Perceptions of stigma among outpatients with schizophrenia

Perceptions of stigma among outpatients with schizophrenia

51 several dimensions of poor insight, including lack of awareness, misattribution, and emotional indifference about the illness. These relationships...

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51

several dimensions of poor insight, including lack of awareness, misattribution, and emotional indifference about the illness. These relationships vary both as a function of the dimension of emotion being assessed and of diagnosis. We replicated previous findings that poor insight is related to frontal lobe dysfunction and extend this work by demonstrating that such impairments are also related to diminished emotional experience. Our data do not support the idea that poor insight and diminished emotional experience are associated with right hemisphere impairment. We also replicated previous findings that poor insight is related to decreased depression, the deficit syndrome, and a poorer course of illness. The research and clinical implications of these findings are discussed.

Persons with schizophrenia are adversely affected by news events involving mentally ill individuals who commit violent acts. Efforts to prevent these acts will also serve to reduce the stigma experienced by persons with schizophrenia.

A.30. PERCEPTIONS OF STIGMA AMONG OUTPATIENTS WITH SCHIZOPHRENIA

Dept. of Psychiatry and Neuropsychology, Maastricht University, European Graduate School of Neuroscience. PO Box 616, 6200 MD Maastricht, The Netherlands

A.31. DIAGNOSTIC PROPERTIES OF THE DSM AND ICD CATEGORIES OF PSYCHOSIS: AN EVIDENCE-BASED APPROACH J. v a n Os, C. Gilvarry, R. Bale, E. v a n H o r n , T. Tattan, Ian W h i t e a n d R. M u r r a y o n b e h a l f of the U K 7 0 0 Group

F.B. Dickerson, J.S. Blume, A.E. Origoni, N.B. Ringel

Sheppard Pratt Health System, 6501 N. Charles St., Baltimore, Md. 21204 USA Many individuals with schizophrenia are devalued and discriminated against because of their mental illness. However, there has been only limited study of how individuals with schizophrenia perceive and experience mental illness stigma. We evaluated 74 stable outpatients with schizophrenia receiving care from a public/private psychiatric health system. Study participants were interviewed with the Consumer Experiences of Stigma Questionnaire (CESQ), a battery of neuropsychological tests, the PANSS, and several social functioning measures. On the CSEQ, all but one respondent indicated having had stigma experiences. The most frequently reported items were worry about being viewed unfavorably because of their mental illness and avoidance of telling others about it. A total of 43% of participants reported feeling upset by news events involving persons with mental illness. In a multiple regression analysis, 40% of the variance of the total CESQ score was predicted by the number of hospitalizations, dissatisfaction with family relationships, and frequency of activities of daily living. Symptom and cognitive variables were not significantly related to the frequency of stigma experiences. We conclude that the experience of stigma is nearly universal among persons with schizophrenia and is independent of the severity of illness symptoms. Interventions to help persons cope with stigma should focus on strategies of disclosure about mental illness.

Background: It is generally assumed that the distinction between affective and non-affective psychotic syndromes occasioned by modern diagnostic criteria provides a useful symptomatic contrast. Methods: In a sample of 708 patients with chronic psychosis, the distinction of lifetime DSM-III-R and ICD-10 diagnoses of (schizo)affective versus non-affective psychosis was used as a diagnostic test to detect lifetime presence of depressive, manic, positive, negative and disorganisation symptoms. Results: A manic or depressive (schizo)affective diagnosis was a perfect test to diagnose presence of manic and depressive symptoms, as evidenced by very high diagnostic likelihood ratios. However, this test result was based solely on the inclusion criterion that patients with (schizo)affective psychosis must have affective symptoms (guaranteeing high specificity and high likelihood ratio's), and ignored the fact that patients with non-affective psychosis also had high affective symptom scores (low sensitivity). A non-affective psychotic diagnosis was a very poor test to diagnose correctly the presence of positive, negative and disorganisation symptoms in comparison with an affective psychotic diagnosis. In general, the DSMII-R categories performed somewhat better as a diagnostic test than those of ICD-10. Conclusions: The evidence for true diagnostic value of the distinction between affective and non-affective psychotic diagnoses is weak. Rather, the distinction appears to obscure natural overlap between the symptom dimensions of the various diagnostic categories.