Association between stigmatisation and experiences of evidence-based practice by psychiatric rehabilitation staff in Japan: a cross-sectional survey.

BACKGROUND: Mental health professionals are one of the groups holding harmful stigmatisation towards people with mental illness. AIMS: To investigate the association between the performance of evidence-based practice (EBP) and the staff's level of stigmatisation in Japan. METHODS: The study enrolled 179 staff members in psychiatric day-care, psychiatric community outreach teams, and psychiatric rehabilitation teams at 14 psychiatric hospitals. The Positive Attitudes Scale (PAS), the Japanese-language version of the Social Distance Scale (SDSJ) and the Recovery Attitude Questionnaire (RAQ) were employed as outcome measures. Scores on each scale were compared between participants who performed EBPs and those who had never performed EBPs. RESULTS: Approximately 40% of the staff engaged in at least assertive community treatment, supported employment or family psychoeducation. The staff who performed EBPs had significantly higher scores on PAS (MD, 7.09; 95% CIs, 4.09-10.09) and RAQ (MD, 1.30; 95% CIs, 0.36-2.25) but lower scores on SDSJ (MD, -2.41; 95% CIs, -3.50 to -1.32) than those who never performed EBPs. Multivariate analyses found that EBP experience was associated with a low level of staff stigmatisation after controlling for confounders. CONCLUSION: The findings suggest that an individual EBP experience is associated with their reduced stigmatisation.

Lower anterior cingulate volume in seriously violent men with antisocial personality disorder or schizophrenia and a history of childhood abuse.

OBJECTIVE: Antisocial personality disorder (ASPD) and schizophrenia, as well as childhood abuse, are associated with violent behaviour and show marked volumetric reduction in the anterior cingulate (AC), a brain region implicated in regulation of violence through its involvement in decision making, empathy, impulse control, and emotion regulation. The present study examined, for the first time to the authors' knowledge, the grey matter volume of the AC in relation to seriously violent behaviour and childhood psychosocial deprivation (including physical and sexual abuse) in the context of a mental disorder (schizophrenia or ASPD). METHODS: Fifty-seven men [14 with ASPD and a history of serious violence; 13 with schizophrenia and a history of serious violence (VSZ); 15 with schizophrenia without a violence history (SZ); 15 nonviolent healthy participants] underwent whole-brain magnetic resonance imaging and were rated on the presence of physical abuse, sexual abuse, neglect, extreme poverty, foster home placement, criminal parent, severe family conflict, and broken home (collectively 'psychosocial deprivation'). Stereological volumetric ratings of the AC were examined for group differences and their association with childhood psychosocial deprivation. RESULTS: A higher proportion of ASPD and VSZ patients had suffered psychosocial deprivation as children, in particular severe physical abuse, relative to SZ patients and healthy participants. ASPD and VSZ, but not SZ, patients had significantly lower AC volume relative to healthy participants. AC volumes correlated negatively with (total) psychosocial deprivation as well as physical and sexual abuse ratings. Group differences in AC volume became nonsignificant when psychosocial deprivation ratings were covaried for. CONCLUSIONS: Violent mentally disordered individuals with ASPD or schizophrenia suffer from a significant AC volume loss and this deficit, at least in part, is explained by their histories of stressful childhood experiences. Current and future therapies aiming to reduce violence in such populations would benefit by attending to biological (and other) correlates of childhood abuse.

Strategies and future attempts to reduce stigmatization and increase awareness of mental health problems among young people: a narrative review of educational interventions.

There is a need to reduce stigma and increase awareness in order to prevent social exclusion of people with mental illness and to facilitate the use of mental health services in young people. The purpose of this review was to examine the effects of educational interventions to reduce stigmatization and improve awareness of mental health problems among young people. An electronic search using MEDLINE, PsycINFO and Academic Search Complete was carried out for studies that evaluated the effectiveness of educational interventions. Forty eligible studies were identified. There were three types of educational interventions (Educational condition, Video-based Contact condition and Contact condition). Eighteen of 23 studies reported significant improvements in knowledge, 27 of 34 studies yielded significant changes in attitudes towards people with mental illness. Significant effects in social distance were found in 16 of 20 studies. Two of five studies significantly improved young people's awareness of mental illness. However, six studies reported difficulties in maintaining improved knowledge, attitudes and social distance in young people. Furthermore, the majority of studies did not measure the actual behavioral change. From the comparison of the three types of educational interventions, direct contact with people with mental illness (Contact condition) seems to be key in reducing stigmatization, while the components of Education and Video-based contact conditions are still arguable. Despite the demonstration of the positive effects of each educational intervention, their long-term effects are still unclear. Further research needs to involve measuring actual behavioral change and performing a long-term follow up.

StereoTactic radiotherapy for wet Age-Related macular degeneration (STAR): study protocol for a randomised controlled clinical trial.

BACKGROUND: The standard of care for neovascular age-related macular degeneration (nAMD) involves ongoing intravitreal injections of anti-angiogenic drugs targeting vascular endothelial growth factor (VEGF). The most commonly used anti-VEGF drugs are ranibizumab, bevacizumab and aflibercept. The main objective of the STAR trial is to determine if stereotactic radiotherapy can reduce the number of anti-VEGF injections that patients with nAMD require. METHODS/DESIGN: STAR is a multicentre, double-masked, randomised, sham-controlled clinical trial. It evaluates a new device (manufactured by Oraya, Newark, CA, USA) designed to deliver stereotactic radiotherapy (SRT) to nAMD lesions. The trial enrols participants with chronic, active nAMD. Participants receive a single SRT treatment (16 Gy or sham) with a concomitant baseline intravitreal injection of 0.5 mg ranibizumab. Thereafter, they attend every month for 24 months, and ranibizumab is administered at the visit if retreatment criteria are met. The primary outcome is the number of pro re nata ranibizumab injections during the first 24 months. Secondary outcomes include visual acuity, lesion morphology, quality of life and safety. Additional visits occur at 36 and 48 months to inspect for radiation retinopathy. The target sample size of 411 participants (randomised 2:1 in favour of radiation) is designed to detect a reduction of 2.5 injections against ranibizumab monotherapy, at 90% power, and a significance level (alpha) of 0.025 (one-sided two-sample t test). This gives 97% power to detect non-inferiority of visual acuity at a five-letter margin. The primary analyses will be by intention to treat. DISCUSSION: The safety and efficacy outcomes will help determine the role of SRT in the management of chronic, active nAMD. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: ISRCTN12884465. Registered on 28 November 2014. ClinicalTrials.gov: NCT02243878 . Registered on 17 September 2014.