Stigmatization of psychiatrists and general practitioners: results of an international survey.

The stigma of mental illness affects psychiatry as a medical profession and psychiatrists. The present study aimed to compare the extent and correlation patterns of perceived stigma in psychiatrists and general practitioners. An international multicenter survey was conducted in psychiatrists and general practitioners from twelve countries. Responses were received from N = 1,893 psychiatrists and N = 1,238 general practitioners. Aspects of stigma assessed in the questionnaire included perceived stigma, self-stigma (stereotype agreement), attitudes toward the other profession, and experiences of discrimination. Psychiatrists reported significantly higher perceived stigma and discrimination experiences than general practitioners. Separate multiple regression analyses showed different predictor patterns of perceived stigma in the two groups. Hence, in the psychiatrists group, perceived stigma correlated best with discrimination experiences and self-stigma, while in the general practitioners group it correlated best with self-stigma. About 17% of the psychiatrists perceive stigma as a serious problem, with a higher rate in younger respondents. Against this background, psychiatry as a medical profession should set a high priority on improving the training of young graduates. Despite the number of existing antistigma interventions targeting mental health professionals and medical students, further measures to improve the image of psychiatry and psychiatrists are warranted, in particular improving the training of young graduates with respect to raising awareness of own stigmatizing attitudes and to develop a better profession-related self-assertiveness.

[Stigmatization on the way to recovery in mental illness - the factors associated with social functioning]. / Stygmatyzacja na drodze zdrowienia w chorobach psychicznych - czynniki zwiazane z funkcjonowaniem spolecznym.

Persons with mental disorders often experience stigmatization. There is a number of social factors that may affect the process of recovery and at the same time, in certain circumstances, could be a source of stigma. Mentally ill may find strength in themselves to fight against the disease or the opposite - can internalize the negative attitudes of the society and become self-stigmatized. The patient's family, on the one hand, is often the only source of social support, on the other hand, can experience a destructive influence of courtesy-stigma. Mentally ill have to face social reluctance which is reinforced by stereotypical media coverage of mental disorders. The social network of patients is poor and often limited to a family system. Negative views about persons diagnosed with mental illness are most visible in the labour market. Patients experience many types of discrimination at work,have lower employment rates and lower mean wages than healthy ones. Structural discrimination is a form of stigma which is revealed in underfunded and inefficient system of mental health care. All the social factors mentioned above are necessary for recovery (positive stimulation of functioning), but can also increase stigma and become a significant barrier in the recovery of psychiatric patients. This paper highlights the complex and ambiguous nature of the relationship between social factors and the recovery of the mentally ill basing on the data from the literature.

[Between health and schizophrenia]. / Miedzy zdrowiem a schizofrenia.

The article, based on the literature review, presents actual concerns on prognosis and opportunity to achieve recovery in persons with schizophrenia. Catamnestic long-term studies published during last decades more often indicated a favorable course of schizophrenia than it was in the past. One explanation may be the progress in pharmacotherapy, which allows the achievement of a better outcome in the treatment. On the other hand, the researchers have been committed to more detailed studies on the course of schizophrenia by more frequently repeated public testimonials of the ill persons, which forced the prognosis to be more optimistic. A good example is the discussion about the recovery in schizophrenia and the change in perception of the disease, despite differences in the attitudes between clinicians and patients. Seeing the opportunity to conduct a normal life in spite of serious mental disease is challenging for patients and their relatives, as well for psychiatrists and therapists. It motivates to overcome the limitations that the disease brings and the barriers in society.

[Stigmatization on the way to recovery in mental illness--the factors directly linked to psychiatric therapy]. / Stygmatyzacja na drodze zdrowienia w chorobach psychicznych--czynniki bezposrednio zwiazane z leczeniem psychiatrycznym.

The aim of this study is to draw attention to the ambiguity of the relationship between the process of recovery and implemented psychiatric treatment. With getting the diagnosis, a mentally ill person is automatically assigned to a certain society group and is involved into the mental health care system. People with a diagnosis of serious mental illness have to face not only their new health condition and adapt to the available health care system, but also to deal with the reaction of their environment. The process of recovery in mental illness includes remission of symptoms, getting back to the normal functioning, recuperating the life satisfaction, but also means the personal transformation and opposition to stigma. The most of the public demonstrates the stigmatizing opinions and discriminatory behavior in relation to the mentally ill, which does not foster their recovery and social reintegration. The nearest surrounding of the mentally ill is dominated by psychiatric staff, other mentally ill, psychotropic drugs and psychiatric hospital. These factors directly linked to the diagnosis and treatment of a psychiatric patient are supposed to help in recovery. In fact, at the same time they may contribute to recovery, and be a source of additional suffering or impede recovery. Despite symptomatic and functional remission, the mentally ill people stay outside the mainstream, remain socially isolated and excluded.

Fighting stigma of mental illness in midsize European countries.

PURPOSE: Stigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published. METHODS: The review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible. RESULTS: The anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country. CONCLUSIONS: Although much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

[Compliance in the treatment of schizophrenia--project ADHES (the renewed results)]. / Wspólpraca w leczeniu schizofrenii--wyniki projektu ADHES (poglebiona analiza).

AIM: The aim of this study was to analyse the level of compliance measured by patients, their families and psychiatrists. METHOD: 2009 patients who suffered from schizophrenia, 1791 members of their families and 203 psychiatrists were studied. They answered a questionnaire about the level of compliance and the factors which influence it. RESULTS: The level of compliance in schizophrenia was evaluated by psychiatrists as 48%, families--73% and patients--85%. The psychiatrists assessed that 60% of the schizophrenic patients did not have the sense of illness. 11% of the patients said that they have no benefits from pharmacotherapy. CONCLUSIONS: The level of compliance is the least in doctor's evaluation. The patients evaluation of the level of compliance was the biggest. The level of compliance was related to patients' insight, negative attitude to pharmacotherapy, cognitive deficits. Women were more cooperative with medication than men.

[Antipsychotics in clinical practice. Treatment of the first schizophrenic episode]. / Leki przeciwpsychotyczne w praktyce lekarza psychiatry. Leczenie pierwszego epizodu schizofrenii.

AIM: The aim was to obtain the information regarding the choice of antipsychotic drugs in the treatment of first episode schizophrenia. In particular, the factors influencing doctors' preferences and their opinion about several antipsychotics and the availability of these drugs were evaluated. METHODS: The anonymous questionnaire was presented to 100 psychiatrists; 50 of them were in hospital and 50 were in the out-patient practice. The questionnaire consisted of 17 questions regarding the pharmacological treatment of the first schizophrenic episode. RESULTS: The most frequently prescribed drug was olanzapine (33%), then risperidone (26%), and perazine (25%). In hospitals, risperidone was more frequently administered than perazine (29% and 24% respectively) while in out-patient clinics perazine slightly outnumbered risperidone (25% vs 23%). Fluoxetine was prescribed to 18% of out-patients, but not to hospitalized ones. Doctors performed treatment verification mainly (in 39% of patients) after 4 weeks of therapy. The change of antipsychotics was made more frequently in 28% of those hospitalized than the out-patients (16%) and mainly due to the lack of efficacy. More psychiatrists considered the most important attribute of the drug to be the efficacy toward the negative symptoms (77%) than the positive symptoms (59% of doctors). CONCLUSIONS: Prescription practice of psychiatrists shows the popularity of olanzapine and risperidone in the treatment of the first psychotic episode, but also indicates the strong position of perazine, which results from the current administrative regulations. Three times more psychiatrists think that patients should have an unrestricted (by the law) access to olanzapine or risperidone than to perazine. The most important attribute of an antipsychotic in the first episode schizophrenia turned out to be its efficacy toward the negative symptoms. Psychiatrists admitted that they chose an antipsychotic much more frequently on the basis of their own knowledge than on the basis of experts' opinion or the administrative regulations.

[Antipsychotics in clinical practice. The refractory schizophrenic patients treatment]. / Leki przeciwpsychotyczne w praktyce lekarza psychiatry. Leczenie pacjentów z rozpoznaniem schizofrenii lekoopornej.

AIM: The aim of this paper is to present and to discuss the results of an investigation conducted among Polish psychiatrists in 2007, especially its part relating to the practice of therapeutic patterns in refractory schizophrenia. METHOD: Structured individual interviews were conducted from 100 psychiatrists chosen at random in 9 larger cities in Poland. The interviews were followed by a questionnaire consisting of 52 questions relating to the principles of treatment and a perception of the features of antipsychotics. One part of the interview focused on refractory schizophrenia treatment. The perception of antipsychotics was interpreted with the use of the Pin Points Analysis method. RESULTS: In-patient schizophrenic patients are treated most often with clozapine (57%), but olanzapine (38%) and risperidone (32%) are the most common in out-patients. Other neuroleptics are prescribed considerably seldom. According to the doctors' declaration, their choices of medicines would be different, if there were no external limitations in drug prescription. In spite of this, the psychiatrists' claim, that their choice of antipsychotics is based on their own knowledge (44%), to a smaller degree it is based on the experts' recommendations (32%) and the currently valid reimbursement rules (24%). CONCLUSIONS: The Refractory schizophrenia treatment that is applied in practice, is generally convergent with the principles of the treatment. Clozapine still has a significant place in therapy. Use of all the remaining atypicals, besides risperidone and the olanzapine, they are limited by the high price for patient.