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According to stress-vulnerability models, social stressors contribute to the onset of schizophrenia. Stigma and discrimination associated with mental illness may be a stressor for young people at risk of psychosis even prior to illness onset, but quantitative longitudinal data on this issue are lacking. We examined the cognitive appraisal of stigma-related stress as predictor of transition to schizophrenia among young people at risk of psychosis. In Zurich, Switzerland, 172 participants between 13 and 35years old and with either high or ultra-high risk of psychosis or risk of bipolar disorder were included. With 71 dropouts, transition was assessed during 12months among 101 participants of whom 13 converted to schizophrenia. At baseline, the cognitive appraisal of stigma as a stressor was measured by self-report, based on the primary appraisal of stigma as harmful and the secondary appraisal of resources to cope with stigma. Positive and negative symptoms were examined using the Positive and Negative Syndrome Scale. Compared with participants who did not convert to schizophrenia, converters had significantly more positive (p

Stigma may undermine the well-being of young people at risk of psychosis. We therefore measured self-labeling, stigma variables and well-being at baseline and again one year later among 77 at-risk participants. An increase in self-labeling during this period predicted heightened stigma stress after one year and a decrease in stigma stress predicted better well-being at follow-up, controlling for symptoms, psychiatric comorbidity and sociodemographic variables. Besides early intervention programmes, strategies are needed to reduce the public stigma associated with at-risk status and to support young people at risk to better cope with self-labeling and stigma stress.

Stigma can be a major stressor for individuals with schizophrenia and other mental illnesses. It is unclear, however, why some stigmatized individuals appraise stigma as more stressful, while others feel they can cope with the potential harm posed by public prejudice. We tested the hypothesis that the level of perceived public stigma and personal factors such as rejection sensitivity, perceived legitimacy of discrimination and ingroup perceptions (group value; group identification; entitativity, or the perception of the ingroup of people with mental illness as a coherent unit) predict the cognitive appraisal of stigma as a stressor. Stigma stress appraisal refers to perceived stigma-related harm exceeding perceived coping resources. Stress appraisal, stress predictors and social cue recognition were assessed in 85 people with schizophrenia, schizoaffective or affective disorders. Stress appraisal did not differ between diagnostic subgroups, but was positively correlated with rejection sensitivity. Higher levels of perceived societal stigma and holding the group of people with mental illness in low regard (low group value) independently predicted high stigma stress appraisal. These predictors remained significant after controlling for social cognitive deficits, depressive symptoms and diagnosis. Our findings support the model that public and personal factors predict stigma stress appraisal among people with mental illness, independent of diagnosis and clinical symptoms. Interventions that aim to reduce the impact of stigma on people with mental illness could focus on variables such as rejection sensitivity, a personal vulnerability factor, low group value and the cognitive appraisal of stigma as a stressor.

Stigma can be a major stressor for people with schizophrenia and other mental illnesses, leading to emotional stress reactions and cognitive coping responses. Stigma is appraised as a stressor if perceived stigma-related harm exceeds an individual’s perceived coping resources. It is unclear, however, how people with mental illness react to stigma stress and how that affects outcomes such as self-esteem, hopelessness and social performance. The cognitive appraisal of stigma stress as well as emotional stress reactions (social anxiety, shame) and cognitive coping responses were assessed by self-report among 85 people with schizophrenia, schizoaffective or affective disorders. In addition to self-directed outcomes (self-esteem, hopelessness), social interaction with majority outgroup members was assessed by a standardized role-play test and a seating distance measure. High stigma stress was associated with increased social anxiety and shame, but not with cognitive coping responses. Social anxiety and shame predicted lower self-esteem and more hopelessness, but not social performance or seating distance. Hopelessness was associated with the coping mechanisms of devaluing work/education and of blaming discrimination for failures. The coping mechanism of ingroup comparisons predicted poorer social performance and increased seating distance. The cognitive appraisal of stigma-related stress, emotional stress reactions and coping responses may add to our understanding of how stigma affects people with mental illness. Trade-offs between different stress reactions can explain why stress reactions predicted largely negative outcomes. Emotional stress reactions and dysfunctional coping could be useful targets for interventions aiming to reduce the negative impact of stigma on people with mental illness.

Objectives: The main purpose of this study is to examine whether the relationship between familiarity with mental illness and stigmatizing attitudes about mental illness, which had been observed in a previous study based on a sample of community college students (Psychiatr. Serv. 52 (2001) 953), can be replicated using data from a representative population survey. Methods: In spring 2001, a representative survey was carried out in Germany (n=5025). A personal, fully structured interview was conducted which began with the presentation of a vignette depicting someone with either schizophrenia or major depression. Respondents were asked to respond to measures assessing familiarity, perception of dangerousness, fear, and social distance. Path analysis with manifest variable structural modeling techniques was applied to test the model used in the previous study. Results: Despite differences in methods, most findings of the previous study were replicated. Respondents who were familiar with mental illness were less likely to believe that people with schizophrenia or major depression are dangerous. Weaker perceptions of dangerousness corresponded closely with less fear of such people, which in turn was associated with less social distance. The effect of familiarity was somewhat pervasive: respondents who reported to be familiar with mental illness expressed a less strong desire for social distance. There is also a relatively strong relationship between perceived dangerousness and social distance. Conclusions: Our findings fully support the notion that approaches to social change which increase the public's familiarity with mental illness will decrease stigma.

This review examines the question—Do atypical antipsychotic medications improve psychosocial outcomes?—by examining studies that compared the effects of atypicals to conventional antipsychotics or to other atypical medications. The authors reviewed randomized clinical trials of atypical antipsychotic medication that included psychosocial variables as outcomes. Findings from 31 published studies on more than 12,000 individuals generally showed that atypical medications led to significant improvements in negative symptoms compared to conventional antipsychotics. Effects on global assessment of psychosocial functioning and on the quality of life were mixed with only about half the studies reporting significant improvements. Olanzapine yielded the best results on psychosocial functioning; remoxipride was found to yield few significant changes on these variables. This review provides evidence that some atypical antipsychotics may have direct effects on some of the psychosocial disabilities that result from serious mental illness.

This study examined the relationship between nonverbal social perception and symptomatology in schizophrenia. Schizophrenic patients (n=28) and normal controls (n=28) were given the profile of nonverbal sensitivity test (PONS). Patients' symptoms were rated with the brief psychiatric rating scale (BPRS). Schizophrenic subjects performed significantly more poorly than normal subjects in their ability to decode nonverbal cues. In addition, normal subjects improved their accuracy significantly more than patients when provided with additional cues per scene to decode. The patients' total PONS score was not significantly correlated with the BPRS summary scores for positive or negative symptoms, but was significantly correlated with the individual positive symptom of conceptual disorganization. Subjects classified as having paranoid schizophrenia (n=11) on the basis of chart diagnoses performed significantly better on the PONS than did undifferentiated schizophrenic subjects (n=13). The discussion reviews how these results contribute to our understanding of social deficits in schizophrenia.

This study investigated the interpersonal factors (i.e., social skills, symptoms, perceived physical attractiveness) which are related to the stigma of schizophrenia. Social skills performance was assessed for 39 individuals with schizophrenia who participated in two role-plays with a confederate. Social skills ratings comprised 'overall social skill', 'meshing', 'clarity', and 'fluency' of speech, 'gaze', 'pleasantness' of conversation, 'involvement' in conversation, 'number of questions asked' during conversation, and 'perceived strangeness'. Symptomatology was assessed with the Brief Psychiatric Rating Scale. Ratings of perceived physical attractiveness were obtained by pausing the videotaped role-plays after the first 2s of the interaction. Ratings of 'social distance', based on an independent sample who observed the role-plays, were used as a proxy measure of stigma. The results showed that social distance was best statistically predicted by perceived strangeness, which in turn, was best statistically predicted by ratings of overall social skill. Negative symptoms appeared to have a more robust association with desired social distance than positive symptoms. Interpersonal factors, such as overall social skill, negative symptoms, and perceived strangeness, may contribute to stigma.

Previous research has suggested that social cue recognition in schizophrenia may be significantly associated with visual vigilance and verbal memory. Therefore, we predicted that subjects who participated in a cognitive rehabilitation program that incorporated vigilance and memory training strategies would show significantly better social cue recognition than subjects participating in vigilance training alone. Forty subjects with a DSM-III-R diagnosis of schizophrenia or schizoaffective disorder were randomly assigned to either a vigilance-alone or a vigilance-plus-memory training condition. Results showed that subjects in the vigilance-plus-memory condition were able to identify social cues in the videotaped training materials significantly better than subjects in the vigilance-alone condition. This difference was evident in an independent measure of social cue recognition and was present at a 48 h follow-up. Implications for future development of cognitive rehabilitation for schizophrenia were discussed.

Previous research has shown that both acutely ill and remitted schizophrenic patients are more sensitive to the concrete, than the abstract, cues of a social situation. The purpose of this study is to determine whether this difference is attributable to a generalized performance deficit by determining whether difference in concrete and abstract cue recognition correlates with verbal intelligence. A second goal of this study is to determine whether differences in the cue perception of schizophrenic and normal control samples is also attributable to differences in verbal intelligence. Samples of inpatients (n = 23) and outpatients (n = 20) with DSM-III-R diagnosis of schizophrenia or schizoaffective disorder completed the Social Cue Recognition Test, the Vocabulary Subtest of the WAIS-R, and the Brief Psychiatric Rating Scale. Standardized residual scores representing differences in sensitivity across abstract and concrete cue recognition were not found to correlate significantly with verbal IQ in either sample. However, overall sensitivity was significantly associated with intelligence in both samples and standardized residual scores were significantly associated with thinking disturbance in the inpatients. Differences in cue perception across schizophrenic and normal control samples remained significant after adjusting cue perception scores by scores on the Vocabulary Subtest. These findings suggest that the differential deficit in cue recognition may not be attributable to generalized performance deficit.

Implicit attitudes are automatically activated evaluative impulses that are difficult to control and potentially outside conscious awareness. The association of implicit attitudes toward psychiatric medication with treatment adherence and insight was investigated in 85 persons with schizophrenia, schizoaffective, or affective disorders using the Brief Implicit Association Test. Explicit attitudes, insight, perceived need for treatment and adherence were measured by self-report. Implicit, but not explicit, positive attitudes predicted increased insight and perceived need for treatment. Explicit, but not implicit, positive attitudes predicted self-reported adherence. Implicit measures can improve our understanding of medication attitudes and evaluation of interventions to increase treatment adherence.

The effects of stereotype suppression on psychiatric stigma were investigated in two studies. In experiment 1, 52 participants were presented with a photograph of someone labeled with schizophrenia and instructed to write a passage describing a day in that person's life. Half of the participants were instructed to avoid using schizophrenia-related stereotypes in their passages (the stereotype suppression condition). Participants were then presented with a photograph of a different individual labeled with schizophrenia and asked to write another passage with stereotype suppression instructions omitted. The results showed that while stereotype suppression occurred for the first passage, the expected rebound effects were not observed in the second passage. Furthermore, the results were unchanged when participants' prior experience with persons with mental illness was considered. In a second study, the effects of stereotype suppression on behavior (i.e. seating distance from a person with schizophrenia) were examined in 58 participants. While the stereotype suppression instructions resulted in less stereotypical passages, replicating the results of study 1, no rebound effects on behavior were observed. A non-significant trend was observed whereby previous contact with persons with mental illness was associated with less social distance from someone with schizophrenia. Implications of the findings for reducing psychiatric stigma are discussed.

Subscales of the Empowerment Scale (Rogers, E. S., Chamberlin, J., Ellison, M. L., Crean, T., 1997. A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatr. Serv. 48, 1042-1047) were examined to see whether they fit a model of consumer empowerment that distinguishes self- and community orientations. In addition, the relationship of these two superordinate factors to several psychosocial factors was examined. Thirty-five participants in a partial hospitalization program were administered the Empowerment Scale and measures of quality of life, social support, self-esteem, psychiatric symptoms, needs and resources, global functioning, and verbal intelligence. Analysis of the subscales of the Empowerment Scale yielded two factors consistent with self- and community orientations to empowerment. Correlational analyses revealed that the two superordinate factors were associated with different sets of psychosocial variables. A self-orientation to empowerment was significantly associated with quality of life, social support, self-esteem, and psychiatric symptoms. Community orientation was correlated with self-esteem, resources, verbal intelligence, and ethnicity. The implications of these findings for a model of consumer empowerment are discussed.

Information processing research has suggested that the schizophrenia patient's performance on cognitive tasks is significantly diminished by the complexity of that task. The effects of cognitive complexity on a social cognitive task — sequencing actions that describe a social situation — were examined in this study. A task comprising short and long temporal sequences was administered to 26 subjects with DSM III-R diagnosis of schizophrenia. Differences in discriminating power across the short and long sequences in this task were diminished using standardization and cross-validation samples of normal control subjects. Results showed that schizophrenia patients earned significantly lower scores on the longer sequences. Additional analyses showed that the differential deficit was significantly associated with negative symptoms of social withdrawal and retardation but not with thinking disturbances associated with positive symptoms. Understanding deficits in processing situational schemata may lead to better models of the cognitive underpinnings of social functioning in schizophrenia.

Several recent studies have examined the manner in which social information is processed in an attempt to better understand the interpersonal functioning deficits of schizophrenia. In this study, the manner in which schizophrenic subjects represent social information, and the relationships between these social representations and measures of information processing, are examined. Specifically, 30 DSM-IIIR patients with schizophrenia and 15 normal controls were assessed on measures of social schema processing, information processing, and symptomatology. Results showed that schizophrenic patients earned significantly lower schema processing scores than the normal comparison group. Schema deficits of the schizophrenic group were significantly associated with recall memory and vigilance. These findings suggest that deficits in the representation of social information provides a unique perspective for understanding the interpersonal dysfunctions of schizophrenia.

Given the ever increasing complexity of rehabilitative models of schizophrenia, research methods testing these models must be rigorous and include a wide range of investigative strategies. This paper reviews four elements of rehabilitation research: definition of independent variables, selection of dependent variables, setting up the research design, and the development of conservative inferences from the data analysis. Methodological decisions must be made carefully prior to implementing a research protocol to assure the most valid conclusions when the study is complete.