5.3 Clinical studies Flashcards
What was the aim for the contemporary study for OCD?
The paediatric OCD treatment study (POTS) team including John March wanted to evaluate 3 treatments for OCD for young people, relative to a placebo group. This includes looking at the effectiveness of SSRIs, CBT alone, CBT combined with SSRIs or a placebo.
What was the procedure for the contemporary study for OCD?
(see docs, in OCD folder)
What were the findings for the contemporary study for OCD?
(see docs, in OCD folder)
What was the conclusion for the contemporary study for OCD?
(see docs, in OCD folder)
Evaluate the contemporary study for OCD.
(see docs, in OCD folder)
What is the contemporary study for OCD? (just name it)
POTS team (2004)
What is your clinical classic study? (just name it)
Rosenhan (1973)
What is the aim for your clinical classic study?
- David Rosenhan, was interested in the validity of diagnoses of mental disorders made using such tools as the DSM.
- He wanted to know if psychiatrists could distinguish the sane from the insane
- He wanted to find evidence to support the idea that mental disorders may not lie with the individual but may lie with the observer or person making the diagnosis
- He wanted to see whether 8 healthy, normal people would be detected as fakes if they were sent to 12 different American psychiatric admissions wards claiming to having heard a voice in their head
- He wanted to obtain information about what life was like within the confines of a psychiatric institution; to explore how patients were treated by staff and each other
What is the procedure for your clinical classic study?
- 8 pseudo-patients were made up from a psychology post-grad, 3 psychologists, a paediatrician, a psychiatrist, a painter, and a housewife. There were 3 women and 5 men. David Rosenhan himself acted as a Pp.
- All Pps used fake names and those involved in psychology/medicine gave fake jobs so as not to arouse suspicion
- 12 different hospitals were located in five different states on both the East and West coasts; some old, some new; some well staffed, some under-staffed; only one private hospital.
- Pseudo-patients phoned the wards to make appointments, arrived at admissions office and complained of hearing same-sex, unfamiliar voices that were unclear but said “empty”, “hollow,” and “thud.”
- No further lies were told; if they were asked questions they answered honestly, including, if asked saying that they were no longer hearing a voice in their head
- Once admitted they behaved normally, following an initial period of a little nervousness, being cooperative, following orders from staff, chatting with other patients and keeping records of their observations, initially in private but later publically since staff didn’t pay much attention to the patient’s activities anyway
FOLLOW UP STUDY
In a follow up study, conducted at the request of hospitals that wanted to show this could not happen in their workplace, Rosenhan agreed with them to send some more pseudo-patients to their wards to see whether they would be identified as healthy imposters; staff had to rate every patient from 1-10, the lower the score the higher their confidence that the patient was a fake.
What are the findings for your clinical classic study?
- All were admitted to the hospitals; 7 diagnosed with schizophrenia and one with bi-polar disorder
- When released they were said to have ‘schizophrenia in remission’, i.e. they are still ‘insane’; once labelled, patients are stuck with that label.
- Length of hospitalization ranged from 7 to 52 days, with an average of 19 days.
- The pseudo patients were not carefully observed by the psychiatrists in order to get further evidence of their condition,
- In 3 cases, 35 of 118 patients on the wards voiced suspicion about the pseudo-patients, i.e. they thought they were sane and that they were perhaps journalists or professors checking up on the hospitals
- In the second study, at least one staff member wrongly reported, with high confidence, that 41/193 patients were fake, 23/193 were reported by at least one psychiatrist and a further 19 were thought to be fakers by at least one psychiatrist and one other staff member.
What is the conclusion for your clinical classic study?
Clinicians tend to be strongly biased towards reporting that healthy people are sick/insane rather than reporting that sick people are healthy, erring on the side of caution and assuming illness rather than assuming health
Rosenhan concludes that we cannot distinguish the sane from the insane in psychiatric hospitals. He felt that the hospital environment creates a set of situational factors which lead to depersonalisation and segregation and this meant that people were seen as insane.
Evaluate your clinical classic study.
(obvs need AO1 first if this was an acc question)
- Well designed study
- Standardised
- Demand characteristics
- Application to DSM
- Subjective (because Rosenhan was one of the pseudo-patients)
(see docs, in Sz folder)
What is your clinical contemporary study for Sz? (just name it)
Carlsson (2000)
What is the background for your clinical contemporary study for Sz?
- Until recently the dopamine hypothesis was only ever supported by “indirect” evidence; now PET imaging has demonstrated that there is abnormal dopaminergic activity in patients with Sz
- Schizophrenia is usually treated by inducing a state of hypodopaminergia, i.e. lowered dopamine levels
- Chlorpromazine blocks D2 receptors
- side effects - unpleasant, e.g. extrapyramidal dysfunction, dysphoria and anhedonia
- esp. in periods in between acute episodes, where people with schizophrenia may revert to more ‘normal’ levels of dopamine;
- arguably typical anti-psychotics (i.e. dopamine antagonists) bring the person down to atypically low levels in between psychotic episodes
- we urgently need to develop drugs that prevent relapse without these side effects
What is the aim for your clinical contemporary study for Sz?
- He hypothesises that excess dopamine may be a by-product of dysfunction of some other neurotransmitter; also an excess in one area may be compensating for a deficiency in some other area
- He says to understand schizophrenia we must examine other neurotransmitters to see whether there are abnormalities in people with schizophrenia, BUT…the trouble is they are not as easy to study in a living brain as dopamine
. - the easiest to study is SEROTONIN; you can study serotonin levels using a radiolabelled precursor (5-hydroxytryptophan) in order to see how quickly serotonin is synthesised; similar research has been done with people with depression and the expected abnormalities revealed.
