Perceived Course of Illness on the Desire for Social Distance From People Suffering From Symptoms of Schizophrenia in India

BACKGROUND

Stigmatization of people with schizophrenia remains a highly relevant topic worldwide, particularly in low- and middle-income countries like India. It is crucial to identify the determinants of the desire for social distance as a proxy for discriminatory behavior in a socio-cultural context to indicate ways to reduce stigma. This study aims to explore whether the public perception of the perceived course of an illness concerning people with symptoms of schizophrenia has an impact on the desire for social distance.

SUBJECTS AND METHODS

Data collection took place in five cities in India. The sample (N = 447) was stratified for gender, age, and religion. Desire for social distance was sampled based on a self-reported questionnaire using unlabelled vignettes for schizophrenia. First, factor analysis was conducted to identify the main factors underlying the perception of the perceived course of the illness. Subsequently, a regression analysis was conducted to examine the impact of the perception of those prognostic factors on the desire for social distance.

RESULTS

Factor analysis revealed two independent factors of the perceived course of an illness: (1) life-long dependency on others and loss of social integration and functioning and (2) positive expectations toward treatment outcome. This second factor was significantly associated with a less desire for social distance toward persons with schizophrenia.

CONCLUSION

The desire for social distance toward people with schizophrenia reduces with the expectation of positive treatment outcomes which underlines the need to raise public mental health awareness and provide psychoeducation for affected people and their family members in India. Help-seeking behaviors can be promoted by directing those needing treatment toward locally available, affordable and credible community-based services rather than facility-based care. Strikingly, lifelong dependency and the inability to socially integrate do not increase the desire for social distance, reflecting the Indian nation's socio-relational values and insufficiency of public mental health services. This indicates the suitability of systemic therapy approaches in public mental healthcare services to support the family's involvement and family-based interventions in caregiving for mentally ill people across the lifespan.

Public Attitudes Toward Psychiatric Hospitals: A Rural-Urban Comparative Public Survey in Odisha State, India

Background: Integration of psychiatric care with public health services and offering mental health care services to patients from lower socioeconomic status remains a global challenge. Scarcity of funds and professional workforce in psychiatric hospitals contribute to this situation. However, negative attitudes in the population are also a known impediment to patients seeking mental health services. This study aimed to assess the attitudes toward psychiatric hospitals among the urban and rural population in India. Subjects and Methods: The study was carried out amongst the general population in Odisha, India. The total sample (n = 988) includes 496 respondents from an urban-setting, and 492 respondents from rural parts of the district. Participants were selected by using simple random-sampling from the Asian Institute of Public Health (AIPH) data base. A standardized seven-item questionnaire was adopted, with responses indicated on a 5-point Likert-scale. Interviews were fully structured and conducted face-to-face. Results: Level of education (B = -0.192, ß = -0.320, p < 0.000) and urban-rural comparison (B = -0.272, ß = -0.189, p < 0.000) significantly influenced attitudes toward psychiatric hospitals. Gender, age, and religious beliefs did not show any significant effect on attitudes toward psychiatric hospitals. Individuals in rural areas and those with lower education levels showed more negative attitudes toward psychiatric hospitals. Conclusion: Negative attitudes toward psychiatric hospitals from those living in rural areas as well as those with lesser education may be reflective of the lack of availability, accessibility, affordability, and credibility of such mental health services. The Mental Health Care Act in India is a progressive legislation which might improve the situation of the provided services and, consequently, reduce negative attitudes in the years to come.

Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India

BACKGROUND

India faces a significant gap between the prevalence of mental illness among the population and the availability and effectiveness of mental health care in providing adequate treatment. This discrepancy results in structural stigma toward mental illness which in turn is one of the main reasons for a persistence of the treatment gap, whereas societal factors such as religion, education, and family structures play critical roles. This survey-based study investigates perceived stigma toward mental illness in five metropolitan cities in India and explores the roles of relevant sociodemographic factors.

MATERIALS AND METHODS

Samples were collected in five metropolitan cities in India including Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). Stratified quota sampling was used to match the general population concerning age, gender, and religion. Further, sociodemographic variables such as educational attainment and strength of religious beliefs were included in the statistical analysis.

RESULTS

Participants displayed overall high levels of perceived stigma. Multiple linear regression analysis found a significant effect of gender (P < 0.01), with female participants showing higher levels of perceived stigma compared to male counterparts.

CONCLUSION

Gender differences in cultural and societal roles and expectations could account for higher levels of perceived stigma among female participants. A higher level of perceived stigma among female participants is attributed to cultural norms and female roles within a family or broader social system. This study underlines that while India as a country in transition, societal and gender rules still impact perceived stigma and discrimination of people with mental illness.

Attitude toward psychiatrists and psychiatric medication: A survey from five metropolitan cities in India

BACKGROUND

Stigmatization and overall scarcity of psychiatrists and other mental health-care professionals remain a huge public health challenge in low- and middle-income countries, more specifically in India. Most patients seek help from faith healers, and awareness about psychiatrists and treatment methods is often lacking. Our study aims to explore public attitudes toward psychiatrists and psychiatric medication in five Indian metropolitan cities and to identify factors that could influence these attitudes.

MATERIALS AND METHODS

Explorative surveys in the context of public attitudes toward psychiatrists and psychiatric medication were conducted using five convenience samples from the general population in Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). We used a quota sample with respect to age, gender, and religion using the census data from India as a reference.

RESULTS

Mean scores indicate that attitudes toward psychiatrists and psychiatric medication are overall negative in urban India. Negative attitudes toward psychiatrists were associated with lower age, lower education, and strong religious beliefs. Negative attitudes toward psychotropic medication were associated with lower age, male gender, lower education, and religion.

CONCLUSION

In line with the National Mental Health Policy of India, our results support the perception that stigma is widespread. Innovative public health strategies are needed to improve the image of psychiatrists and psychiatric treatment in society and ultimately fill the treatment gap in mental health.

Influence of urbanity on perception of mental illness stigma: a population based study in urban and rural Hanoi, Vietnam

BACKGROUND AND AIMS

To examine, for the first time in Vietnam, whether urbanity of respondents among other socio-demographic factors affects the public perception of stigma attached to persons with mental illness in Hanoi.

METHODS

A general population-based survey was carried out in 2013 in the greater Hanoi area. The perception of stigma attached to people with mental illness was elicited using Link's perceived discrimination and devaluation scale (PDDS) carried out in Vietnamese language. The survey sample (n = 806) was stratified for gender, urban/rural location, age, household size and marital status, in accordance with the 2013 Vietnamese census.

RESULTS

Comparing the total score of the PDDS and its single items, we found less perceived stigma and discrimination among the rural population of Hanoi and in respondents who reported religious attainment to either Buddhism or Christianity. Logistic regression analyses found no significant influences of gender, age, household size or marital status regarding the perceived stigma toward persons with mental illness.

CONCLUSION

Less negative perception of stigma attached to persons with mental illness that was observed among the rural population in the Hanoi area may be interpreted in the light of possibly more demanding living conditions in modern urban Vietnam with less opportunities for mentally ill patients and points toward a dynamic interaction with rapidly changing living conditions in Asian megacities.

Perceived stigma of mental illness: A comparison between two metropolitan cities in India

PURPOSE

An increasing number of comparative studies are conducted on the stigmatization of persons with mental illness, in particular with regard to regional and diachronic variation. So far, there have been no studies comparing stigmatization of persons with mental illness in two different regions of India. Therefore, we examined the differences in perception of stigma attached to mental illnesses in Kolkata and Chennai, with regard to cultural and geographical differences to better understand the roots and origins of this issue.

MATERIALS AND METHODS

Explorative surveys in the context of public attitudes toward people with mental disorders were conducted among conveniently selected members of the general population in Chennai (n = 166) and Kolkata (n = 158) with identical methodology. Link's perceived devaluation-discrimination measure was used. The samples were matched for age, gender, and education.

RESULTS

The calculated sum score indicated that respondents from Kolkata had a higher level of perceived discrimination toward persons with mental illness than respondents from Chennai (P = 0.043). Furthermore, regression analysis revealed that lower perceived stigma was associated with stronger religious devotion (P = 0.049) and higher educational attainment (P = 0.001) in both cities.

DISCUSSION

The results showed that perceived stigma was higher in Kolkata than in Chennai. The correlation of higher stigma with lower education was in line with the previous research, and interestingly, it was found that higher stigma correlated with weaker religious devotion. Further studies exploring a wider variety of factors may provide us with a better understanding of the roots of perceived stigma in India.

Bone micro-architecture of elite alpine skiers is not reflected by bone mineral density

Bone quality is affected by muscle forces and external forces. We investigated how micro-architecture is influenced in elite alpine skiers who have received high loading levels throughout their adolescent bone development. Bone strength was higher in skiers, likely due to external forces, but muscle forces may also be a significant contributor.

INTRODUCTION

Impact loading and muscle forces affect bone quality, but little is known about how they influence 3 dimensional aspects of bone structure. This study investigated bone quality in female and male elite alpine skiers using high-resolution peripheral quantitative computed tomography (HR-pQCT).

METHODS

HR-pQCT at the distal radius and tibia, whole-body lean mass, and muscle strength were assessed in 10 female (22.7 ± 3.9 years) and 12 male (25.5 ± 3.3 years) Canadian national alpine team athletes and compared to recreationally active female (N = 10, 23.8 ± 3.2 years) and male (N = 12; 23.7 ± 3.6 years) control subjects. HR-pQCT standard parameters and customized cortical and finite element (FE) analyses were performed and analyzed using one-way ANOVA and Pearson's correlation.

RESULTS

Male and female skiers had stronger bones than controls at radius (38-49 %, p < 0.001) and tibia (24-28 %, p < 0.001). This result was not consistently reflected by total bone mineral density (BMD) because higher trabecular BMD occurred in parallel with lower cortical BMD, which was due to a redistribution of mineral leading to a shift of the endocortical margin toward a thicker cortex. The endocortical regional adaptation was likely responsible for the greater strength of the athletes' bones. Lean mass and muscle strength was 29 to 90 % greater (p < 0.001) in athletes compared to controls. Good associations between muscle strength and FE-estimated bone strength were found (r = 0.63 to 0.80; p < 0.001), although micro-architecture was more strongly associated with muscle outcomes in females than males.

CONCLUSIONS

Higher bone strength in elite alpine skiers is achieved through micro-architectural adaptation that is not apparent by BMD measurements alone. The improved micro-architecture at radius and tibia suggests that muscle forces may play an important role in bone adaptation.

[New research and considerations in managing minimally conscious coma patients]

The "Wachkoma", minimally conscious state (synonyms in use: "apallic syndrome", "vegetative state"), is a severe, complex condition arising from brain damage of diverse etiologies, for which definitional consensus does not exist internationally; it gives rise to frequent misdiagnosis and carries substantial insecurities concerning treatment outcomes. In the framework of expanding early rehabilitation, however, recent years have seen a distinct shift away from a defect-oriented, reductionist view towards a relational-medicine based understanding of patients with severe brain damage, seeking to gain a comprehensive perception of the patient's altered physical existence and taking a multidisciplinary--nursing, medical, therapeutic and neuropsychological--perspective which includes the patient's relatives and family. Historically, a transition is under way away from the classical brain-pathology focus toward a neuropsychologically grounded, differentiated perspective. Along with in-depth differential diagnostics and assessment of rehab potentials (early intervention diagnostics), comprehensive intervention measures are initiated as early as possible by an interdisciplinary team. These include "coma stimulation" measures, body language forms of interaction ("dialogue management"), and technical communication devices. By building long-term care assistance in ambulatory and residential service delivery systems ("small social network"), social reintegration of these very severely affected patients is attempted, involving the familial and social resources available. Recurrently raised within the bioethical discourse, demands to consider doctor-assisted dying or food withdrawal are to be rejected from a clinical, medical and social-ethical perspective.

Differentiation of autonomic nervous activity in different stages of coma displayed by power spectrum analysis of heart rate variability

The analysis of heart rate (HR) variability offers a noninvasive method to investigate autonomic nervous system activity in comatose patients. We analyzed three components of the HR variability in a group of comatose patients: the low-frequency band (LF), representing mainly sympathetic influence, the mid-frequency band (MF), representing sympathetic and parasympathetic influence, and the high-frequency band (HF), representing the parasympathetic influence. A value for sympathovagal balance was defined as LF/HF and MF/HF ratio. Moreover, the skin conductance level (SCL) and the skin conductance resistance (SCR) variability were recorded. The patient group consisted of 22 patients with traumatic brain injuries. Coma depth was assessed by the Glacow Coma Scale and artifact-free HR, SCL, and SCR were measured 75 times in the patient group. The results documented a significant gain in sympathetic nervous system activity corresponding with the state of emerging from coma. This gain was most pronounced in the HF component of the HR and in the sympathovagal balance between LF/HF. The findings in SCL and SCR variability endorsed this result. It is concluded that emerging from coma is accompanied by an increasing influence of the sympathetic nervous system on HR control. This leads to a change in the sympathovagal balance, i.e., a reintegration of parasympathetic and sympathetic activity.

Unconscious activation of motor responses in a hemiplegic patient with anosognosia and neglect

Unconscious processing of environmental stimuli has been convincingly demonstrated for a large number of neuropsychological syndromes. However, only few studies have successfully recorded on-line the activation of the autonomous or the motoric nervous systems. The activation of the motor system by unconscious stimuli would be a strong argument that information processing in the brain is not organized into two serial steps (stimulus identification first, response selection second). This would argue for parallel processes of stimuli identification routines and response selection mechanisms on the basis of only provisionally worked out stimulus features. Investigating an anosognostic patient we found electrodermal activity (EDA) and electromyographic responses (EMG) to bimanual tasks, mental imagery, and to the request to execute specific actions. But overt behavior remained hemiplegic and the patient was unable to feel any kind of control of her paralyzed left arm and hand. Generally, the data can be interpreted along the lines of a theory of two different routes to action, leaving the unconscious selection of action patterns intact, whereas the intentional triggering of overt behavior with the left hand and arm was impossible for the patient.

Usefulness of bioelectric impedance and skinfold measurements in predicting fat-free mass derived from total body potassium in children

Despite the increasing use of tetrapolar whole-body bioelectric impedance (BI) analysis in the assessment of body composition, its usefulness in estimating fat-free mass (FFM) has not been evaluated in comparison with conventional skinfold anthropometry in children. We therefore compared 1) the intraobserver and interobserver reproducibility of BI and skinfold measurements and the derived FFM estimates, and 2) the predictability of FFM as calculated from measurements of total body potassium (TBK) using 40K spectrometry by equations based on either BI or skinfold measurements in 112 healthy children, adolescents, and young adults aged 3.9 to 19.3 y. A best-fitting equation to predict TBK-derived FFM from BI and other potential independent predictors was developed and cross validated in two randomly selected subgroups of the study population by stepwise multiple regression analysis. Although the technical error associated with BI measurements was much smaller than that of skinfold measurements, the reproducibility of BI-derived FFM estimates (intraobserver coefficient of variation [CV], 0.39%; interobserver CV, 1.23%) was only slightly better than that of FFM estimates obtained by use of weight and two skinfold measurements (0.62% and 1.39%, respectively). The cross validation procedure yielded the following best-fitting prediction equation: FFM = 0.65 x (height2/impedance) + 0.68 x age + 0.15 (R2 = 0.975, root mean square error = 1.98 kg, CV = 5.8%, 95% limits of agreement = -11.1% to +12.4%). Conventional anthropometry, using published equations to estimate FFM from skinfolds, slightly over-estimated TBK-derived FFM, but predicted FFM with precision similar to the best-fitting equation involving BI. Previously published FFM equations incorporating BI predicted TBK-drived FFM with variable predictive precision and accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)

Practical co-table for direct coronal CT scanning

Direct coronal CT scanning can be efficiently performed by a new co-table equipment, which requires a comfortable prone positioning of the patient, whereby the patient must only extend his head slightly. The co-table-unit is linked to the original CT table board directly within a few minutes, coming through the opening of the gantry from the rear. This practical co-table method serves to reduce motion artifacts and to improve image quality significantly. By this method coronal follow-up CT scans are exactly reproducable.

Nontraumatic intracerebellar hematomas: prognostic value of volumetric evaluation by computed tomography

Thirty-two consecutive cases of nontraumatic intracerebellar hematomas detected by computed tomography are reviewed. A strong correlation was found between the clinical course and the volumetrically calculated size of the hematomas. Prompt evacuation has the best prognosis in cases that have an acute or subacute course (hematoma size, 22.5 to 66 cm3). Conservative treatment was most successful in chronic cases (hematoma size, 8 to 16 cm3). Surgical treatment should be the treatment of choice in very acute cases also (hematoma size, over 70 cm3) if the hematoma is diagnosed immediately after the onset of bleeding. Early detection and volumetric evaluation by computed tomography have great prognostic value for managing nontraumatic intracerebellar hematomas.

Subdural hematoma associated with dural metastatic tumor

Two cases of subdural hematoma associated with dural metastasis are reported. The computed tomographic and angiographic features are presented. The possible pathogenetic mechanism is discussed. Our cases support the idea of obstruction of dural capillaries by neoplastic cells and subsequent subdural bleeding.

[On relapsing paraneoplastic cerebral embolism. Case report and survey of literature (author's transl)]

The disease of a 34-year-old patient with relapsing cerebral embolisms, endocarditis, thrombophlebitis and hypercoagulopathy had the characteristics of paraneoplastic syndromes described and discussed in literature. Autopsy yielded a clinically unrecognised, dedifferentiated adenocarcinoma of the bronchial system. At an early stage of the disease cerebral embolisms had produced severe cerebral neurological signs with varying manifestations. This influenced not only the clinical picture and course of the disease to a considerable extent, but also focussed diagnostic attention on these signs to such a degree that the possibility of a masked carcinoma did not seem to suggest itself. The assumption of paraneoplastic linkups is supported by experimental and postmortem examinations on metabolic and immunological remote action of tumours on cardiac valves and on the vascular and coagulation system. However, the exact pathogenetic details are still largely unknown.