BackgroundAn important issue concerning the worldwide fight against stigma is the evaluation of psychiatrists’ beliefs and attitudes toward schizophrenia and mental illness in general. However, there is as yet no consensus on this matter in the literature, and results vary according to the stigma dimension assessed and to the cultural background of the sample. The aim of this investigation was to search for profiles of stigmatizing beliefs related to schizophrenia in a national sample of psychiatrists in Brazil.MethodsA sample of 1414 psychiatrists were recruited from among those attending the 2009 Brazilian Congress of Psychiatry. A questionnaire was applied in face-to-face interviews. The questionnaire addressed four stigma dimensions, all in reference to individuals with schizophrenia: stereotypes, restrictions, perceived prejudice and social distance. Stigma item scores were included in latent profile analyses; the resulting profiles were entered into multinomial logistic regression models with sociodemographics, in order to identify significant correlates.ResultsThree profiles were identified. The “no stigma” subjects (n = 337) characterized individuals with schizophrenia in a positive light, disagreed with restrictions, and displayed a low level of social distance. The “unobtrusive stigma” subjects (n = 471) were significantly younger and displayed the lowest level of social distance, although most of them agreed with involuntary admission and demonstrated a high level of perceived prejudice. The “great stigma” subjects (n = 606) negatively stereotyped individuals with schizophrenia, agreed with restrictions and scored the highest on the perceived prejudice and social distance dimensions. In comparison with the first two profiles, this last profile comprised a significantly larger number of individuals who were in frequent contact with a family member suffering from a psychiatric disorder, as well as comprising more individuals who had no such family member.ConclusionsOur study not only provides additional data related to an under-researched area but also reveals that psychiatrists are a heterogeneous group regarding stigma toward schizophrenia. The presence of different stigma profiles should be evaluated in further studies; this could enable anti-stigma initiatives to be specifically designed to effectively target the stigmatizing group.

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Epidemiology and Psychiatric Sciences (2013), 22, 269-274.

Some findings from the international literature were replicated; however, familial contact increased stigma, possibly denoting a locally modulated determinant. Hereby, our study also adds important cross-cultural data by showing that stigma toward schizophrenia is high in a Latin-American setting. We highlight the importance of analyzing the general population as a heterogeneous group, aiming to better elaborate anti-stigma campaigns.

Background: Literature on how the general population stigmatizes individuals with mental disorders has increased considerably over the last decades. But the question remains if psychiatrists also stigmatize their patients. Objective: The present study aimed to assess Brazilian psychiatrists' attitude towards individuals with schizophrenia. Methods: Out of the approximately 6,000 participants of the 2009 National Psychiatry Congress in Brazil, 1,414 psychiatrists agreed to undergo the survey. Face-to-face interviews were conducted using a questionnaire that assessed stigma in three dimensions: stereotypes, social distance and prejudice towards a person with schizophrenia. Their opinion on psychotropic drugs and tolerance of side-effects were also assessed. Socio-demographic and professional data were collected. Results: Brazilian psychiatrists tend to negatively stereotype individuals with schizophrenia. More negative stereotypes correlated with a positive opinion on psychotropic drugs and with a higher tolerance of side-effects. Higher age was correlated with positive stereotyping and with less prejudice.

ResumoContexto: O estigma que pesa sobre as doenças psiquiátricas é o mais forte impedimento para que o paciente busque tratamento, mais até que a di culdade de acesso aos serviços de saúde. A esquizofrenia também é a doença mais usada hoje como metáfora na mídia, aparecendo rotineiramente associada a crimes e violência. Objetivos: Avaliação da presença do estigma estrutural na mídia brasileira por meio do levantamento de notícias em imprensa e internet que utilizam o termo "esquizofrenia" e correlatos ("esquizofrênico/a") sob três aspectos: (a) uso médico e cientí co; (b) atribuição do diagnóstico de esquizofrenia a suspeitos de crimes com pouco ou nenhum rigor médico ou cientí co; (c) uso metafórico. Métodos: O estudo foi realizado em três etapas: levantamento de notícias, classi cação dos itens encontrados e análise do contexto em que foram publicados. O levantamento foi realizado em dois períodos -2008 e 2011 -, sendo o primeiro restrito ao jornal Folha de S. Paulo e o segundo ampliado para os portais dos principais veículos impressos brasileiros. Resultados: Foram encontrados 229 textos, distribuídos da seguinte forma: 89 (39%) registros em ciência e saúde, com tendência à impessoalidade; 62 (27%) registros em crime e violência, em que o "diagnóstico" de esquizofrenia é feito por leigos e "corroborado" por uma arqueologia da vida do suspeito que arrola toda sorte de comportamentos fora de padrão; 78 (34%) de uso metafórico, sempre de caráter depreciativo. Conclusões: A maioria dos textos encontrados (a) não dá voz ao portador de esquizofrenia e a seu sofrimento, (b) banaliza a doença psiquiátrica ao empregá-la fora de contexto para caracterizar decisões políticas e econômicas contraditórias ou de caráter duvidoso e (c) reforça o estigma que pesa sobre o portador de esquizofrenia ao personalizá-lo apenas nos raros casos de violência em que se supõe seu diagnóstico. AbstractBackground: Schizophrenia is the most common illness used today as a metaphor in the media and routinely appears associated with crime and violence with no medical or scienti c rigor, reinforcing the stigma against this disorder. Objectives: Evaluation of the presence of structural stigma in the Brazilian media by means of a survey of printed news and the Internet using the term "schizophrenia" and its correlates under three aspects: (a) medical and scienti c uses, (b) assigning a diagnosis of schizophrenia to crime suspects with little or no medical or scienti c rigor, and (c) the metaphorical use. Methods: e study was conducted in three stages: search for publications, classi cation of items found and analysis of the context in which they were published. e survey was conducted in two periods: 2008 and 2011, the rst being restricted to the newspaper Folha de S. Paulo and the second extended to the homepage of the main Brazilian print media. Results: We found 229 texts, distributed as follows: 89 (39%) records as science and health, with a tendency to impersonality; 62 (27%) records as crime and violence, in which the "diagnosis" of schiz...

O transtorno factício caracteriza-se por produção de sintomas por parte do pacientede forma intencional, com o intuito de assumir o papel de paciente. É uma doença de graves implicações clínicas e que gera elevados gastos para o sistema de saúde público. O caso da paciente DLK, ilustrado nesse relato, exemplifica bem esse transtorno. A paciente iniciou suas queixas clínicas com alucinações visuais e um quadro delirante. Com o tempo surgiram queixas de dores abdominais, retenção urinária, fraqueza muscular e um quadro psicótico de difícil resolução. A paciente passou por diversas internações e especialistas e foi submetida a diversos exames e uma laparoscopia, todos de resultados frustros. Apresentou melhora progressiva e importante dos sintomas após o estabelecimento de um vínculo positivo com a equipe e redução das medicações utilizadas. A detecção precoce dessa doença é fundamental, reduzindo a morbidade do transtorno e a prática de medidas iatrogênicas que esses pacientes demandam.

Presence of major depressive episode and dysthymia influences suicide-related cognitions and behaviors, independently of the presence of alcohol or substance use disorders. However, alcohol use disorders and gender interact with depressive disorders, displaying a differential effect on suicide-related cognitions and behaviors.