Scale development and an educational program to reduce the stigma of schizophrenia among community pharmacists: a randomized controlled trial.

BACKGROUND: Stigma associated with mental disorders is rooted among many pharmacists, and represents a major barrier to patient support in community-based psychiatry. We developed an assessment scale that is specifically designed to assess the level of stigma that pharmacists may have toward schizophrenia, and then examined the effects of reducing stigma with an educational program that focuses on communication with patients diagnosed with schizophrenia (PDS) using the newly developed Stigma Scale towards Schizophrenia for Community Pharmacists (SSCP). METHODS: SSCP was developed by exploratory factor analysis with promax rotation based on responses from 822 randomly selected community pharmacists. Furthermore, a randomized controlled trial was conducted for 115 community pharmacists to clarify the effects of reducing the stigma of schizophrenia using an educational program for them with a focus on communication with PDS. Participants were individually allocated to two groups: educational lecture group (56; only attending a lecture on schizophrenia) or contact-based intervention group (59; communicating with PDS and attending the lecture). The stigma assessment using SSCP was conducted immediately before and after the educational intervention. RESULTS: A total of 4 factors and 27 items were extracted from the exploratory factor analysis to comprise the SSCP. Cronbach's α of SSCP, social distance at professional pharmacy service (factor I), attitudes towards PDS (factor II), self-disclosure (factor III), and social distance in personal (factor IV) were 0.89, 0.88, 0.76, 0.62, and 0.62, respectively. Educational program-related changes of the median (interquartile range) total SSCP score from baseline were - 9.0 (- 16.0 - - 5.0) in the contact-based intervention group and - 3.0 (- 7.0-1.0) in the educational lecture group, reflecting a significant reduction of stigma levels in the contact-based intervention group. On examining the SSCP subscales, scores for factor I and factor II significantly improved. The educational program was more effective for pharmacists aged 20-39 years or with negligible experience of communicating with PDS at work and/or in private life. CONCLUSIONS: SSCP and the educational program for community pharmacists that focuses on communication with PDS were useful for assessing and reducing, respectively, the stigma attached by these pharmacists to schizophrenia. TRIAL REGISTRATION: UMIN Clinical Trials Registry ( UMIN000043189 , registered on January 30, 2021), Retrospectively registered.

An internet-based survey in Japan concerning social distance and stigmatization toward the mentally ill among doctors, nurses, pharmacists, and the general public.

Stigma associated with psychiatric disorders tends to be manifested as negative attitudes or behavior toward the mentally ill. It has negative influences, such as leading to difficulty in establishing trust-based relationships and interfering with medical treatment. In order to reduce such stigma, it is necessary to clarify its extent and characteristics in healthcare professionals. Considering this, an Internet-based questionnaire survey was conducted, involving doctors (n = 186), nurses (n = 161), and pharmacists (n = 192) in comparison with the general public (n = 331), and using the Whatley Social Distance Scale (WSDS) and Index of Attitudes toward the Mentally Ill (IATM) as stigma-related indices. Median total WSDS scores and interquartile range were as follows: doctors: 15.5(12.0-18.0), nurses: 14.0(12.0-16.5), pharmacists: 15.0(13.0-17.0), and the general public: 16.0(13.0-18.0). Similarly, median IATM scores were as follows: doctors: 39.0(36.0-42.0), nurses: 39.0(37.0-43.0), pharmacists: 40.0(36.0-42.0), and the general public: 37.0(33.0-41.0). IATM scores were significantly higher in the professional groups than the general public group. Both healthcare professionals and the general public with prior exposure to mental illness were more favorable attitudes toward the mentally ill. Especially among healthcare professionals, they working in psychiatric departments were more favorable attitudes. These results suggest that the stigma of healthcare professionals toward the mentally ill was shown to have a smaller and relatively favorable attitude than that of the general public. In order to correct the stigma it was suggested that a good contact experience with the patient such as work and training in psychiatry is effective.

A case of hepatocellular carcinoma with bleeding gingival metastasis treated by transcatheter arterial embolization.

The patient was a terminally ill 80-year-old man with multiple lung metastases from hepatocellular carcinoma, that had developed following hepatitis-C virus-associated cirrhosis. He was admitted to our hospital with gingival bleeding, and we diagnosed gingival metastasis from hepatocellular carcinoma, based on histological examination. The bleeding could not be controlled, and the patient became dyspneic. After transcatheter arterial embolization, his bleeding was successfully controlled until his death due to respiratory failure. Transcatheter arterial embolization was a safe and effective treatment in our case.