Studies

Question 1

Describe the procedure used by Rosenhan (1973). (4)

Answer 1

Rosenhan used a total of three women and five men, who were all sane were selected via volunteer sample , for the eight confederates that assumed the role of pseudo-patients which included Rosenhan himself

Each pseudo-patients telephoned a hospital for an appointment, and when at the admissions office they gave one symptom of hearing an unfamiliar same sex voice saying ‘empty’, ‘hollow’, and ‘thud’

When admitted to the psychiatric ward the pseudo patients stopped simulating any symptoms of abnormality and behaved and spoke ordinarily

Pseudo-patients made observations while on the ward about their experiences in the mental health institutions and how the staff treated patients

Question 2

Suggest improvements that could be made to the research by Rosenhan (1973)

Answer 2

To improve the ethics of the study Rosenhan could have gained consent from the management within the hospitals

Rosenhan could have used hospitals in different countries to increase the generalizability of the results

Observations could have been made of pseudo patient experiences rather than just self reported diaries to triangulate the data

Question 3

Strength in generalisability of Rosenhan’s study

Answer 3

Eight pseudo-patients were called a ‘varied’ group which adds to the possible generalisability of the findings because the sample included people from different backgrounds and ages (including one psych graduate in his 20s)

Question 4

Weakness in generalisability of Rosenhan’s study

Answer 4

Researcher himself was part of the sample and knowing the full aims of the study may have acted differently from the other participants, this questions the generalisability as some of the data collected may have shown researcher bias

Question 5

Analyse whether the study by Rosenhan (1973) can be considered valid (6)

Answer 5

Rosenhan (1973) conducted his study using 12 real mental health hospitals in several states of the USA, including state and private care facilities so there is high ecological validity as the hospitals were real life settings and represented how psychiatric care took place for real patients.

However, the volunteer confederates were eight sane people who were given a set of fixed, clear and specific symptoms to describe to the psychiatrists which may not be a valid test of the diagnosis of those who are insane who may present in distress with confusion and unclear descriptions of their symptoms.

The pseudo-patients took detailed notes of what actually happened while they were on the hospital wards which gives validity to the data gathered, giving rich detail about the treatment of inpatients as they documented their experiences of how they were treated and how they felt.

Question 6

Evaluate the classic study by Rosenhan (1973) (16)

Answer 6

A volunteer sample of eight sane people were used as confederate observers and contained a total of three women and five men.There is a lack of generalisability to the experiences of the wider population of patients in psychiatric institutions because the confederates did not represent those with mental health conditions

The pseudo-patients included a psychology graduate student, three psychologists, a paediatrician, a psychiatrist, a painter, and a ‘housewife’.There could have been specific/bias reasons for the psychologists volunteering to take part which decreases the objectivity of their data about institutions and patient experiences.

The study was conducted in 12 hospitals in several states of the USA, including state and private care facilities.The study is generalisable to other psychiatric hospitals of the era as it suitably represents a variety of psychiatric care in the USA at that timeThere is high ecological validity as the hospitals were real life settings and represented how psychiatric care took place for real patients.

The hospitals and staff who did not know that pseudo-patients were in the hospital, except for when Rosenhan was a pseudo-patient. There was a lack of informed consent from hospital staff as they did not know they were participating in a study and being observed. Hospitals/staff were deceived by pseudo-patients but this was necessary to prevent demand characteristics so data is reliable and valid.

The pseudo-patients made notes of their observations in written records and diaries that documented their experiences on the psychiatric wards. The pseudo-patient reports could have been affected by their emotions so the data gathered would have been subjective and could be unreliable. Detailed notes by the pseudo-patients gives validity to the data about experiences as they documented how they were treated and how they felt.

Findings could be applied to hospital procedures in 1970’s to improve the treatment of patients in psychiatric institutions, such as maintaining dignity and privacy.
The findings were important in highlighting the role of the context as a factor that should be considered in schizophrenia diagnosis/treatment.

Question 7

what is the aim of Rosenhan (1973) study

Answer 7

• To investigate whether the sane could be distinguished from the insane, and whether degrees of insanity can be distinguished from each other.
• To investigate how patients are treated in psychiatric hospitals.

Question 8

Rosenhan (1973) what type of experiment and design was used?

Answer 8

• field experiment using an independent groups design

Question 9

IV of Rosenhan (1973) study

Answer 9

the schizophrenic symptoms that the pseudo patients presented with

Question 10

DV of Rosenhan (1973) study

Answer 10

admission (or not) and diagnostic label (or not) given to the pseudo patient.

Question 11

Result of Rosenhan (1973) study

Answer 11

• none of the pseudo patients were detected
• nurses stayed in ward offices was about 90% of the time
• remained in hospital for 7 to 52 days.

Question 12

Conclusion of Rosenhan (1973) study

Answer 12

The study revealed that the environment has a major impact on the process of diagnosis, and in the hospital environment staff could not tell the mentally disordered from the mentally healthy.

There was evidence in some hospitals of abusive behaviours towards patients in full view of other patients, but this would stop as soon as another staff member approached. This indicated that staff were credible witnesses but patients were not.

Rosenhan suggests that, in general, doctors are more likely to err on the side of caution and call a healthy person sick rather than a stick person healthy.

Question 13

Study 2 aim of Rosenhan (1973)

Answer 13

To investigate whether the tendency to diagnose the sane as insane could be reversed.

Question 14

Study 2 procedure Rosenhan (1973)

Answer 14

Staff at a teaching hospital (who disbelieved the results of Rosenhan’s study) were
informed that over the next 3 months one or more pseudo patients would make an attempt to gain admission to the hospital.

Each staff member had to rate each patient presenting for diagnosis or who had been admitted on the likelihood that they were the pseudo patient.

Rosenhan did not send any pseudo patients to the hospital.

Question 15

Study 2 results of Rosenhan (1973)

Answer 15

• 193 patients recieved judgements from staff who had detained contact with them
• 23 patients were suspected of being pseudo patients by at least 1 psychiatrist.

Question 16

Study 2 conclusion Rosenhan (1973)

Answer 16

This indicates that the tendency to diagnose insane over sane could be reversed if there is something at stake, in this case the reputation or status of the staff and psychiatrists and their hospital.

Rosenhan noted that there was not any way to actually know if those patients where judgements were made were actually sane or insane.

Question 17

Explain strengths of Suzuki et al’s (2014) study

Answer 17

• Suzuki et al (2014) conducted their research with inpatients during actual, real life hospitalisation due to schizophrenia
• There is a high level of ecological validity as the setting was a real life situation making it valid to Japanese schizophrenic inpatients
• Reliability of the results about nutritional status of schizophrenic inpatients is increased by supporting evidence with consistent findings
• Kitabayashi et al (2006) found similar results with a higher frequency of underweight inpatients with schizophrenia in all age groups than in the normal population

Question 18

Explain weakness of Suzuki et al’s (2014) study

Answer 18

Suzuki et al (2014) did not control for eating behaviours and exercise in their sample of schizophrenic inpatients, both of which can affect the participant’s weight so

there may be extraneous/confounding variables affecting underweight or obesity data that reduces the reliability of the results found about underweight schizophrenic patients

Question 19

Describe how Suzuki et al (2014) sampled participants for their control group in this study

Answer 19

The control group was a volunteer sample who were matched on age and sex to the experimental group

Question 20

Suzuki et al (2014) concluded that the prevalence of underweight inpatients with schizophrenia was higher than in the general population of the country.

Describe how this conclusion can be used to improve the care of inpatients with schizophrenia

Answer 20

Conclusions help institutions understand that they need to monitor more than just the mental health of inpatients as part of their care

Institutions should improve food services/meal times to increase inpatients weight so they as physically healthy as the general population

Question 21

Explain two reasons why the conclusion wasn’t generalisable (suzuki)

Answer 21

Sample of participants all from Japan, study lacks population validity for inpatients with schizophrenia in other countries

The health care systems of other countries may be different as patients with schizophrenia in Japan remain impatiens for a longer period of time than in Europe or North America

Question 22

Describe one control used by Suzuki et al. (2014) when selecting the inpatient sample. (2)

Answer 22

They controlled for recent changes in patient drug therapy and treatments and drugs other than benzodiazepines and mood stabilisers by excluding those patients from the study.

Question 23

Explain two weaknesses of the sample used by Suzuki et al. (2014). (4)

Answer 23

The sample of 333 inpatients with schizophrenia did not include patients from countries other than Japan so was not representative of any cultural differences that may affect the nutritional status of patients with schizophrenia

The nine hospitals may not reflect the treatment of all patients with schizophrenia in Japan therefore the findings of the study have limited generalisability to only hospitals in Niigata Prefecture

Question 24

State two improvements that could be made to the control group used by Suzuki et al. (2014). (2)

Answer 24

Suzuki et al. (2014) could have included schizophrenics who were not inpatients in the control group to compare to inpatients. An equal number of individuals to the sample of 333 could have been used in the control group instead of just 191.

Question 25

Describe the inpatient sample used by Suzuki et al. (2014).

Answer 25

333 inpatients diagnose with schizophrenia using the DSM IV-TR from different psychiatric hospitals in japan

Question 26

Describe how Suzuki et al. (2014) operationalised nutritional status.

Answer 26

Nutritional status was operationalised as total protein, cholesterol, triglyceride and fasting plasma glucose levels

Question 27

Give one conclusion from the study by Suzuki et al. (2014).

Answer 27

Obesity was similar between inpatients with schizophrenia and healthy control griup and the risks related to obesity are alike for inpatients with schizophrenia to the general t the general population

Question 28

Evaluate the contemporary study by Suzuki et al. (2014) (16)

Answer 28

Height and bodyweight were measured to calculate BMI. BMI is an objective measure of nutritional status as it is calculated based on physical evidence so is not influenced by the researcher’s judgement of underweight or obesity. The use of BMI measures gives an accurate and consistent comparison point between schizophrenic inpatients and the general population to measure nutritional status increasing internal validity. Nutritional status was operationalised using measures such as fasting plasma glucose (FPG) levels. Operationalising the measurement of nutritional status by using empirically testable, objective measures gives the study credible scientific status. 333 inpatients diagnosed with schizophrenia using the DSM-IV-TR, all aged between 16 and 80 years old. The large sample of 333 inpatients with a wide age range has good representativeness of inpatients with schizophrenia in Japanese hospitals, increasing generalisability of findings to this target group. The sample was not representative of cultural differences in nutritional status for patients with schizophrenia as it did not include patients beyond Japan. Patients were from nine psychiatric hospitals in Niigata Prefecture, Japan. The nine hospitals may not represent the treatment of all patients in Japan, therefore the findings of the study are limited to the hospitals in Niigata Prefecture and not all areas of Japan. Participants were matched on age and sex with a control group of 191 healthy volunteers. The use of a matched control group gives baseline comparisons stronger credibility as Suzuki et al. (2014) were comparing their group with similar individuals. BMI and nutritional status of patients with schizophrenia and the control group was compared. The results for underweight in schizophrenic patients are consistent with results found by Kitabayashi et al. (2006) who also found higher rates of underweight in schizophrenic patients, giving the study higher reliability. Any physical illness or changes in drug therapy were controlled for and these patients were removed from the study. Controlling for variables such as drug treatment changes increases the internal validity as Suzuki et al. (2014) can be sure they are testing the link between schizophrenia and nutrition and not side effects of new drugs. The study has practical value for treatments and support for schizophrenic patients in Japan to improve their nutritional physical health as well as their mental wellbeing during hospital stays.

Question 29

State one aim of the study by Suzuki et al (2014)

Answer 29

To investigate the prevalence of underweight and obesity in Japanese inpatients with schizophrenia.

Question 30

Results of Suzuki et al study

Question 31

Suzuki et al - Conclusion

Answer 31

The nutritional status of Japanese inpatients with schizophrenia is poorer than that of the general population. There is no significant difference between the inpatients with schizophrenia and the control group for overweight/obesity. Therefore, the health hazards related to overweight/obesity are similar for inpatients with schizophrenia to the general population. Underweight appears to be correlated with risk of death, therefore suggesting that underweight patients with schizophrenia have a higher risk factor. Therefore, the physical health of inpatients with schizophrenia should be taken into account in clinical practice.