toward life can have a detrimental impact on patients' psychological and physical well-being, contributing to high levels of distress.

Differences in attitudes towards mental illness and psychiatry among medical students, before and after the academic course of psychiatry

Background

Stigma towards mental illness and psychiatry have a major impact on psychiatric patients’ quality of life; in particular, prejudicial beliefs make it more difficult for future doctors to send patients to mental health services, leading to a delay of necessary care.

Aims

Our aim is to evaluate the stigma towards mental illness and psychiatry, in a sample of Italian medical students. We studied the differences between the first-year students who have not attended the academic course in psychiatry, compared to the senior students who have attended the psychiatric lectures.

Methods

We tested 113 medical students, using the following questionnaires:

– Attitudes Towards Psychiatry (ATP 30);

– Community Attitudes Towards Mental Ill (CAMI);

– Perceived Discrimination Devaluation Scale (PDD), to assess the discrimination towards mental illness perceived in society;

– Baron-Cohen's Empathy Quotient (EQ), to measure empathy.

Results

Among the 113 students, 46 have already attended the academic course of psychiatry and CAMI scores were less stigmatizing as total score (P = 0.014) and in authoritarianism subscale (P = 0.049), social restriction (P = 0.022) and ideology of mental health in the community (P = 0.017). However, there were no statistically significant differences in empathy, perceived discrimination in the society and stigmatization of psychiatry.

Conclusions

The 67 students who have not attended the academic course of psychiatry are more stigmatizing, considering psychiatric patients as inferior people that require coercive attitudes, socially dangerous and that should be treated faraway from the community. Studying psychiatry is therefore useful to reduce, in the future doctors, these prejudices toward mentally ill patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mental Health and Empathy: Do Nursing Students Have Better Attitudes to Psychiatric Patients?

Background

Stigma towards mental illness has a major impact on the quality of life and the health care of psychiatric patients. Several studies have reported that health professionals have more negative attitudes than general population.

Aims

To explore empathy and attitudes towards mental illness in nursing students (NS) and non-health university students. Our purpose is to see how NS have more empathic and less stigmatizing attitudes towards psychiatric patients, compared to other university students.

Methods

We tested 96 university students (50 NS and 46 non-health university students), with the following questionnaires anonymously filled out:

– Community attitudes towards mental ill (CAMI), to evaluate the different students’ attitudes towards mental illness;

– Empathy quotient (EQ), to assess empathy.

Results

NS differs from the other group in 5 items of CAMI (P < 0.05 in 3 items and P < 0.01 in 2 items), and Authoritarianism subscale (P = 0.023). This shows that NS have a greater general awareness and less stigmatizing attitudes about the need to hospitalize the mentally ill, the difference between psychiatric patients and general population, the wrong need of segregation and the real causes of mental illness. There is also a significant difference in EQ (items 6, 21, 25, 44, 59): future nurses seem to have a slightly higher empathy, even though the EQ total score does not differ in the two groups.

Conclusions

These results suggest that there is a difference with respect to the attitudes towards psychiatric patients in NS and students who do not follow health-care courses: NS have more empathetic and less stigmatizing attitudes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Different Attitudes Toward Psychiatry and Psychiatric Patients in Nursing Students: Can Personal Experiences Reduce Stigma?

Background

Psychiatric patients often do not receive the same health treatment reserved for patients with no mental disorders. Stigma in mental-health nurses can worsen the patients’ healing time and quality of care.

Objective

To explore the different attitudes towards mental illness and psychiatry in nursing students (NS) of the first and the final year of university, and the importance of having visited a psychiatric ward and having known a psychiatric patient.

Methods

Fifty NS completed the following tests:

– Community attitudes towards mental ill (CAMI);

– Attitudes towards psychiatry (ATP-30);

– Empathy quotient (EQ).

Results

NS of the final year differ significantly from those of the first year in 4 CAMI items, in Authoritarianism subscale (P = 0.041), Social Restrictiveness (P = 0.029) and Community Mental Health Ideology (P = 0.045), indicating a more mature and responsible approach to psychiatric patients, without considering them a threat to be secluded. EQ does not show a significant difference in empathy, not even considering the individual items. Final year NS also have more positive attitudes toward Psychiatry in 3 ATP-30 items and total score (P = 0.01). Those who visited a psychiatric ward have more positive attitudes towards mental illness and Psychiatry, in 6 CAMI items and 3 ATP-30 items. Having personally known a psychiatric patient leads to positive attitudes in only a few CAMI items.

Conclusions

Last-year NS, who have had more direct relationships with patients through practical training, have more empathetic and less stigmatizing attitudes. It is also very useful to attend a psychiatric ward during the nursing training.

Normal 0 14 false false false IT X-NONE X-NONE.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Attitudes toward psychiatry and psychiatric patients in medical students: Can real-world experiences reduce stigma?

Introduction

Stigma towards psychiatry and mental illness significantly worsens the quality of life of psychiatric patients. Negative prejudices in medical students make it difficult for future doctors to send patients to mental health services and promote an increased risk of premature death.

Aims

Our aim is to assess stigma towards mental illness and psychiatry in medical students, and to study the influence of real-world experiences, such as having visited a psychiatric ward, having personally met a psychiatric patient or having friends and/or family members who suffer from a mental illness.

Methods

One hundred and thirteen Italian medical students completed the following tests:

– Attitudes Towards Psychiatry (ATP-30);

– Community Attitudes Towards Mental Ill (CAMI);

– Perceived Discrimination Devaluation Scale (PDD);

– Baron-Cohen's Empathy Quotient (EQ).

Results

Having visited a psychiatric ward correlates with a better attitude towards psychiatry (P = 0.008), rather than towards the mentally ill. Having personally known someone with mental disorders correlates with less stigmatizing scores in CAMI: total score (P = 0.002), authoritarianism (P < 0.001), benevolence (P = 0.047) and social restriction (P = 0.001). Similar results emerged in those who have close relationships with a psychiatric patient. There is no statistical significance as to empathy.

Conclusions

The students who have visited a psychiatric ward have a less stigmatizing vision of psychiatry, while having personally known psychiatric patients favors a less stigmatizing attitude towards them. Those who have not had this experience, have a more hostile and intolerant vision of mental illness, and consider psychiatric patients as inferior subjects that require coercive attitudes and that would be better to avoid because socially dangerous.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

EPA guidance on how to improve the image of psychiatry and of the psychiatrist

Stigma against mental illness and the mentally ill is well known. However, stigma against psychiatrists and mental health professionals is known but not discussed widely. Public attitudes and also those of other professionals affect recruitment into psychiatry and mental health services. The reasons for this discriminatory attitude are many and often not dissimilar to those held against mentally ill individuals. In this Guidance paper we present some of the factors affecting the image of psychiatry and psychiatrists which is perceived by the public at large. We look at the portrayal of psychiatry, psychiatrists in the media and literature which may affect attitudes. We also explore potential causes and explanations and propose some strategies in dealing with negative attitudes. Reduction in negative attitudes will improve recruitment and retention in psychiatry. We recommend that national psychiatric societies and other stakeholders, including patients, their families and carers, have a major and significant role to play in dealing with stigma, discrimination and prejudice against psychiatry and psychiatrists.

EPA guidance on the role and responsibilities of psychiatrists

Psychiatry is that branch of the medical profession, which deals with the origin, diagnosis, prevention, and management of mental disorders or mental illness, emotional and behavioural disturbances. Thus, a psychiatrist is a trained doctor who has received further training in the field of diagnosing and managing mental illnesses, mental disorders and emotional and behavioural disturbances. This EPA Guidance document was developed following consultation and literature searches as well as grey literature and was approved by the EPA Guidance Committee. The role and responsibilities of the psychiatrist include planning and delivering high quality services within the resources available and to advocate for the patients and the services. The European Psychiatric Association seeks to rise to the challenge of articulating these roles and responsibilities. This EPA Guidance is directed towards psychiatrists and the medical profession as a whole, towards other members of the multidisciplinary teams as well as to employers and other stakeholders such as policy makers and patients and their families.

Improvements in metabolic abnormalities among overweight schizophrenia and bipolar disorder patients

PURPOSE

As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psycho-education and medical monitoring on metabolic changes among severely mentally ill patients.

MATERIALS AND METHODS

During repeated, systematic psycho-education about general health among 66 consecutive patients diagnosed with DSM-IV-TR schizophrenia (n=33) or type-I bipolar disorder (n=33), we evaluated (at intake 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, recorded physiological parameters, and assessed attitudes about medication.

RESULTS

At intake, patients with schizophrenia vs bipolar disorder were receiving 3-7 times more psychotropic medication, with 14% higher initial body-mass index (BMI: 29.1 vs 25.6 kg/m²), 12 times more obesity, and significantly higher serum lipid concentrations. During 6-months follow-up, among bipolar disorder patients, polytherapy and serum lipid concentrations declined more than among schizophrenia patients (e.g., total cholesterol+triglycerides, by 3.21 vs 1.75%/month). BMI remained stable. Declining lipid levels were associated with older age, bipolar disorder, being unemployed, higher antipsychotic doses, and lower initial BPRS scores (all P ≤ 0.001).

CONCLUSIONS

Psychotropic treatments were more complex, and metabolic measures more abnormal among bipolar disorder than schizophrenia patients. Intensive psycho-education, clinical monitoring, and encouragement of weight-control for six months were associated with improvements in metabolic measures (but not to BMI), and more realistic attitudes about medication.

Characteristics and clinical changes during hospitalization in bipolar and psychotic disorder patients with versus without substance-use disorders

BACKGROUND

Co-morbid substance-use disorders (SUDs) are prevalent among patients with severe psychiatric disorders, but the characteristics of such patients remain incompletely defined, and their current treatments and responses, poorly documented.

METHODS

We evaluated the records of 481 consecutive inpatients diagnosed with DSM-IV bipolar or schizoaffective disorders, or schizophrenia, admitted to McLean Hospital in 2004 or 2009. Demographic and clinical characteristics, and treatments, were extracted from hospital and pharmacy records for bivariate and multivariate analyses.

RESULTS

SUD prevalence increased 1.84-times from 2004 (31.3%) to 2009 (57.6%). Patients with (n=204) versus without co-morbid SUDs (n=277) were similar in many respects, but in multivariate modeling, the following factors were more likely with SUD, in rank-order: co-morbid anxiety disorders > men more than women > greater prevalence in 2009 vs. 2004 > younger age > greater doses of mood-stabilizers > shorter hospitalization.

CONCLUSIONS

Hospitalized patients with severe primary psychiatric disorders, and comorbid SUD were more likely to be young and have anxiety disorders, to receive more combinations and higher doses of mood-stabilizers, and show more improvement in impulsivity and hostility, but otherwise differed little in treatment-responses. Prevalence of SUD rose substantially in the past five years, with increased but largely unproved use of mood-stabilizers.