Prime and prejudice: Brief stereotypical media representations can increase prejudicial attitudes and behaviour towards people with schizophrenia

Prejudice against people with mental illnesses remains a significant problem in the United Kingdom and in many other countries despite sustained efforts by governments and charities. This is particularly so for people with schizophrenia, who are seen as dangerous and unpredictable. The present study investigated the effect of brief, casual, stereotypical representations on prejudice and behavioural intentions towards people with schizophrenia. Participants viewed Halloween costumes in an online environment under the guise of product research. In the experimental condition, they were exposed to a “Psycho Ward” Halloween outfit identical to one sold online by a leading supermarket chain in the United Kingdom. Participants in the control condition saw a neutral “pumpkin” Halloween costume. Exposure to the Psycho Ward outfit resulted in more negative behavioural intentions towards people with schizophrenia, mediated by increased prejudice. These findings confirm and extend earlier research that implicates adverse media stereotypes in the persistence of prejudice against people with mental illness. More research is warranted on the relative effects of different influences on community attitudes to mental illness.     

A systematic review of the association between attributional bias/interpersonal style,and violence in schizophrenia/psychosis

Despite the widely recognized link between schizophrenia and violence, the illness-specific factors underlying that association remain unclear. A body of work has implicated deficits in social cognition, consistently seen in schizophrenia, that may mediate the risk of violence. Two specific areas of interest are attributional bias and interpersonal style. We conducted a systematic literature search using EMBASE, Scopus, Ovid Medline, PsycINFO and Science Direct databases with search terms relating to attributional bias, interpersonal style and violence/aggression in schizophrenia. Eleven studies were identified, six related specifically to attributional bias and five to interpersonal style. Results suggest an association between hostile and externalizing attribution biases, and violence in schizophrenia. Furthermore, hostile, dominant, and coercive interpersonal styles are also frequently associated with violence in schizophrenia. An interaction between cognitive impairments and underlying personality traits, as well as other co-morbid or illness factors, is proposed to likely underpin associations with violence in schizophrenia. Conclusions are limited by methodological constraints. The field would benefit from consistent definitions of violence, and a more systematic approach to cognitive assessment. Furthermore, studies with more homogeneous samples; and longitudinal designs are warranted in order to gain a better understanding of causation with regard to illness factors specific to schizophrenia.     

Historical origins of schizophrenia: two early madmen and their illness

Schizophrenia is a serious mental illness with a remarkably short recorded history. Unlike depression and mania, which are recognizable in ancient texts, schizophrenia-like disorder appeared rather suddenly in the psychiatric literature of the early nineteenth century. This could mean that the illness is a recent disease that was largely unknown in earlier times. But perhaps schizophrenia existed, embedded and disguised within more general concepts of madness and within the arcane languages and cultures of remote times. Both possibilities present major challenges to historical and psychiatric scholarship. These challenges are explored in this paper by presenting two "new" cases of schizophrenia, one from the eighteenth and one from the fourteenth century. The cases suggest that the illness may have existed as early as the medieval period. However, establishing the population prevalence of schizophrenia in earlier times--and therefore resolving the permanence-recency debate--may not be a feasible enterprise.     

The shame of being undone by illness and the power of support through the body of Christ

This paper examines shame that arises from living with a body that has been undone by cancer or other serious illness. It draws on first-person narratives and social-scientific studies of cancer patients to explore how bodies undone by illness often cease to conform to cultural standards of health as well as gendered expectations of bodies, and how experiences of shame arise from those shifts in how sick bodies appear and perform. Analysis of narratives by and qualitative data about those who are seriously ill also reveals how the undoing of the body by illness often precipitates an undoing of one's sense of self that leads to experiences of shame over an inability to fill roles and expectations in ways that were possible in life before serious illness. The paper then utilizes biblical and theological resources to explore ways religious communities can make space for those living with serious illness to lament what it's like to be undone by illness, to hold them up amid their experiences of vulnerability through public lament and acts of accompaniment, and to affirm their worth in the eyes of God and in the body of Christ.     

Schizophrenia, ketamine and cannabis: evidence of overlapping memory deficits

Drug models of mental illness are considered useful if they provoke its characteristic symptoms. In this respect, ketamine and tetrahydrocannabinol (cannabis) are coming under increasing scrutiny as models for schizophrenia. However, although both undoubtedly produce psychotic symptoms characteristic of the disorder, we argue here that, because schizophrenia is also accompanied by cognitive deficits, a full understanding of the impact of these drugs on cognition will be crucial in taking these models further. Memory deficits are pronounced in schizophrenia and we focus upon patterns of working and episodic memory impairment produced by ketamine and cannabis, identifying overlaps between drug and illness. We suggest that close attention to these deficits can offer insights into core pathophysiology of schizophrenia.     

Schizotypy: An Organizing Framework for Schizophrenia Research

ABSTRACT— Schizophrenia is the most devastating form of psychopathology known to humankind, and it has been slow to yield clues to its origins. Meehl's (1962, 1990) model detailed the nature of the latent liability for schizophrenia known as schizotypy and provided a major organizing function for research on schizophrenia. The schizotypy model integrates genetic and environmental contributions to liability as well as accounting for a range of clinical outcomes, all deriving from a genuine liability for the illness. Schizotypy, as a latent personality organization that harbors the liability for schizophrenia, provides a framework for detecting fundamental features of liability to schizophrenia prior to the onset of clinical illness. The schizotypy model is reviewed, the strategic benefits of it are discussed, and methods for detecting schizotypy are presented. A focus on perceptual aberrations—a schizotypic feature—in individuals unaffected by schizophrenia has yielded valuable clues to preclinical disturbances in neurocognitive processes, risk for schizophrenia among biological relatives, and genomic substrates, all of which are of interest to schizophrenia researchers.     

Perceptual organization in schizophrenia spectrum disorders: empirical research and theoretical implications

The research into perceptual organization in schizophrenia spectrum disorders has found evidence for and against a perceptual organization deficit and has interpreted the data from within several different theoretical frameworks. A synthesis of this evidence, however, reveals that this body of work has produced reliable evidence for deficits in schizophrenia, as well as for the clinical, stimulus, and task parameters associated with normal and abnormal performance. Recent models of cognition have also advanced understanding of the underlying pathophysiological processes of perceptual organization dysfunction in schizophrenia spectrum disorders. These suggest that deficits in perceptual organization may be one manifestation of a wider disturbance in the integration of contextually related information across space and time.     

人体系统的非优性与疾病的时空特征

人体系统并非完美,生命抛物线是由生理年龄、社会年龄、人体熵三大要素在非线性作用下相干的结果,从而呈现一种复杂的网状“大Ｘ构架”。每一个交叉点都具有阶段性态变的意义和对生命质量的表征。疾病是人体系统非优的必然。熵压决定了熵的退行性运动,从而也决定了生命时间的有限性。疾病是熵增过程造成机体不同程度封闭的结果。每次疾病都是对熵的增压,造成机体的物质丢失、时间丢失与跳跃,出现熵运动方面的引力偏折,从而在局     

Preventing clinical deterioration in the course of schizophrenia: the potential for neuroprotection

Schizophrenia, which has both genetic and environmental causes, is associated with persistent symptoms and severe functional disability. The illness lies dormant during the premorbid phase and begins to express itself during adolescence or early adulthood. Clinical progression and deterioration reaches a plateau in which the patient is said to be in the chronic phase of illness and at which point restoration of prior functioning is unlikely. The severe deficits associated with schizophrenia are often the result of progression of illness due to lack of appropriate treatment. However, recent advances in neuropsychiatry have led to very early identification of individuals at risk for psychosis, even during the prodromal stage when psychosis has not yet manifested clinically. While research has demonstrated that the efficacy of antipsychotics is limited when used during the chronic phase of illness, these medications can effectively control symptoms and prevent progression of illness when used during the early stages of illness. The evidence of neural degeneration in the pathophysiology of schizophrenic illness suggests that there may be treatment opportunities through neural protection. Neuroprotection, which refers to treatment that helps maintain central nervous system functionality in response to neurobiologic stress, may be responsible for prevention of disease progression and deterioration. In this monograph, Jeffrey L. Lieberman, MD, introduces the phases of schizophrenic illness in relation to the concepts of progression and deterioration. Next, Dolores Malaspina, MD, reviews the neurodevelopmental and neurodegenerative components of schizophrenia. Finally, L. Fredrik Jarskog, MD, focuses on the neuroprotective aspects of therapeutic interventions in schizophrenia.     

Mentalising, schizotypy, and schizophrenia.

Despite accumulating evidence that patients with schizophrenia perform poorly in mentalising tasks, doubts remain about the primacy of the role played by defective mentalising in schizophrenia. This study investigated the relationship between mentalising ability and self-reported schizotypal traits in non-clinical adults who reported no history of psychiatric illness in order to test two counter-proposals: (1) defective mentalising is a primary cause of psychotic symptoms in schizophrenia; and (2) defective mentalising in schizophrenia is a secondary consequence of the chronic asociality that is typical of general psychiatric illness. Mentalising ability was tested using a false-belief picture sequencing task that has been used elsewhere to demonstrate poor mentalising in patients with schizophrenia. Evidence of selective mentalising deficits in high schizotypal non-clinical subjects discounted the view that defective mentalising is restricted to psychiatric illness and strengthened the case for continuity models of psychosis-proneness. Furthermore, evidence that poor mentalisers in the normal population are more likely to self-report psychotic-like traits, as well as asocial or idiosyncratic behaviours, refuted suggestions that defective mentalising is linked solely to asocial symptomatology and supported the view that defective mentalising may have a fundamental role to play in the explanation of psychotic symptoms. In order to specify what that role might be, alternative theoretical accounts of defective mentalising were tested. Neither executive planning deficits nor failure to inhibit cognitively salient inappropriate information could adequately explain the pattern of selective mentalising deficits found in high schizotypal non-clinical subjects. Our findings suggest that there exists a domain-specific cognitive module that is dedicated to inferring and representing mental states which, when dysfunctional, causes defective mentalising that manifests phenomenologically in psychotic-like traits and impoverished social awareness of variable expression and ranging severity.     

The Impact of Films on Viewer Attitudes towards People with Schizophrenia

The media, including television, newspapers, and popular films have been implicated in the facilitation of mental illness stigmatization by presenting negative and inaccurate depictions of various diagnoses. The current study examined the impact of film on participants’ knowledge, attitudes, and behaviors towards people with schizophrenia. A total of 106 participants completed questionnaires before and after viewing a 45-min film excerpt. Films viewed included a fear-based inaccurate, likeable-inaccurate, and an educational-accurate depiction of schizophrenia. There was also a control group. There were significant increases in stigmatizing attitudes for participants in the fear-based inaccurate group compared to the accurate and control group. Fear-based participants reported increased negative affect and endorsed statements suggesting that people with schizophrenia were unpredictable, dependent, and dangerous. These results provide support for the hypothesis that negative, inaccurate portrayals of severe mental illness enhance stigmatizing attitudes. Accurate film depictions, advocacy for social equality, and the continued education of individuals, clients, families, communities and organizations will help to mitigate the impact of films on mental illness stigmatization.     

Being the Shadow: Witnessing Schizophrenia

This essay discusses Susan Smiley’s documentary film, Out of the Shadow (2004), and Tina Kotulski’s memoir, Saving Millie: A Daughter’s Story of Surviving Her Mother’s Schizophrenia, as filmic and narrative treatments of their mother’s schizophrenia. Mildred Smiley, and her diagnosis of and treatment for schizophrenia, is at the center of both her daughters’ treatments of mental illness, and in these texts, all three become witnesses to the multiple experiences of mental illness and the multiple events of psychiatric power. As I will argue, these two texts are treatments of schizophrenia that both see and don’t see Mildred Smiley’s experience of mental illness. Through these texts, we—viewer and reader—are asked to look again, or to look for the first time, at mental illness, and we are positioned as having the agency to look or look away. As we look and try to make sense of what we see (and don’t see), we too participate in the production of mental illness as a category of analysis.     

Error monitoring dysfunction across the illness course of schizophrenia

Response monitoring abnormalities have been reported in chronic schizophrenia patients, but it is unknown whether they predate the onset of psychosis, are present in early stages of illness, or are late-developing abnormalities associated with illness progression. Response-synchronized event-related potentials (ERP) recorded during a picture-word matching task yielded error-related negativity (ERN), correct-response negativity (CRN), and error positivity (Pe) from 84 schizophrenia patients (SZ), 48 clinical high risk patients (CHR), and their age-matched healthy controls (HC; n = 110 and 88, respectively). A sub-sample of 35 early illness schizophrenia patients (ESZ) was compared to 93 age-matched HC and the CHR patients (after statistically removing the effects of normal aging). Relative to HC, 1) SZ, ESZ, and CHR had smaller ERNs, and 2) SZ and ESZ had larger CRNs and smaller Pes. Within the SZ, longer illness duration was associated with larger CRNs but was unrelated to ERN or Pe. CHR and ESZ did not differ on ERN or CRN, although Pe was smaller in ESZ than CHR. These results indicate that while ERN, CRN, and Pe abnormalities are present early in the illness, only the ERN abnormality is evident prior to psychosis onset, and only the CRN abnormality appears to worsen progressively over the illness course. Brain regions subserving response monitoring may be compromised early in the illness and possibly during its clinical prodrome.     

Influences upon willingness to participate in schizophrenia research: an analysis of narrative data from 63 people with schizophrenia

Schizophrenia affects more than 1% of the world's population, causing great personal suffering and socioeconomic burden. These costs associated with schizophrenia necessitate inquiry into the causes and treatment of the illness but generate ethical challenges related to the specific nature and deficits of the illness itself. In this article, we present a systematic analysis of narrative data from 63 people living with the illness of schizophrenia collected through semistructured interviews about their attitudes, beliefs, and experiences related to psychiatric research. In the comments of these individuals, half of whom had had prior personal experience in research protocols, we identified factors influencing openness toward research involvement as well as deterrents that appear to lessen interest in participation. Clear response pattern differences emerged between those with prior research experience and those without such experience. In the discussion, we explore the key findings and outline the implications for safeguards in mental illness research.     

Mental Illness and the Ministry of the Local Church

Due to the stigma associated with mental illness in America, religious leaders and their congregations might be fearful of caring for and worshipping alongside a person with mental illness. This article recounts some of the challenges encountered by the pastor of a small congregation in attempting to provide care for a church member suffering with schizophrenia. It is proposed here that congregations need to grow in courage as they attempt to serve people who struggle with mental illness, just as people with mental illness exhibit courage in venturing out to participate in church life.     

Clinical Ethics and Intervention in Domestic Violence

Schizophrenia affects more than 1% of the world's population, causing great personal suffering and socioeconomic burden. These costs associated with schizophrenia necessitate inquiry into the causes and treatment of the illness but generate ethical challenges related to the specific nature and deficits of the illness itself. In this article, we present a systematic analysis of narrative data from 63 people living with the illness of schizophrenia collected through semistructured interviews about their attitudes, beliefs, and experiences related to psychiatric research. In the comments of these individuals, half of whom had had prior personal experience in research protocols, we identified factors influencing openness toward research involvement as well as deterrents that appear to lessen interest in participation. Clear response pattern differences emerged between those with prior research experience and those without such experience. In the discussion, we explore these key findings and outline the implications for safeguards in mental illness research.     

Verbal Declarative Memory Dysfunction in Schizophrenia: From Clinical Assessment to Genetics and Brain Mechanisms

The recent literature on the neuropsychology of schizophrenia has emphasized memory deficits as a key area of impairment. Abnormalities in the medial temporal lobe, a brain region crucial for long-term memory formation, have also consistently been reported. We conducted a comprehensive review of verbal declarative memory (VDM) in schizophrenia with the aim of systematically addressing the nature of this impairment. We conclude that verbal declarative memory is significantly impaired in schizophrenia and is largely accounted for by deficits in the encoding stage. Subtle impairments in increased rates of forgetting are present, but are mild compared with those in amnestic disorders. Impairment in other cognitive domains studied thus far (e.g., attention), medication effects, or fluctuations in symptoms do not completely account for the deficit. VDM is among the most impaired neurocognitive domains in schizophrenia (along with attention and executive functions). Milder encoding deficits are present in high-risk subjects and non-psychotic relatives of individuals with schizophrenia suggesting that components of the deficit are associated with a genetic vulnerability to the illness, and are independent of the frank psychotic illness. Furthermore, VDM is observed in individuals experiencing their first-psychotic episode and it remains fairly consistent over time. Preliminary imaging studies and other work suggest abnormalities in prefrontal-hippocampal processing networks. Future work should emphasize delineating specific information processing components contributing to the deficit. This would allow imaging studies to determine which brain regions contribute to specific information processing deficits in schizophrenia.     

Performance of schizophrenia and bipolar patients on verbal and figural working memory tasks

Working memory (WM) was studied in 82 healthy volunteers, 43 schizophrenia patients, and 81 bipolar patients. Schizophrenia patients were impaired on verbal and figural WM tasks that possessed similar test discriminating power. Bipolar patients performed similarly to healthy volunteers. A mathematical model of WM performance revealed a primary role for reduced WM span in accounting for the impaired verbal WM of schizophrenia patients and a primary role for diminished attention in accounting for impaired figural WM. Although WM impairment in schizophrenia is due neither to the general effects of severe mental illness nor to the specific type of material studied, the microarchitecture of abnormal WM in schizophrenia may depend on the stimulus material presented.     

The sociocultural conceptualisations of schizophrenia and patterns of help seeking in south-east Nigeria

Socioculturally influenced interpretations of mental illness play decisive roles on the time and choice of treatment. These often result in significant delays before patients present at the psychiatric services, with consequent worsening of the prognosis. The aim was to assess the association between sociocultural factors, choice of treatment and treatment delay among patients with schizophrenia. A cross-sectional study of 360 patients with schizophrenia, without previous contact with any statutory psychiatric services, was done. Of this, 75.8% of the participants had visited traditional/faith healers as the first treatment option and have attributed schizophrenia to magico-supernatural causation, despite 70.0% of the participants being educated, while 24.2% of them believed in the natural causation of the illness and presented early to psychiatric hospital. There is a need for community-based psychiatric services that would have mental health education as one of their core mandates; and collaborations with traditional and faith-based healers aimed to reduce delay in their facilities.