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 Table of Contents    
ORIGINAL ARTICLE  
Year : 2016  |  Volume : 58  |  Issue : 2  |  Page : 204-207
“Why not psychiatry??” Interns of a medical college in Northern Kerala responds


Department of Psychiatry, Kannur Medical College, Anjarakandy, Kannur, Kerala, India

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Date of Web Publication10-Jun-2016
 

   Abstract 

Purpose: This study is to assess the attitude of the medical interns toward psychiatry, psychiatrists and patients with mental health problems.
Materials and Methods: A personal data sheet and the Balon et al. questionnaire was used to assess the attitude among medical interns (n = 44) of a medical college in Northern Kerala.
Results: There was modestly good attitude toward psychiatry throughout the study. Data were compared between interns who have completed their posting in psychiatry and those who have not. There was no significant difference except for their awareness about consultation liaison services and the authoritative power of psychiatrists in mental health field. The stigma toward psychiatry is on the decline at least among medical professionals, and more interns are interested in taking up psychiatry as a future specialty.
Conclusion: Although the study has evidenced a positive attitude to psychiatry, there is still room to improve. A clearer picture could be attained by conducting similar studies in a bigger sample size. A structured curriculum and compulsory internship during the undergraduate course have greatly contributed toward building a more positive opinion of the subject.

Keywords: Attitude, interns, psychiatry

How to cite this article:
Prasad K N, Sajeev Kumar P B, Narayanankutty O K, Abraham A, Raj Z, Madanagopal V, Balu A. “Why not psychiatry??” Interns of a medical college in Northern Kerala responds. Indian J Psychiatry 2016;58:204-7

How to cite this URL:
Prasad K N, Sajeev Kumar P B, Narayanankutty O K, Abraham A, Raj Z, Madanagopal V, Balu A. “Why not psychiatry??” Interns of a medical college in Northern Kerala responds. Indian J Psychiatry [serial online] 2016 [cited 2020 Feb 26];58:204-7. Available from: http://www.indianjpsychiatry.org/text.asp?2016/58/2/204/183785



   Introduction Top


Mental and behavioral disorders are universal. They are common and affect more than 25% of all people at some time during their lives. The point prevalence of mental illness in the adult population at any given time is about 10%. Similarly, around 20% of all patients seen by primary health care providers have one or more mental health disorders.[1]

People tend to have strong beliefs about the mentally ill, and many of these concepts are based on prevailing local systems of belief.[2] Many people have prejudiced attitudes toward mentally ill individuals. Social stigma and negative attitudes can affect the quality of life for people with mental illness. There may be various reasons for this negative attitude.[3] Lack of accurate information about mental illness, lack of contact with individuals with mental illness, and lack of familiarity might be one of the most important reasons of these.[4] Studies looking into the impact of education or information on people's attitudes toward the mental illness and mentally ill have shown that education may have a positive impact on the prejudice.[5] Such negative attitudes may be detrimental not only to the patient care but also to the society's attitude to psychiatric disorders, more so if they are present in the health professionals.

The knowledge of the attitude and awareness of the interns toward psychiatry, mental health, and psychiatric disorders is of utmost importance as these individuals are going to be involved in the care of these patients either directly or indirectly during the later years of their careers. Psychiatry as a discipline is felt to be given a step-motherly treatment at the undergraduate level which is reflected in the number of lectures in psychiatry and number of hours of psychiatry clinical posting. Until recently, during the internship posting, psychiatry used to be an optional department as compared to compulsory posting in surgery, medicine, gynecology, among other branches.

Several studies indicate a decline in the number of students who choose psychiatry as a specialty. These studies mostly focus on students' attitude toward psychiatry as a career, and some of which also highlight the factors that affect this attitude.[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] Many studies have been shown that the medical students' attitude toward psychiatry at the end of the psychiatry internship is an influential predictor of their decision to choose a career in psychiatry in the future.

Evidence shows that students regard psychiatry as an interesting medical discipline, whereas they believe this career has a low socioeconomic level among other specialties. Besides, students are worried about other family members or friends' judgment about their scores because of this career preference.[7] It is explicable that the curricula, duration, and students' duties during psychiatry clerkship are different among various universities which make it difficult to compare these studies with one another.[10]

This study aims at understanding the attitude of interns toward psychiatry as a prospective career and the degree of attractiveness of psychiatry as a medical specialty, mental health in general and their treatment outcomes in a Medical college in Kannur, Kerala.


   Materials and Methods Top


The study was conducted at a tertiary care teaching medical college in Kannur. It was carried out during August 2014.

The study involved the distribution of study questionnaire to the participants which included the graduates currently undergoing their Compulsory Rotatory Residential Internship. The interns were approached by the authors and were explained the purpose of the study. Those who were willing to participate were given the questionnaire to be filled up.

The authors utilized the Bulbena et al. questionnaire to evaluate the perceptions, attitudes and beliefs of the interns to psychiatry, mental health, and psychiatric disorders.[17] The performa included questions based on overall merits of psychiatry, efficacy of psychiatry, role definition and functioning of psychiatrist, possible abuse and social criticisms of a psychiatrist, career and personal reward and specific medical school factors. It had questions about the interns' psychiatry posting, contact with a psychiatric patient and research opportunities in psychiatry, skill levels of attending psychiatrists, and the status of psychiatrists among other medical professionals and also enquired about the encouragement offered to them during their psychiatry clinical postings to take up psychiatry as a subject of postgraduation. The interns were also asked about their perception of psychiatry as a future career and the personal rewards at stake by taking up the same.

The data were analyzed using the Statistical Package for Social Sciences (version 17 for Windows; SPSS Inc, Chicago, IL) software. The analysis involved descriptive analysis of the data.


   Results Top


In total, 44 interns took part in the questionnaire and responded in the performa given to them. Of these 29 of the participating interns were females. 42 of them had joined their MBBS course in 2008. Of the participating interns, 29 had already completed their posting in psychiatry which consisted of 15 days while the rest were waiting for their turn. All the interns who had completed their posting have had to present a seminar on various topics in the subject. All 29 of them agreed that the posting was a useful experience and 15 of them preferred to have a longer posting in psychiatry.

On the topic of overall merits of psychiatry 43 of the participants agreed that psychiatric research had made good strides in advancing care of major mental disorders, with 19 of them strongly agreeing to the fact [Figure 1]. 40 also said that psychiatry is an expanding frontier of medicine and 38 denied that psychiatry is unscientific and imprecise.
Figure 1: Overall merits in psychiatry

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On the efficacy front 40 agreed that they would recommend a psychiatric consultation if any of their family members were emotionally upset and was not showing signs of improvement. 37 also agreed that psychiatric consultation for medical and surgical patients were helpful [Figure 2].
Figure 2: Efficacy

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Forty-one of the participants were of the opinion that psychiatry was a genuine branch of medicine and 30 of them agreed that psychiatrists were clear logical thinkers. 28 interns thought that psychiatrists have the most authority and influence among mental health professionals. 32 disagreed with the concept that psychiatrists are too frequently apologetic while teaching psychiatry and 41 also disagreed with the notion that psychiatrists are too biologically minded and are not attentive enough to the patient's personal life and psychological problems. 37 interns also disagreed that psychiatry is too analytical, theoretical, and psychodynamic and not attentive enough to the patients physiology [Figure 3].
Figure 3: Role definition and functioning of psychiatrists

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Thirty-three agreed and 11 disagreed that psychiatrists abuse their legal power to hospitalize patients against their will. 32 also agreed that psychiatrists make as much money as most other doctors.

Twenty participants opined that psychiatry has a low prestige among the general public, but 35 was of the opinion that psychiatry has a high status among other medical disciplines. 17 agreed that people who could not obtain postgraduation in other specialties eventually end up in psychiatry and 42 people disagreed to the point that psychiatry is filled with graduates who's skills are of low quality. 25 candidates said that their family would discourage them from taking up psychiatry, and 28 said that their friends discourage them from entering psychiatry. 23 interns were of the opinion that by expressing interest in psychiatry he/she risks being associated with other would be psychiatrists who are often seen by others as odd peculiar or neurotic. 35 candidates said that they do not feel uncomfortable with mentally ill patients.

The results of the specific medical school factors were particularly encouraging with 39 having the opinion that teaching in their medical school is interesting and of good quality. 42 of them said that the attending psychiatrists were good role models in their institute and 39 had the same opinion about the postgraduates. 39 people had the opinion that psychiatrists at their medical school were clear logical thinkers and 33 opined that other doctors and staff at their medical school are respectful of psychiatrists. 33 interns also opined that they were encouraged to take up psychiatry as a specialty [Table 1] and [Figure 4].
Table 1: Comparison of responses of interns who have completed and not completed psychiatry posting during internship

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Figure 4: Specific medical school factors

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   Discussion Top


There are many literature showing the attitude of medical students and interns to psychiatry, but Indian studies are few in number. The significance of this study in India is higher as this country is plagued with various superstitious beliefs and practices regarding mental illnesses. Since interns are the population who step into the mainstream of medical services very soon, their attitude toward psychiatric illnesses is more relevant and of utmost importance.

People who specialize in psychiatry often differ from most other mental health professionals and physicians in that they must be familiar with both the social and biological sciences. The discipline studies the operations of different organs and body systems as classified by the patient's subjective experiences and the objective physiology of the patient. Although the medical specialty of psychiatry utilizes research in the field of neuroscience, psychology, medicine, biology, biochemistry, and pharmacology it has generally been considered a middle ground between neurology and psychology. Psychiatry has come a long way from asylum model of treatment to a general hospital setting equaling other medical specialties with a definite biological basis. The classificatory system in psychiatry had to play an important role in this evolution. Psychiatry is getting more diverse with more than 300 diseases classified under this specialty. Likewise, the stigma has also come down a lot among the general population as well as the medical professionals. This is evidenced by the high number of referrals from other specialties. Our study is very well reinforcing these thoughts.

In this study the interns are evaluated on their attitudes towards psychiatry based on the overall merits of psychiatry, the efficacy of the subject, role definition and functioning of the psychiatrist, possible abuse and social criticisms, career and personal rewards and specific medical school factors. Extensive training and teaching program during the undergraduate course and the recent implementation of compulsory internship in psychiatry for 15 days have helped them to form an opinion about this field. It is interesting that 15 of the interns actually preferred a longer psychiatry posting during their internship. Almost everyone agreed to the fact that psychiatry is an expanding frontier in medicine and is scientific and precise. 40 of the 44 participating interns in our study said that they would recommend a psychiatric consultation if any of their family members needed it, which goes a long way in showing that the stigma that was previously associated with mental illnesses, even among the medical fraternity is fading. The reduction in this stigma probably would have played a role in the growth of Consultation Liaison Psychiatry. The majority of the interns understand the need for prompt referral of medical and surgical patients for a psychiatric consult.


   Conclusion Top


The attitude of medical students towards psychiatry has been repeatedly studied.[18] All studies showed the prevalence of various misconceptions and a lack of motivation among students to take up psychiatry as specialty.[19] Current study points out that a good curriculum during undergraduate days and a structured internship in Psychiatry helps in changing attitude toward psychiatry. The fact that misconceptions, although substantially lower, prevails need to be addressed. Few Interns did suggest that a longer posting in psychiatry would help. Furthermore, psychiatry is an evolving branch of medicine that requires more researchers and practitioners for the steady growth and advancements. The need for a comprehensive training in psychiatry in medical school is the need of the hour. Furthermore, regular feedback from students to enhance the training methods and encouraging students with an interest in psychiatry to take up the specialty is important. A more extensive study involving interns and students of multiple institutions may be needed for getting a nationwide picture.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
World Health Organization. The World Health Report 2001. Mental Health: New Understanding. Geneva: WHO; 2001.  Back to cited text no. 1
    
2.
Asuni T, Schoenberg F, Swift C, editors. Mental Health and Disease in Africa. 2nd ed. Ibadan: Spectrum Books Ltd.; 1994. p. 42-53.  Back to cited text no. 2
    
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Wolff G, Pathare S, Craig T, Leff J. Community attitudes to mental illness. Br J Psychiatry 1996;168:183-90.  Back to cited text no. 3
    
4.
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;52:953-8.  Back to cited text no. 4
    
5.
Corrigan PW, River LP, Lundin RK, Penn DL, Uphoff-Wasowski K, Campion J, et al. Three strategies for changing attributions about severe mental illness. Schizophr Bull 2001;27:187-95.  Back to cited text no. 5
    
6.
Balon R, Franchini GR, Freeman PS, Hassenfeld IN, Keshavan MS, Yoder E. Medical students' attitudes and views of psychiatry: 15 years later. Acad Psychiatry 1999;23:30-6.  Back to cited text no. 6
    
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Nielsen AC 3rd, Eaton JS Jr. Medical students' attitudes about psychiatry. Implications for psychiatric recruitment. Arch Gen Psychiatry 1981;38:1144-54.  Back to cited text no. 7
    
8.
Yager J, Lamotte K, Nielsen A 3rd, Eaton JS Jr. Medical students' evaluation of psychiatry: A cross-country comparison. Am J Psychiatry 1982;139:1003-9.  Back to cited text no. 8
    
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Calvert SH, Sharpe M, Power M, Lawrie SM. Does undergraduate education have an effect on Edinburgh medical students' attitudes to psychiatry and psychiatric patients? J Nerv Ment Dis 1999;187:757-61.  Back to cited text no. 9
    
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11.
Malhi GS, Parker GB, Parker K, Carr VJ, Kirkby KC, Yellowlees P, et al. Attitudes toward psychiatry among students entering medical school. Acta Psychiatr Scand 2003;107:424-9.  Back to cited text no. 11
    
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Samuel-Lajeunesse B, Ichou P. French medical students' opinion of psychiatry. Am J Psychiatry 1985;142:1462-6.  Back to cited text no. 12
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Koh KB. Medical students' attitudes toward psychiatry in a Korean medical college. Yonsei Med J 1990;31:60-4.  Back to cited text no. 14
    
15.
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17.
Bulbena A, Pailhez G, Coll J, Balon R. Changes in the attitudes towards psychiatry among Spanish medical students during training in psychiatry. Eur J Psychiatry 2005;19:79-87.  Back to cited text no. 17
    
18.
Araya RI, Jadresic E, Wilkinson G. Medical students' attitudes to psychiatry in Chile. Med Educ 1992;26:153-6.  Back to cited text no. 18
    
19.
Burra P, Kalin R, Leichner P, Waldron JJ, Handforth JR, Jarrett FJ, et al. The ATP 30-a scale for measuring medical students' attitudes to psychiatry. Med Educ 1982;16:31-8.  Back to cited text no. 19
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Correspondence Address:
Dr. K Niranjan Prasad
Department of Psychiatry, Kannur Medical College, Anjarakandy, Kannur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.183785

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