Effect of diagnostic labeling and causal explanations on medical students' views about treatments for psychosis and the need to share information with service users

The Assessment of Attitudes of Students at Medical Schools towards Psychiatry and Psychiatric Patients-A Cross-Sectional Online Survey

The aim of the study was the assessment of the level of stigmatisation of psychiatric patients and psychiatry as a field of study by students at medical schools in Poland and the comparison of students’ attitudes over the years. The study was conducted based on a proprietary questionnaire assessing the stage of tertiary education, sociodemographic status, and MICA-2 psychometric tool that is used for assessing both the attitudes of students at medical schools towards psychiatry as a field of study and patients with mental health disorders. According to the MICA score, those who have higher scores have more negative attitudes towards psychiatry. The survey consisted of two rounds at an interval of 3 years. Results. The first-round survey, conducted in 2017, involved 480 students. The second-round survey, conducted in 2020, involved 573 students. In both cases, women constituted the vast majority of respondents. Women, as well as medical major students, achieved significantly lower scores than men p < 0.001. The said relationship was also observed for individual experience with mental illness. There was no correlation between the MICA-2 total score and the psychiatry course completion—p = 0.105. However, the levels of stigmatisation are still high. The implementation of educational methods to improve the perception of psychiatric patients by students at medical schools should be taken into consideration. An increase in direct student–patient contact, for example, by means of intensive elective classes, could be beneficial.

Attitudes towards People with Mental Illness and Low Interest in Psychiatry among Medical Students in Central and Eastern Europe

This study aimed to examine attitudes towards people with mental illness and psychiatry and interest in career choice in psychiatry among medical students from three medical schools in Czechia and Slovakia. A total of 495 medical students participated in a cross-sectional study. Participants completed (1) the Medical students' version of mental illness: clinicians' attitudes (MICA-2) scale, (2) the Reported and intended behaviour scale (RIBS), (3) the Attractiveness of working on a psychiatry-related position scale (P-ATTRACT), and (4) the Status of psychiatry scale (P-STATUS). Descriptive statistics, group comparisons and regression models were calculated. From 23 to 30% of students considered a specialization in psychiatry. However, only about 1% of them had a strong interest in psychiatry as a future career, moreover, students of higher years of study found psychiatry less attractive compared to those who are in the beginning of the study. The consideration of specialization in psychiatry was found to be statistically significantly associated with less stigmatizing attitudes and lower social distance towards people with mental illness. There were statistically significant differences in stigmatizing attitudes among medical schools, with a medical school emphasizing the education in psychiatry the most showing more positive attitudes. It is necessary to increase the interest in psychiatry and minimize stigma among medical students. Psychiatry curriculum in Central and Eastern European region should include more psychiatry-related courses, training in community and out-patient facilities, peer-lectors, and offer counselling after exposure to emotionally challenging clinical situations.

The beliefs of non-psychiatric doctors about the causes, treatments, and prognosis of schizophrenia

OBJECTIVES

To examine the causal beliefs about schizophrenia of non-psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors' views about treatments and prognosis.

DESIGN AND METHODS

Three hundred and five non-psychiatric doctors working in outpatient community centres completed the 'Opinions on mental disorders Questionnaire' after reading a clinical description of people with schizophrenia.

RESULTS

The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy-five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty-two per cent of respondents thought it 'completely true' that drugs are useful in schizophrenia, and 33.9% thought it 'completely true' that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia.

CONCLUSIONS

These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed.

PRACTITIONER POINTS

Viewing schizophrenia as mainly due to a biological cause is associated with greater confidence in the usefulness of drugs, higher belief in the need for lifelong pharmacological treatments, and greater prognostic pessimism. Belief in a biologically oriented model of schizophrenia may lead doctors to underestimate the value of psychologists. Prognostic pessimism among doctors may negatively influence clinical decisions, the information doctors provide to their clients, and clients' own beliefs about their chances of recovery. Belief in the need for lifelong pharmacological treatments in schizophrenia may lead doctors to resist drug withdrawal in case of severe side effects.

Mental illness stigma among medical students and teachers

BACKGROUND

Medical school curriculum contributes to future doctors' attitude formation towards people with mental illness.

AIM

The purpose of this study was to compare stigmatizing attitudes between medical students and faculty, analyse stigmatizing attitudes among students from different years of study and identify factors predicting stigma.

METHODS

A cross-sectional study with the use of scales measuring attitudes and social distance was designed. Online questionnaires were distributed to all students and teachers at a medical faculty in the Czech Republic.

RESULTS

The response rate was 32.1% ( n = 308) among students and 26.7% ( n = 149) among teachers. Teachers had a greater prevalence of stigmatizing attitudes than students. Increased tolerant attitudes in students were detected after the fourth year, that is, following introduction to psychiatry. Preferred specialization in psychiatry and attending two psychiatry courses predicted more tolerant attitudes. Among both students and teachers, men possessed more stigmatizing attitudes towards people with mental illness. Age was an important predictor of stigmatizing attitudes among teachers.

CONCLUSION

Educators should pay closer attention to the role of medical psychology and communication training implementation, which may be beneficial to improving skills and increasing medical students' self-esteem and feeling of competence throughout their psychiatry rotation.

The Influence of Causal Explanations and Diagnostic Labeling on Psychology Students' Beliefs About Treatments, Prognosis, Dangerousness and Unpredictability in Schizophrenia

This study explored views of 566 Italian psychology students about schizophrenia. The most frequently cited causes were psychological traumas (68 %) and heredity (54 %). Thirty-three percent of students firmly believed that people with the condition could recover. Reporting heredity among the causes, and identifying schizophrenia were both associated with prognostic pessimism, greater confidence in pharmacological treatments and lower confidence in psychological treatments. Schizophrenia labeling was also associated with higher perception of unpredictability and dangerousness. Compared to first year students, fourth/fifth year students more frequently reported heredity among the causes, and were more pessimistic about schizophrenia recovery. Stigma topics should be included in future psychologists' education.

The Australian public׳s beliefs about the causes of schizophrenia: associated factors and change over 16 years

This study investigated the Australian public׳s beliefs about the causes of schizophrenia and whether these beliefs have changed over a 16-year period. Data came from the 2011 Australian National Survey of Mental Health Literacy and Stigma which involved telephone interviews with 1995 Australians aged 15 or over. The survey interview used the same questions as those of the 2003/4 and 1995 national mental health literacy surveys, in which participants were presented with a case vignette describing either early or chronic schizophrenia. Questions were asked about recognition of, exposure to and causal beliefs about these disorders, including those relating to psychosocial, biogenetic and personality factors. Results showed that most Australians believe in multifactorial causes of schizophrenia and that, between 1995 and 2011, belief in problems from childhood and inherited or genetic causes of early schizophrenia increased while belief in weakness of character decreased. Overall, the findings are consistent with evidence that mental health literacy in Australia has improved over a 16-year period.

"Social dangerousness and incurability in schizophrenia": results of an educational intervention for medical and psychology students

This study explored the influence of an educational intervention addressing common prejudices and scientific evidence about schizophrenia on medical and psychology students' views of this disorder. The intervention--consisting in two three-hour lessons with an interval of a week between--was run at first for medical students and then for psychology students. Participants' views of schizophrenia were assessed at baseline vs. at post intervention by matched questionnaires. At medical school, participation was voluntary and also included a six-month online re-assessment, while at psychology school, participation was mandatory. A total of 211 students attended the educational initiative. At post intervention assessment, students more frequently mentioned psychosocial causes of schizophrenia, and more firmly believed that recovery in schizophrenia is possible and that persons with this disorder are not unpredictable and dangerous vs. their baseline assessment. The online six-month assessment confirmed favourable changes in medical students' views found at post intervention. These results confirm that an educational intervention including personal experiences and scientific evidence can be successful in reducing students' prejudices toward persons with schizophrenia.

Diagnosis telling in people with psychosis

PURPOSE OF REVIEW

There are complexities in communicating diagnostic information relating to schizophrenia spectrum disorders. There is a current dearth of research in understanding how clinicians effectively communicate with service users about such diagnostic news. In this review, we aim to synthesize the latest research throughout 2012 and 2013 that presented data relating to the communication of a diagnosis of schizophrenia spectrum disorders, including individuals who had experienced first-episode psychosis or were in at-risk mental states. Comprehensive database and manual searches were conducted which obtained data from both service users and health professional groups.

RECENT FINDINGS

Fourteen quantitative and qualitative studies were found. The majority of studies were descriptive and heterogeneous in content. Key themes included service user preferences towards disclosure and diagnostic terminology, health professional training, stigma-related issues and the use of diagnostic communication models.

SUMMARY

Overall, communication models that foster therapeutic relationships and actively encourage the health professional to reduce stigma may be a key to initial diagnostic discussions in clinical practice. Such communication models and intervention require further more rigorous evaluation, as none have been tested through randomized controlled protocols in clinical settings.

Distortion, Bias, and Ethical Informed Consent: Presentations of Etiological and Treatment Factors in Abnormal Psychology Textbooks

Concerns have been made highlighting the need for true informed consent and choice when patients and/or parents are confronted with seeking treatment for severe emotional states and crises. Yet, psychosocial treatments are often derided or recommended only in conjunction with psychotropic medications because of the assumed biological basis of mental distress. At the same time, the benefits of medications are often inflated, whereas the harmful effects are drastically minimized or not reported at all. This misinformation is distributed to the public, and to patients, in part through the education of students and trainees. Early educational experiences can shape the thinking of trainees as they begin to formulate their respective approaches to clinical populations, and textbooks are a fundamental part of this education. The purpose of this study was to analyze popular abnormal psychology textbooks to evaluate their representation of the current scientific literature regarding psychopathology. Content areas that were explored were those related to depression, attention-deficit/hyperactivity disorder, and schizophrenia. Misrepresentations of the literature were pervasive in areas associated with biological findings. In addition, there were multiple omissions or biased statements related to psychosocial findings, distortions regarding the efficacy of and adverse effects of various treatments, and a lack of reports of the existence of effective alternative approaches to standard mental health care. Concerns regarding the dissemination of distorted and false information in higher education as it pertains to ethics and informed consent are discussed.