Handout – How to Talk to a Psychiatric Patient.

duck

Finished the CME talk I did last week and thought, you might find some use for it.

I’ve received bad press many times for not being, in so many words, legit or academic enough. Check out the comments on my ECT book on Amazon.com for examples :). Maybe this one leaning into that bosom of greatness will turn public opinion. (Sneeze.)

…Formatting has been a real bear.

As you go through it, please talk out. Tell me what you think. I may do it again. (That’s right. I’m not afraid to threaten. You heard me.)

Keep on, Friends.

How to Speak to a Psychiatric Patient

Introduction:

  • You quack like a duck, avert your gaze, and then hold a fetal position. It’s good for core.
  • Be sure to carry your portable speakers playing zen chakra music in the background.
  • Offer cigarettes.
  • Bring a healthy white chicken to sacrifice over their chest for the exorcism.
  • Introduce yourself with an alias name. Hopefully a superhero.

This is a fail safe method of communication to pretty much hit all the difficult misperceptions we are contending with in psychiatry – demonic possession, shame, violent tendencies, weak character, and poor moral choices.

I’d like to give you the 1,2,3’s on how to talk to psychiatric patients. But as I researched this topic, it became apparent that this wasn’t the direction for us to go in. You have better algorithms, systems, and manuals based on research for this in your own departments. I know you have people who are specialists in the administrative side of things.

For us today, we are going to turn rather toward the innuendos that interplay in communication between caregiver and patient.

The is the first place for us to start, let’s just talk about it here.

What is it like for you to talk with a psychiatric patient?

  • Identifying Me in the mental health treatment paradigm.
  • Not implying that we have skills but no awareness. We are just deliberately putting the practitioner into “it.”
  • It’s a “how to,” but first we need to address our personal limitations.
  • Why do we have these limitations?

I: Clinician/Caregiver barriers

II: Patient barriers

  • What’s over-scored is that the problem is on the patient’s side. The patient is sick after all. We agree. Brain illness and all that.
  • Even so, what is underscored is our side. And that’s what this talk is going to be about.
  • We want to focus on our own thoughts about this. What it says about ourselves. Who am I if my identity changes with how I feel and behave? etc.
  • And then, how do we respond to that?

III: Understand Personal Biases – Likes and dislikes

  • Figure out where we are at. What makes it difficult to talk to patients?
  • What are the common myths? Get the myths out there. 
  • Some reasons are true and not myths.
  • What are some personal biases about working with psychiatric patients?
  • (Bias means – likes and dislikes)

IV:   Define Stigma

1. Prejudice – Attitudes, feelings/emotions (Amygdala)

2. Discrimination – attitudes lead to actions

1: Prejudice

  • Weakness of character
  • Supernatural explanations. (Statistically significant association with superstitions.)
  • The word “patient” not talking about disease, perhaps, but rather about character – something of moral value.
  • Religion. (But only a few believe that spiritual leaders can play a role in treatment! People don’t relate stigma issues to biology.  i.e., It is not biology or medicine that increase the problems, but belief that the person has a personal weakness as demonstrated by their behaviors – A conflict in beliefs, or prejudice, worth exploring.) (…But where do emotions and behaviors come from? The Brain. Thinking they come from a cloud by day or a fire by night fall into the category of prejudice.)
  • Time consumption.
  • Danger
  • Treatment skepticism – no recovery, there’s less hope for them
  • Punishment from God for evildoers.
  • Demonic possession
  • I am lessened by my affiliation with the mentally ill

What are our fears? Fears are an emotion and/or attitude…

  • Brings into play, how do we identify ourselves? …And that part of us that remains even when we are in a changing body (identity).  I call this, “Me,” with a capital “M.”
  • Think about this when we look at responses to prejudice; “discrimination.”

Caregiver stigma – “self-stigma” comes when we internalize public attitudes and turn it onto ourselves

  • We perceive stigma from others due to those we care for.
  • Shame/Embarrassment
  • Fears of what it says about ourselves

2. Discrimination – How we act on those prejudices.

Example:

  • Take “Caregivers Stigma.” We can bring this into our work place as well, from what we glean in our community.
  • We avoid patients who make us feel uncomfortable.

Who has Stigma?

Everyone.  It is in our community, including we who serve and are involved in mental healthcare services.

1. Patient

2. Clinician

Patient

Example: Mr. Whineheart misses his medications approximately three times a week due to logistical reasons. However, we know that Mr. Whineheart has had a long history of difficulty with treatment noncompliance. As we explore further, we discover that Mr. Whineheart dislikes taking medication. It makes him feel like he is weak. Not taking his medication is Mr. Whineheart’s discriminating behaviors against himself in response to his prejudices, (emotions and attitudes of shame.)

Clinician

Examples:

  • Refusing care for psychiatric patients.
  • Starting with Questions:  How do we respond to challenges to our identity? When our identity’s confronted by seeing our patients with psychiatric illnesses, our patients who demonstrate changes in their emotions and behaviors since brain illness set in, we ask, what part of us remains even when we are in a changing body and mind (identity)? How do we respond?
  • If it is positive, it is not discriminatory toward ourselves. If it is negative, it is discriminatory to ourselves and inevitably to others.

V: What are the barriers to talking with psychiatric patients?

  • The tension is when the patient and the clinician’s personal views, life stories come together.
  • Where those thoughts collide is where the tension is.
  • That’s where the barrier is.
  • Once this tension is resolved it’s easier to go into action

VI: Why bother about Stigma?

Because:

  • Stigma is a feature and a cause of health problems. (Both clinician and patient)
  • Belief —> action.
  • i.e., In caregivers, emotional toll can be devastating – may lead to injury or illness of caregiver

Because It Affects:

  • How we speak to psychiatric patients. (Human Value.)
  • Choices in our clinician-patient relationship.
  • Perceived quality of work experience.
  • “Me” and QOL (Quality of Life).

Because It Engenders:

  • Social distance. (Comes from fear. But connection is healthy for “Me.”)
  • We are robbed of opportunities (Think – Agendas, Connection, etc.)
  • Avoidance. (Comes from belief of danger.)
  • Treatment skepticism (What is “recovery” anyway?)
  • We need to ask, “What are our treatment goals?” (Agenda)
  • Frustration and anger, negative emotions.

Responsibility:

  • There’s an unequal level of power (Us v. patients/clients) – inherently increases our responsibility toward others to overcome this.
  • What about us?
  • Identify that. Then fear can become strength. Presence. Actions of discrimination change to actions of hope.

VII:  Agendas

  • Part of our “belief systems.”
  • Exposing agendas, leads us toward action. 
  • Just like exposing prejudice leads to actions of hope.
  • Just like starting with Me leads to actions of accountability and presence.

1.  Traditional agendas in the medical model:

a.  Serve altruistically.

  • Saying we don’t have an agenda is grossly dishonest.
  • Maybe we are uncomfortable speaking about agendas because it creates tension with the classic view that practicing medicine is supposed to be Altruistic.  Altruism is just another “pressure.”
  • It’s a perfectionistic model. It’s false. To ally ourselves with it is a mistake. Brings discriminatory behaviors toward ourselves, driven by prejudices of shame.

b.   Healing

  • The paradigm that never fits for psychiatry – cure, getting rid of something bad, not joining it and integrating it. (Presence.)
  • Can’t stop disease even with appropriate treatment – Treatment agenda changes to center around QOL experience rather than cure.
  • Caregivers in long-term care are not looking for recovery in their patients.

c.  Serve patient (Service)

2.  Traditional agendas of business

  • $, Profit

3.  Quality of work experience

  • Not only do we get money, we get other stuff (biopsychosocial needs).  That affects how we talk to people.

VII:  Solutions

1.  Start with Me. Own that we have stigma: prejudice and discrimination.

  1.  Protest
  2.  Put own selves in the way of these treatments
  3.  Rely on evidence (biomedical conceptualization or education), not ideation (prejudice, emotions, religious causation…)
  4.  Pay more attention to emotions, senses, thoughts.
  5.  Reconsider your agendas e.g., Not necessarily recovery but rather QOL
  6.  Engender a culture of expectation (ex: We expect ourselves and each other to participate…)

2. “Contact based” solutions.

  • The impact of experience and exposure
  • Best treatment is contact with the mentally ill vs. Educational approaches, which, although are helpful, are not as effective. Nor are psychotherapeutic approaches.
  • Maybe we overemphasize education in our culture and undervalue human relationships.
  • We see this anecdotally, but also notice that nearly all interventions studied, (multiple metanalysis, etc.,) used educational interventions primarily.

3. Education (Still important and demonstrates degree of efficacy)

4. Collaborate

  • Involve family

5. Collaborate

  • Involve community, Partnerships with community resources

Conclusion

  1. Start with at Me.
  2. More contact and exposure to people with mental illness.
  3. More education.
  4. More collaboration.

How to Talk to a Psychiatric Patient: Post-test

Mrs. Albritton is a caregiver at Grace Landing for Mr. Bluhm, who has dementia and yells whenever she is around. Mr Bluhm’s daughter comes to visit him once a month. Mr. Bluhm’s daughter, Margaret, smells of cigarette smoke, has crooked teeth, and her grooming is limited. Margaret visits for only a short time even though she doesn’t have a job.

The caregiver wants the attending physician to better control the patient’s behaviors. She also secretly tries to maneuver the patient assignments so she doesn’t have to work with Mr. Bluhm as much as possible.

1. The most important problem for Mrs. Albritton to address is:

  1. Daughter smokes.
  2. She can’t believe how unkempt Margaret is and suspects her of taking her father’s money.
  3. She knows that Mr. Bluhm was a violent drunk before.
  4. She is avoiding her patient.

2. The best thing is to address at this point in treatment is the:

  1. behavior of the daughter
  2. behavior of the patient
  3. behavior of the caregiver
  4. behavior of the physician

3. This behavior is an example of:

  1. prejudice
  2. stereotype
  3. discrimination
  4. bias

Since Mr. Bluhm was in-house, Mrs. Albritton has worked at Grace Landing for five years now.

She just returned from a CME on the aging mentally ill population and is pleased to reflect that her work has been less stressful since the days of Mr. Bluhm.

4. This is because:

  1. The patient population has improved
  2. She has been in contact with this patient population for five years
  3. She has been getting cognitive behavioral therapy on how to interact with this patient population group
  4. She has received three salary raises since she began

5. This is an example of healing in:

  1. prejudice
  2. bias
  3. discrimination
  4. stereotyping

Complete Bibliography

  1. Gras LM, Swart M, Slooff CJ, van Weeghel J, Knegtering H, Castelein S. Differential stigmatizing attitudes of healthcare professionals towards psychiatry and patients with mental health problems: something to worry about? A pilot study. Soc Psychiatry Psychiatr Epidemiol. 2015 Feb;50(2):299-306. doi: 10.1007/s00127-014-0931-z. Epub 2014 Aug 15.
  2. Mittal D, Corrigan P, Sherman MD, Chekuri L, Han X, Reaves C, Mukherjee S, Morris S, Sullivan G. Healthcare providers’ attitudes toward persons with schizophrenia. Psychiatr Rehabil J. 2014 Dec;37(4):297-303. doi: 10.1037/prj0000095. Epub 2014 Oct 13.
  3. Kuo YP, Hung JT, Huang TW, Hsu PC, Su HC, Lin CL. [Developing and testing the validity and reliability of the Chinese version attitudes toward mental illness scale in a sample of senior high school students]. Hu Li Za Zhi. 2014 Dec;61(6):48-56. doi: 10.6224/JN.61.6.48. Chinese.
  4. Stuart H, Chen SP, Christie R, Dobson K, Kirsh B, Knaak S, Koller M, Krupa T, Lauria-Horner B, Luong D, Modgill G, Patten SB, Pietrus M, Szeto A, Whitley R. Opening minds in Canada: targeting change. Can J Psychiatry. 2014 Oct;59(10 Suppl 1):S13-8.
  5. Knaak S, Modgill G, Patten SB. Key ingredients of anti-stigma programs for health care providers: a data synthesis of evaluative studies. Can J Psychiatry. 2014 Oct;59(10 Suppl 1):S19-26.
  6. Ozcan NK, Bilgin H, Badırgalı Boyacıoğlu NE, Kaya F. Student nurses’ attitudes towards professional containment methods used in psychiatric wards and perceptions of aggression. Int J Nurs Pract. 2014 Aug;20(4):346-52. doi: 10.1111/ijn.12157. Epub 2013 Aug 29.
  7. Valdivieso S, Sirhan M, Aguirre C, Ivelic JA, Aillach E, Villarroel L. Attitudes of medical students toward psychiatry in a Chilean medical school. Acad Psychiatry. 2014 Jun;38(3):309-11. doi: 10.1007/s40596-014-0089-8. Epub 2014 Mar 26.
  8. Zhou YZ, Wilde A, Meiser B, Mitchell PB, Barlow-Stewart K, Schofield PR. Attitudes of medical genetics practitioners and psychiatrists toward communicating with patients about genetic risk for psychiatric disorders. Psychiatr Genet. 2014 Jun;24(3):94-101. doi: 10.1097/YPG.0000000000000030.
  9. Griffiths KM, Carron-Arthur B, Parsons A, Reid R. Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry. 2014 Jun;13(2):161-75. doi: 10.1002/wps.20129.
  10. Karavia A, Michopoulos I, Liappas I. Attitudes of mental health private practitioners dealing with patients with schizophrenia: a qualitative study from Greece. In Vivo. 2014 Mar-Apr;28(2):243-7.
  11. Richards M, Hori H, Sartorius N, Kunugi H. Cross-cultural comparisons of attitudes toward schizophrenia amongst the general population and physicians: a series of web-based surveys in Japan and the United States. Psychiatry Res. 2014 Feb 28;215(2):300-7. doi: 10.1016/j.psychres.2013.12.012. Epub 2013 Dec 13.
  12. Hansson L, Markström U. The effectiveness of an anti-stigma intervention in a basic police officer training programme: a controlled study. BMC Psychiatry. 2014 Feb 25;14:55. doi: 10.1186/1471-244X-14-55.
  13. Reynders A, Kerkhof AJ, Molenberghs G, Van Audenhove C. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Soc Psychiatry Psychiatr Epidemiol. 2014 Feb;49(2):231-9. doi: 10.1007/s00127-013-0745-4. Epub 2013 Jul 30.
  14. Lyons Z. Impact of the psychiatry clerkship on medical student attitudes towards psychiatry and to psychiatry as a career. Acad Psychiatry. 2014 Feb;38(1):35-42. doi: 10.1007/s40596-013-0017-3. Epub 2014 Jan 24. Review.
  15. Chang J, Kim B. A survey study of the satisfaction and attitude of the Korean psychiatrists toward antipsychotic polypharmacy. Ann Clin Psychiatry. 2014 Feb;26(1):64-9.
  16. Girma E, Möller-Leimkühler AM, Dehning S, Mueller N, Tesfaye M, Froeschl G. Self-stigma among caregivers of people with mental illness: toward caregivers’ empowerment. J Multidiscip Healthc. 2014 Jan 15;7:37-43. doi: 10.2147/JMDH.S57259.
  17. Balasubramanian N, Sathyanarayana Rao TS, D’Sa JL. Development of the caregivers attitude scale on home care of schizophrenics (CASHS). Indian J Psychiatry. 2014 Jan;56(1):67-71. doi: 10.4103/0019-5545.124716.
  18. Shen Y, Dong H, Fan X, Zhang Z, Li L, Lv H, Xue Z, Guo X. What can the medical education do for eliminating stigma and discrimination associated with mental illness among future doctors? effect of clerkship training on chinese students’ attitudes. Int J Psychiatry Med. 2014;47(3):241-54. doi: 10.2190/PM.47.3.e.
  19. Almeida OP, Hankey GJ, Yeap BB, Golledge J, Norman PE, Flicker L. Mortality among people with severe mental disorders who reach old age: a longitudinal study of a community-representative sample of 37,892 men. PLoS One. 2014 Oct 31;9(10):e111882. doi: 10.1371/journal.pone.0111882.
  20. Waqas A, Zubair M, Ghulam H, Wajih Ullah M, Zubair Tariq M. Public stigma associated with mental illnesses in Pakistani university students: a cross sectional survey. PeerJ. 2014 Dec 16;2:e698. doi: 10.7717/peerj.698.
  21. Hofmann M, Harendza S, Meyer J, Drabik A, Reimer J, Kuhnigk O. Effect of medical education on students’ attitudes toward psychiatry and individuals with mental disorders. Acad Psychiatry. 2013 Nov;37(6):380-4.
  22. Ando S, Yamaguchi S, Aoki Y, Thornicroft G. Review of mental-health-related stigma in Japan. Psychiatry Clin Neurosci. 2013 Nov;67(7):471-82. doi: 10.1111/pcn.12086. Epub 2013 Sep 30. Review.
  23. Papish A, Kassam A, Modgill G, Vaz G, Zanussi L, Patten S. Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial. BMC Med Educ. 2013 Oct 24;13:141. doi: 10.1186/1472-6920-13-141.
  24. Ewalds-Kvist B, Högberg T, Lützén K. Impact of gender and age on attitudes towards mental illness in Sweden. Nord J Psychiatry. 2013 Oct;67(5):360-8. doi: 10.3109/08039488.2012.748827. Epub 2012 Dec 14.
  25. Herisko C, Puskar K, Mitchell AM. Psychiatric nurses’ beliefs, attitudes, and perceived barriers about medical emergency teams. Issues Ment Health Nurs. 2013 Oct;34(10):725-30. doi: 10.3109/01612840.2013.823633.
  26. Nebhinani M, Nebhinani N, Tamphasana L, Gaikwad AD. Nursing students’ attitude towards suicide attempters: A study from rural part of Northern India. J Neurosci Rural Pract. 2013 Oct;4(4):400-7. doi: 10.4103/0976-3147.120240.
  27. Liekens S, Smits T, Laekeman G, Foulon V. A depression training session with consumer educators to reduce stigmatizing views and improve pharmacists’ depression care attitudes and practices. Am J Pharm Educ. 2013 Aug 12;77(6):120. doi: 10.5688/ajpe776120.
  28. Clement S, Lassman F, Barley E, Evans-Lacko S, Williams P, Yamaguchi S, Slade M, Rüsch N, Thornicroft G. Mass media interventions for reducing mental health-related stigma. Cochrane Database Syst Rev. 2013 Jul 23;7:CD009453. doi: 10.1002/14651858.CD009453.pub2. Review.
  29. De Rosa C, Luciano M, Del Vecchio V, Sampogna G, Del Gaudio L, Fizzotti C, Palumbo C, Atti AR, Di Iorio G, Pinna F, Signorelli MS, Gotelli S, La Ferla T, Piselli M, De Fazio P, Bardicchia F, Fantini E, Spattini L, Ginanneschi A, Piras S, Mulè A, Ciafone M, Cava L, Tarsitani L, Botter V, Bertossi F, Macina A, Carrà G, Catapano F, Fiorillo A. [Urban insecurity and fear of crime in people suffering from mental disorders: a study in 24 Mental Health Centers in Italy]. Riv Psichiatr. 2013 Jul-Aug;48(4):321-7. doi: 10.1708/1319.14629. Italian.
  30. Nebhinani N, Mamta, Gaikwad AD, Tamphasana L. Nursing students’ attitude toward suicide prevention. Ind Psychiatry J. 2013 Jul;22(2):114-7. doi: 10.4103/0972-6748.132922.
  31. Martínez-Zambrano F, García-Morales E, García-Franco M, Miguel J, Villellas R, Pascual G, Arenas O, Ochoa S. Intervention for reducing stigma: Assessing the influence of gender and knowledge. World J Psychiatry. 2013 Jun 22;3(2):18-24. doi: 10.5498/wjp.v3.i2.18.
  32. Lyons Z. Attitudes of medical students toward psychiatry and psychiatry as a career: a systematic review. Acad Psychiatry. 2013 May 1;37(3):150-7. doi: 10.1176/appi.ap.11110204.
  33. Aggarwal R, Guanci N, Caracci G, Concepcion E. Medical students and psychiatry: an attitude change? Med Educ Online. 2013 Apr 2;18:1-2. doi: 10.3402/meo.v18i0.20676.
  34. Amini H, Majdzadeh R, Eftekhar-Ardebili H, Shabani A, Davari-Ashtiani R. How Mental Illness is Perceived by Iranian Medical Students: A Preliminary Study. Clin Pract Epidemiol Ment Health. 2013 Apr 19;9:62-8. doi: 10.2174/1745017901309010062. Print 2013.
  35. Wang X, Xiang X, Hao W, Liu T. Attitudes toward psychiatry as a prospective career among medical students in their pre-clinical year in China- a pilot study. PLoS One. 2013 Sep 2;8(9):e73395. doi: 10.1371/journal.pone.0073395.
  36. Inagaki M, Ohtsuki T, Ishikura F, Kodaka M, Watanabe Y, Yamada M. Factors associated with perceived feasibility and willingness of non-psychiatric doctors in Japan to treat depressed patients. Int J Psychiatry Med. 2013;46(2):153-67.
  37. Ebrahimi H, Namdar H, Vahidi M. Mental illness stigma among nurses in psychiatric wards of teaching hospitals in the north-west of Iran. Iran J Nurs Midwifery Res. 2012 Nov;17(7):534-8.
  38. Giannakopoulos G, Assimopoulos H, Petanidou D, Tzavara C, Kolaitis G, Tsiantis J. Effectiveness of a school-based intervention for enhancing adolescents’ positive attitudes towards people with mental illness. Ment Illn. 2012 Sep 6;4(2):e16. doi: 10.4081/mi.2012.e16.
  39. Korszun A, Dinos S, Ahmed K, Bhui K. Medical student attitudes about mental illness: does medical-school education reduce stigma? Acad Psychiatry. 2012 May 1;36(3):197-204. doi: 10.1176/appi.ap.10110159.
  40. Högberg T, Magnusson A, Lützén K, Ewalds-Kvist B. Swedish attitudes towards persons with mental illness. Nord J Psychiatry. 2012 Apr;66(2):86-96. doi: 10.3109/08039488.2011.596947. Epub 2011 Sep 29.
  41. Yadav T, Arya K, Kataria D, Balhara YP. Impact of psychiatric education and training on attitude of medical students towards mentally ill: A comparative analysis. Ind Psychiatry J. 2012 Jan;21(1):22-31. doi: 10.4103/0972-6748.110944.
  42. Kassam A, Glozier N, Leese M, Loughran J, Thornicroft G. A controlled trial of mental illness related stigma training for medical students. BMC Med Educ. 2011 Jul 29;11:51. doi: 10.1186/1472-6920-11-51.
  43. Dipaula BA, Qian J, Mehdizadegan N, Simoni-Wastila L. An elective psychiatric course to reduce pharmacy students’ social distance toward people with severe mental illness. Am J Pharm Educ. 2011 May 10;75(4):72.
  44. Schenner M, Kohlbauer D, Günther V. Communicate instead of stigmatizing – does social contact with a depressed person change attitudes of medical students towards psychiatric disorders? A study of attitudes of medical students to psychiatric patients. Neuropsychiatr. 2011;25(4):199-207.
  45. Chikaodiri AN. Health professionals’ familiarity and attributions to mental illness. Ment Illn. 2010 Jan 22;2(1):e1. doi: 10.4081/mi.2010.e1. eCollection 2010 Jan 25. Review.
  46. Angermeyer MC, Holzinger A, Matschinger H. Emotional reactions to people with mental illness. Epidemiol Psichiatr Soc. 2010 Jan-Mar;19(1):26-32. Review.
  47. Kohlbauer D, Meise U, Schenner M, Sulzenbacher H, Frajo-Apor B, Meller H, Günther V. [Does education focusing on depression change the attitudes towards schizophrenia? A target-group oriented anti-stigma-intervention]. Neuropsychiatr. 2010;24(2):132-40. German.
  48. Lee M, Chodosh J. Dementia and life expectancy: what do we know? J Am Med Dir Assoc. 2009 Sep;10(7):466-71. doi: 10.1016/j.jamda.2009.03.014. Epub 2009 Jun 27. Review.
  49. Sawayama E, Takahashi M, Arai H, Nakajima K, Kano A, Sawayama T, Miyaoka H. Characteristics of elderly people using the psychiatric emergency system. Psychiatry Clin Neurosci. 2009 Aug;63(4):577-9. doi: 10.1111/j.1440-1819.2009.01975.x. Epub 2009 Apr 27.
  50. Mehta N, Kassam A, Leese M, Butler G, Thornicroft G. Public attitudes towards people with mental illness in England and Scotland, 1994-2003. Br J Psychiatry. 2009 Mar;194(3):278-84. doi: 10.1192/bjp.bp.108.052654.
  51. Buhler AV, Karimi RM. Peer-level patient presenters decrease pharmacy students’ social distance from patients with schizophrenia and clinical depression. Am J Pharm Educ. 2008 Oct 15;72(5):106. PubMed PMID: 19214260; PubMed Central PMCID: PMC2630131.
  52. Jorm AF, Griffiths KM. The public’s stigmatizing attitudes towards people with mental disorders: how important are biomedical conceptualizations? Acta Psychiatr Scand. 2008 Oct;118(4):315-21. doi: 10.1111/j.1600-0447.2008.01251.x. Epub 2008 Aug 27.
  53. Högberg T, Magnusson A, Ewertzon M, Lützén K. Attitudes towards mental illness in Sweden: adaptation and development of the Community Attitudes towards Mental Illness questionnaire. Int J Ment Health Nurs. 2008 Oct;17(5):302-10. doi: 10.1111/j.1447-0349.2008.00552.x.
  54. Putman S. Mental illness: diagnostic title or derogatory term? (Attitudes towards mental illness) Developing a learning resource for use within a clinical call centre. A systematic literature review on attitudes towards mental illness. J Psychiatr Ment Health Nurs. 2008 Oct;15(8):684-93. doi: 10.1111/j.1365-2850.2008.01288.x.
  55. Roberts LM, Wiskin C, Roalfe A. Effects of exposure to mental illness in role-play on undergraduate student attitudes. Fam Med. 2008 Jul-Aug;40(7):477-83.
  56. Adewuya AO, Makanjuola RO. Social distance towards people with mental illness in southwestern Nigeria. Aust N Z J Psychiatry. 2008 May;42(5):389-95. doi: 10.1080/00048670801961115.
  57. Fischel T, Manna H, Krivoy A, Lewis M, Weizman A. Does a clerkship in psychiatry contribute to changing medical students’ attitudes towards psychiatry? Acad Psychiatry. 2008 Mar-Apr;32(2):147-50. doi: 10.1176/appi.ap.32.2.147.
  58. Baumann AE. Stigmatization, social distance and exclusion because of mental illness: the individual with mental illness as a ‘stranger’. Int Rev Psychiatry. 2007 Apr;19(2):131-5.
  59. Lauber C, Rössler W. Stigma towards people with mental illness in developing countries in Asia. Int Rev Psychiatry. 2007 Apr;19(2):157-78.
  60. Kuhnigk O, Strebel B, Schilauske J, Jueptner M. Attitudes of medical students towards psychiatry : effects of training, courses in psychiatry, psychiatric experience and gender. Adv Health Sci Educ Theory Pract. 2007 Feb;12(1):87-101. Epub 2006 Nov 17.
  61. Picardi A, Rucci P, de Girolamo G, Santone G, Borsetti G, Morosini P. The quality of life of the mentally ill living in residential facilities: findings from a national survey in Italy. Eur Arch Psychiatry Clin Neurosci. 2006 Sep;256(6):372-81. Epub 2006 Jun 20.
  62. Muga F, Hagali M. What do final year medical students at the University of Papua New Guinea think of psychiatry? P N G Med J. 2006 Sep-Dec;49(3-4):126-36.
  63. Weiss MG, Ramakrishna J, Somma D. Health-related stigma: rethinking concepts and interventions. Psychol Health Med. 2006 Aug;11(3):277-87.
  64. Angermeyer MC, Dietrich S. Public beliefs about and attitudes towards people with mental illness: a review of population studies. Acta Psychiatr Scand. 2006 Mar;113(3):163-79. Review.
  65. Baldwin ML, Marcus SC. Perceived and measured stigma among workers with serious mental illness. Psychiatr Serv. 2006 Mar;57(3):388-92.
  66. Corrigan P, Gelb B. Three programs that use mass approaches to challenge the stigma of mental illness. Psychiatr Serv. 2006 Mar;57(3):393-8. Review.
  67. Reddy JP, Tan SM, Azmi MT, Shaharom MH, Rosdinom R, Maniam T, Ruzanna ZZ, Minas IH. The effect of a clinical posting in psychiatry on the attitudes of medical students towards psychiatry and mental illness in a Malaysian medical school. Ann Acad Med Singapore. 2005 Sep;34(8):505-10.
  68. Corrigan PW, Lurie BD, Goldman HH, Slopen N, Medasani K, Phelan S. How adolescents perceive the stigma of mental illness and alcohol abuse. Psychiatr Serv. 2005 May;56(5):544-50.
  69. Dunion L, Gordon L. Tackling the attitude problem. The achievements to date of Scotland’s ‘see me’ anti-stigma campaign. Ment Health Today. 2005 Mar:22-5.
  70. Angermeyer MC, Matschinger H, Corrigan PW. Familiarity with mental illness and social distance from people with schizophrenia and major depression: testing a model using data from a representative population survey. Schizophr Res. 2004 Aug 1;69(2-3):175-82.
  71. Pinfold V, Huxley P, Thornicroft G, Farmer P, Toulmin H, Graham T. Reducing psychiatric stigma and discrimination–evaluating an educational intervention with the police force in England. Soc Psychiatry Psychiatr Epidemiol. 2003 Jun;38(6):337-44.
  72. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Howes MJ, Normand SL, Manderscheid RW, Walters EE, Zaslavsky AM. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003 Feb;60(2):184-9.
  73. Tharyan P, John T, Tharyan A, Braganza D. Attitudes of ‘tomorrow’s doctors’ towards psychiatry and mental illness. Natl Med J India. 2001 Nov-Dec;14(6):355-9.
  74. Corrigan PW, Green A, Lundin R, Kubiak MA, Penn DL. Familiarity with and social distance from people who have serious mental illness. Psychiatr Serv. 2001 Jul;52(7):953-8.
  75. Baxter H, Singh SP, Standen P, Duggan C. The attitudes of ‘tomorrow’s doctors’ towards mental illness and psychiatry: changes during the final undergraduate year. Med Educ. 2001 Apr;35(4):381-3.
  76. Roth D, Antony MM, Kerr KL, Downie F. Attitudes toward mental illness in medical students: does personal and professional experience with mental illness make a difference? Med Educ. 2000 Mar;34(3):234-6.
  77. Jorm AF, Korten AE, Jacomb PA, Christensen H, Henderson S. Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals. Aust N Z J Psychiatry. 1999 Feb;33(1):77-83.
  78. Singh SP, Baxter H, Standen P, Duggan C. Changing the attitudes of ‘tomorrow’s doctors’ towards mental illness and psychiatry: a comparison of two teaching methods. Med Educ. 1998 Mar;32(2):115-20.
  79. Sohng SS. Supported housing for the mentally ill elderly: implementation and consumer choice. Community Ment Health J. 1996 Apr;32(2):135-48.
  80. Senf JH, Campos-Outcalt D. The effect of a required third-year family medicine clerkship on medical students’ attitudes: value indoctrination and value clarification. Acad Med. 1995 Feb;
  81. Holcomb WR, Morgan P, Adams NA, Ponder H, Farrel M. Development of a structured interview scale for measuring quality of life of the severely mentally ill. J Clin Psychol. 1993 Nov;49(6):830-40.
  82. Araya RI, Jadresic E, Wilkinson G. Medical students’ attitudes to psychiatry in Chile. Med Educ. 1992 Mar;26(2):153-6.
  83. Kelly B, Raphael B, Byrne G. The evaluation of teaching in undergraduate psychiatric education: students’ attitudes to psychiatry and the evaluation of clinical competency. Med Teach. 1991;13(1):77-87. Review.
  84. Crismon ML, Jermain DM, Torian SJ. Attitudes of pharmacy students toward mental illness. Am J Hosp Pharm. 1990 Jun;47(6):1369-73.
  85. Brugha TS, Wing JK, Smith BL. Physical health of the long-term mentally ill in the community. Is there unmet need? Br J Psychiatry. 1989 Dec;155:777-81.
  86. Yager J, Lamotte K, Nielsen A 3rd, Eaton JS Jr. Medical students’ evaluation of psychiatry: a cross-country comparison. Am J Psychiatry. 1982 Aug;139(8):1003-9.
  87. Brockman J, D’Arcy C, Edmonds L. Facts or artifacts? Changing public attitudes toward the mentally ill. Soc Sci Med Med Psychol Med Sociol. 1979 Nov;13A(6):673-82. Review.
  88. Epidemiol Psichiatr Soc. 2001 Jan-Mar;10(1):8-11. Stigma: many mechanisms require multifaceted responses. Link BG1.
  89. Psychiatr Prax. 2005 Jul;32(5):221-32. [The stigma of mental illness: concepts, forms, and consequences]. Rüsch N1, Angermeyer MC, Corrigan PW.

4 thoughts on “Handout – How to Talk to a Psychiatric Patient.

  1. Thank you Sana, for posting this talk. I had wanted to read it and read it again. WOW…makes so much sense to me – as a patient SPMI (depression/anxiety) – I also have stigma towards psychiatric patients and caregivers. Lots of work to do, more to say. You are an awesome, thinker, writer, psych doctor and speaker. I feel fortunate to have found your blog!
    As you say “keep on”

  2. I think some data could have been sited, e.g. 50% of patient report Dr failed to understand me because… or 25% of Drs changed treatment method after realizing they had an initial misperception of the patients…due to…

    The more human vs education I’m guessing may not be a fit for some. Instinct and/or boredom of the provider may be an important influence.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s