The influence of patient-centered teaching on medical students' stigmatization of the mentally ill

Aim

Stigmatization by healthcare workers poses a challenge to providing care to the mentally ill. Bedside teaching during undergraduate medical education offers students an opportunity to directly interact with patients with a range of psychiatric disorders and thereby gather reflective experience. The present study investigates if this supervised contact with mentally ill patients during a one-week clinical course on psychosomatic medicine leads to stigma reduction in medical students. The factors influencing stigmatization were also investigated.

Method

This was a prospective, non-randomized, controlled interventional study done in the 2019/20 winter semester involving fourth-year medical students who attended a week-long practical block on psychosomatic medicine (intervention group). This group was compared to students who had attended a week-long practical block with a somatic focus during the same time period (control group). Stigmatization was measured before and immediately upon completion of the week using the MICA-4 scale. Data on age, sex, experience with the mentally ill, interest in psychiatry/psychosomatics, and sense of self-worth were also gathered prior to starting the practical block. Analysis of the sample of 143 students with a complete basic data set was carried out using mixed ANOVA, multiple linear regression and moderator analysis.

Results

In the context of clinical teaching with psychiatric patients, the stigmatization of the mentally ill among medical students decreased significantly more in the intervention group compared to the students in the control group who received instruction on somatic topics (p=.019, η2p=.04). In addition, being female, having previous experience with the mentally ill and general interest in the subjects of psychiatry or psychosomatics at T0 associated with lower stigma. In contrast, stigmatization was increased at the beginning of the study in males and those with low self-esteem. A moderating effect of the factors on stigma reduction was not seen.

Conclusion

Undergraduate clinical instruction that enables direct contact and reflective experiences with the mentally ill leads to a reduction in the stigmatizing attitudes held by medical students toward the mentally ill. This underscores the need to have practical clinical instruction using patients.

The level of the stigma of medical students at King Saud bin Abdulaziz University for Health Sciences, towards mentally ill patients

Aim:

The study aimed to measure the level of the stigma of medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh campus, towards mentally ill patients.

Material and Methods:

A cross-sectional survey was conducted in King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh. The data collection was started in July 2017 till March 2018. The students completed a self-administered questionnaire consisting of sociodemographic data and the Community Attitudes toward the Mentally Ill (CAMI) Scale.

Results:

The sample size was realized as 274 participants. There were no significant differences in all CAMI subscales for the different academic years except for Authoritarianism which showed a significant increase in the level of stigma (P-value = 0.04). Male gender, previous psychiatric treatment, and having a relative with psychiatric illness were associated with higher Authoritarianism and Social Restrictiveness scores and lower Benevolence and CMHI scores.

Discussion:

More stigma was observed among the 4^th year students and it might be due to insufficient academic preparation as well as more exposure to psychiatric rotations.

Conclusion:

The results support the importance of implementing anti-stigma programs throughout the medical program to improve the healthcare provided to mentally ill patients.

Part I: Effects of diet modification on carbohydrate-lipid metabolism

OBJECTIVES

The study was aimed at finding out whether, and to what extent, it is possible to introduce and maintain proper nutrition habits in chronically mentally ill residents of a24-hour Nursing Home.

METHODS

The study involved 52 residents of a 24-hour Nursing Home (NH) for the chronically mentally ill. The study was carried out with a prospective method using questionnaires, nutrition-related interviews, anthropometric measurements, and analysis of selected blood biochemical indicators. Diet modification, accompanied by simultaneous health-promoting nutrition-related education, involved balancing the energy and nutrient contents, with adue consideration to gender and age as well as the major ailment and the accompanying disorders. Sources of the basic nutrients, i.e., proteins, carbohydrates and lipids, were replaced by recommended and/or health-promoting ones.

RESULTS

Both female and male patients showed a statistically significant reduction in energy uptake, resulting primarily from a significant reduction in the uptake of lipids and simple carbohydrates. Changes in nutritional habits were reflected in statistically significant increase in the uptake of vitamins, minerals and liquids (in the form of water). Diet composition modifications translated into beneficial changes in concentrations of glucose, triacylglycerols, cholesterol (total as well as HDL and LDL fractions) in numerous patients examined.

CONCLUSIONS

The study showed chronic mental patients to be capable of adopting, with full acceptance and cooperation, proper nutritional habits. Changes in those habits were reflected in improved body functions, including carbohydrate-lipid metabolism indicators, also in schizophrenia patients treated with antipsychotics.

Lifetime Punishments for Mentally Ill Juvenile Rampage School Shooters: No Hope for the Future?

This study examines the roles of age and mental health in the processing of 10 adolescent rampage school shooters who had shown signs of mental instability prior to their rampage, but were tried and convicted as adults and sentenced to life or almost life in prison. Findings from court transcripts show that expert witnesses for the defense provided evidence of mental illness in all cases; however, the court determined that the diagnoses failed to meet the insanity standard or did not qualify as a significant mitigating circumstance. The reality of the boys' actual guilt, the low competency standard, and the transfer of jurisdiction from Juvenile Court to criminal court all worked against their defense. Although in recent years the Supreme Court has ruled that because of the lesser development of children, life sentences for juveniles constitute cruel and unusual punishment, appeals on behalf of these boys have been routinely denied. Cross-national comparisons reveal the rarity of school shootings outside the United States and suggest that juvenile justice processing in many countries is far less punitive than that in the United States.

A review of mental health policies from Commonwealth countries

BACKGROUND

The burden of disease related to mental disorders across the world is substantial. However, there remains inequality between funding for clinical and research activities between physical illness and mental illness in almost all countries.

AIMS

One way of reducing this inequality is to ensure that mental health policies reflect this. We were interested in looking at the policies of members of Commonwealth.

METHOD

We decided to survey 52 member countries of the Commonwealth to explore whether mental health policies existed and whether there was equity between physical and mental health services funding. Using World Health Organization (WHO) data sets and other sources when indicated, we looked at the existence and contents of mental health policies.

RESULTS

We found that less than half of the countries had a mental health policy. Deinstitutionalization was not seen as a priority in many countries and there was no equity between physical and mental health funding. Although integration between physical and mental health care was recommended in many countries, there was a clear gap.

CONCLUSION

It is apparent that there is still a long way to go in terms of equity between physical and mental health in terms of funding in member states of the Commonwealth. These findings confirm earlier observations of discrimination against people with mental illness. We suggest that there must be mechanisms in place to facilitate and support change wherever required.

A systematic narrative review of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups (2010-2017)

INTRODUCTION

Tobacco remains the key modifiable risk factor for the development of a number of diseases, including cardiovascular disease, cerebrovascular disease, lower respiratory infections, chronic obstructive pulmonary disease, tuberculosis and cancer. Among priority populations, smoking prevalence remains high, smokers tend to relapse more often and earlier and fewer are able to sustain quit attempts. This systematic review provides an update on the literature. Areas covered: Twenty-four randomized controlled trials published from 2010-2017, in English language, were identified after searching on Medline, Ovid, Embase and PsycINFO databases. Studies reported on the effectiveness of smoking cessation interventions among six disadvantaged groups known to have high smoking rates: (i) homeless, (ii) prisoners, (iii) indigenous populations, (iv) at-risk youth, (v) people with low income, and (vi) those with a mental illness. Narrative review and assessment of methodological quality of included papers was undertaken. Expert commentary: There is a growing evidence base of methodologically robust studies evaluating a variety of behavioural smoking cessation interventions for priority populations. Multi-component interventions and those examining behavioural interventions incorporating mindfulness training, financial incentives, motivational interviewing and extended telephone-delivered counseling may be effective in the short-term, particularly for smokers on low incomes and people with a mental illness.

Pavel Ivanovich Karpov (1873-1932?)--the Russian Prinzhorn: art of the insane in Russia

The complicated relationship between the discipline of mental health and the arts has barely been studied systematically. Mental hospitals, shelters and prisons--institutions that accommodate the mentally ill--sometimes promote but often discourage and disrupt the patients' artistic creativity and the images created. In psychiatric circles, the recognition of patient art was a long, slow and frustrating process. Among the Western psychiatrists who studied the creative activity of the mentally ill, researchers usually mention such names as C. Lombroso, M. Shearing, V. Morgentaller, H. Prinzhorn and others, but rarely refer to their Russian colleagues and contemporaries. Pavel Ivanovich Karpov (1873-1932?), a Russian psychiatrist, was one of the most extensive researchers in the field of the art of the insane, but unfortunately his name is little known among modern psychiatrists. For his clinical and scientific contributions, he deserves to be remembered in the history of psychiatry.

Rehabilitation of mentally ill women

Women, the fair sex, are principal providers of care and support to families. But, they are considered to be the weaker sex and one of the most powerless and marginalized sections of our society. The provision of Rehabilitation for mentally ill women has been, and still is, one of the major challenges for mental health systems reform in the last decades, for various reasons. The present paper discusses the global and Indian scenario of rehabilitation of mentally ill women and goes on to detail the contribution of the state and voluntary agencies in this regard. It explores the need of recovery, multilayered strategy of Rehabilitation services and the availability of present services. The stigma attached and legal defects which interfere in good quality of life for the mentally ill women are reviewed. Strategies for changes in future are recommended.

Barriers to Effective Implementation of Programs for the Prevention of Workplace Violence in Hospitals

Effective workplace violence (WPV) prevention programs are essential, yet challenging to implement in healthcare. The aim of this study was to identify major barriers to implementation of effective violence prevention programs. After reviewing the related literature, the authors describe their research methods and analysis and report the following seven themes as major barriers to effective implementation of workplace violence programs: a lack of action despite reporting; varying perceptions of violence; bullying; profit-driven management models; lack of management accountability; a focus on customer service; and weak social service and law enforcement approaches to mentally ill patients. The authors discuss their findings in light of previous studies and experiences and offer suggestions for decreasing WPV in healthcare settings. They conclude that although many of these challenges to effective implementation of workplace violence programs are both within the program itself and relate to broader industry and societal issues, creative innovations can address these issues and improve WPV prevention programs.

Violence, mental illness, and the brain - A brief history of psychosurgery: Part 2 - From the limbic system and cingulotomy to deep brain stimulation

Knowledge of neuroscience flourished during and in the wake of the era of frontal lobotomy, as a byproduct of psychosurgery in the late 1930s and 1940s, revealing fascinating neural pathways and neurophysiologic mechanisms of the limbic system for the formulation of emotions, memory, and human behavior. The creation of the Klüver-Bucy syndrome in monkeys opened new horizons in the pursuit of knowledge in human behavior and neuropathology. In the 1950s specialized functional neurosurgery was developed in association with stereotactic neurosurgery; deep brain electrodes were implanted for more precise recording of brain electrical activity in the evaluation and treatment of intractable mental disorders, including schizophrenia, "pathologic aggression," and psychomotor seizures in temporal lobe epilepsy. Psychosurgical procedures involved deep brain stimulation of the limbic system, as well as ablative procedures, such as cingulotomy and thalamotomy. The history of these developments up to the 21(st) century will continue in this three-part essay-editorial, exclusively researched and written for the readers of Surgical Neurology International.

Violence, mental illness, and the brain - A brief history of psychosurgery: Part 1 - From trephination to lobotomy

Psychosurgery was developed early in human prehistory (trephination) as a need perhaps to alter aberrant behavior and treat mental illness. The “American Crowbar Case” provided an impetus to study the brain and human behavior. The frontal lobe syndrome was avidly studied. Frontal lobotomy was developed in the 1930s for the treatment of mental illness and to solve the pressing problem of overcrowding in mental institutions in an era when no other forms of effective treatment were available. Lobotomy popularized by Dr. Walter Freeman reached a zenith in the 1940s, only to come into disrepute in the late 1950s. Other forms of therapy were needed and psychosurgery evolved into stereotactic functional neurosurgery. A history of these developments up to the 21st century will be related in this three-part essay-editorial, exclusively researched and written for the readers of Surgical Neurology International (SNI).

People with mental illness and human rights: A developing countries perspective

BACKGROUND

Human rights violations among the people with mental illness were not an uncommon occurrence. The present study was aimed to compare persons with psychiatric illness and their caregivers' perceptions regarding the human rights status of people with mental illness in the community.

MATERIALS AND METHODS

A descriptive design was carried out among randomly selected asymptomatic psychiatric patients and their caregivers (N=200) at a tertiary care center. Data was collected through face-to-face interview, using a structured questionnaire. Data was analyzed and interpreted using descriptive and inferential statistics.

RESULTS

Our findings revealed that the caregivers than psychiatric patients perceived negatively to the statements i.e., 'Receiving equal information and encouragement about career opportunities' (χ(2)=10.779, P<0.029), 'Opposing discriminatory actions, slurs' (χ(2)=9.472, P<0.050) 'Resolving the conflicts with people with mental illness through nonviolent ways' (χ(2)=27.091, P<0.000), 'Responding to the complaints of harassment or discrimination against the people with mental illness' (χ(2)=18.697, P<0.001), 'Encouraged to continue their education' (χ(2)=13.029, P<0.023) 'Exploitation by the community members' (χ(2)=18.653, P<0.001) and working under fair conditions (χ(2)=13.470, P<0.009).

CONCLUSION

The study suggests that there is an urgent need to take necessary steps to protect, promote, and fulfill human rights of people with mental illness through providing care, educating the community, and strengthening the legislations.

Psychiatric curriculum and its impact on the attitude of Indian undergraduate medical students and interns

CONTEXT

Psychiatry is given very less importance in the Indian undergraduate medical curriculum and this affects the attitudes of students toward psychiatry and mentally ill patients.

AIM

To study the attitude of undergraduate medical students and interns toward psychiatry and mentally ill patients.

MATERIALS AND METHODS

Undergraduate medical students and interns of a private medical college and research institute in South India consented to form our sample. We studied the General Health Questionnaire, overall level of satisfaction in ongoing Medical course using Visual Analog Scale, attitudes toward psychiatry scale and the attitudes toward mentally ill patient's scale of the students, with their informed consent. SPSS version 18 was used for analysis of data.

RESULTS

Participation rate was 96%. Mean age of entire sample was 20.56 years. The total mean score on the General Health Questionnaire was 13.52 in first year but became worse toward internship (18.2). The level of satisfaction in the medical course dipped from 86% at baseline to 20% during internship. Equally high scores were noted in the attitude toward mentally ill scale. On the attitude toward psychiatry scale, there were more views on psychiatry as being an unscientific specialty, psychiatrists being considered poor role models, and psychiatric teaching was of low quality and psychiatry was the least preferred career choice.

CONCLUSIONS

The undergraduate medical students have a very unfavorable attitude toward psychiatry and mentally ill patients.

Psychiatric rehabilitation

Psychiatric rehabilitation is an important component in the management of the mentally ill. This article presents a selective review of the publications in this journal. Questions addressed in this review range from assessment of rehabilitation needs to different rehabilitative approaches. Although the number of publications providing the answers is meager, there are innovative initiatives. There is a need for mental health professionals to publish the models they follow across the country.

Tobacco use among individuals with schizophrenia: what role has the tobacco industry played?

Rates of tobacco use among individuals diagnosed with schizophrenia have been estimated as high as 80%. A variety of hypotheses have been proposed to explain the high rate of tobacco use among this vulnerable group. This study examined the tobacco industry's efforts to establish and promulgate beliefs about schizophrenic individuals' need to smoke and the hazards of quitting. The current study analyzed previously secret tobacco industry documents. The initial search was conducted during January-July 2005 in the Legacy Tobacco Documents Library. The search yielded 280 records dating from 1955 to 2004. Documents indicate the tobacco industry monitored or directly funded research supporting the idea that individuals with schizophrenia were less susceptible to the harms of tobacco and that they needed tobacco as self-medication. The tobacco industry promoted smoking in psychiatric settings by providing cigarettes and supporting efforts to block hospital smoking bans. The tobacco industry engaged in a variety of direct and indirect efforts that likely contributed to the slowed decline in smoking prevalence in schizophrenia via slowing nicotine dependence treatment development for this population and slowing the rate of policy implementation vis-à-vis smoking bans on psychiatric units.

The forgotten millions

Millions of chronic mentally sick are living in this country without proper care. Human rights of most of these patients both for treatment and for leading a life of dignity have been seriously abrogated. This oration discusses the extent of the problem & reviews the won\ done in this area in India and abroad. Major emphasis is to develop a programme for destigmatization of mental illness and to develop suitable models of care for chronic mentally sick keeping the realities of Indian situation in mind. The proposed programme emphasises on multi modal care of the mentally sick and involvement of local self government institutions like panchayats & municipal corporations.

Coping styles and factors in male/female social integration

As part of a larger research undertaking which explores the overall life-experience of former mental hospital patients living in community-based sheltered-care facilities in California, predictors of resident social involvement - both within the facility and outside in the community at large - were delineated. In our sample of 499 residents, we found that the types of variables indicating higher levels of social integration differed between male and female residents. The predictors that were most significant for men tended to indicate a coping style based upon access to community resources and feasibility of becoming socially involved. Thus, the opportunities made available to men in sheltered-care facilities tended to be taken advantage of provided the residents' psychological handicap was not too debilitating. Predictors of higher levels of social involvement for women residents on the other hand, involved the acceptability of such behavior as appropriate by the community and the facility operator. Women residents thus appeared to be more sensitive to social, rather than environmental contingencies.