clinical studies Flashcards
1
Q
aims of rosenhan
A
to see if the sane could be distinguished from the insane using the DSM and if they could, how sanity could be identified
2
Q
procedure of rosenhan
A
-sent 8 pseudopatients to 12 hospitals
- pseudopatients sample was a range of ages and occupations, 5 males and 3 females, rosenhan was one of the pseudo patients, they were all given false identities and occupations but all other information was accurate
- hospitals weren’t made aware of the PP, the hospital sample was among the east and west coast of America, some were old and shabby, some were new and modern, some had good staff to patient ratio, some were research based, one was private the rest was publicly funded, some were underfunded
- the PP called for an appointment and when they arrived they stated that they were hearing voices and although it was unclear to make out what they were saying they could hear ‘hollow’ ‘empty’ ‘thud’.
- as soon as the patients were admitted they stopped showing any symptoms of abnormality and they took part in ward activities, spoke to staff and patients normally and responded to instructions
- the PP kept notes on the ward at first they were done covertly but they realised nobody was taking any notice so they started doing it openly. in 4 hospitals puts asked staff ‘pardon me, could you tell me when I’m likely to be discharged’
3
Q
what were the results of rosenhan
A
- all but one were admitted with schizophrenia the other was diagnosed with manic depression
- average stay was 19 days
- all discharged with schizophrenic in remission
- some real patients were highly suspicious of the pp and even made comments such as ‘you’re not crazy - you’re a journalist or professor’ in reference to the constant note taking
- one pp was pacing up and down because they were bored and a nurse interpreted it as nervous behaviour
- number of times staff cam out the cage: day nurses- 11.5 times, night nurses- 9.4 times, doctors- 6.4 times
4
Q
what happened with the follow up in Rosenhan
A
- at one of the hospitals a follow up was arranged where they said the same mistake wouldn’t be made
- rosenhan informed them that one or more pp would turn up within the next 3 months and they had to make a note of who they were suspicious of
- judgements were obtained on 193 patients
- 41 were thought to be a pp by at least one member of staff, 23 by a psychiatrist, and 19 by a psychiatrist and one other member of staff
- no pseudopatients were actually presented
5
Q
what was the conclusion of rosenhan
A
that staff were unable to distinguish between the sane and the insane and that the ‘stickiness of diagnostic labels’ had important implications for society
6
Q
aims of Carlson et al
A
- to review studies to see if NTs other than dopamine were implicated in causing sz. as part of this, they aimed to see what role glutamate has to play in causing sz
- to show NT functioning between neurons in specific brain areas, focusing on the hypodopamenergia and the hypoglutamatergia
- to use their understanding of psychosis and links to NT functioning to produce new antipsychotic drugs that could be more effective with fewer side effects
7
Q
procedure of Carlson et al
A
- reviewed 32 studies with were published between 1978 and 1999. some were his own studies
- came from a variety of sourced investigating neurochemicals in the brain through brain scans, PET scans and SPECT scans
- some studies used animals some used patients with acute sz, some tested sz in remission and some were tested on post mortem studies
- the review also took into account studies which looked into recreational drugs such as PCP that are known to induce psychotic symptoms
- they also drew on evidence of research into the effectiveness of drugs used to treat sz and the method of action they have on the brain to support the idea that there may be other NTs associated with sz
8
Q
results of Carlson
A
- There is a lot of research around low levels of glutamate in the development of psychotics. glutamate failure in the cerebral cortex may lead to negative symptoms whereas failure in the basal ganglia may lead to positive symptoms
- Evidence from studies into the effectiveness of drugs used to treat sz suggest that clozapine is a very effective treatment for sz.
9
Q
aims of Williams et al
A
- to see if a brief course of internet-delivered CBM-I is effective as a stand alone treatment
- to see if CBM-I works in conjunction with traditional CBT approaches
- to see if CBM-I helped ppts to engage with more challenging aspects of iCBT
10
Q
procedure of Williams
A
- 69 ppts
- randomly assigned to treatment group or the waiting list control group
- control group received the treatment after study
- primary measures- diagnostic interview over the phone, PHQ-9 to measure depression severity, ambiguous scenario test-measure interpretation bias
- secondary measures- state trait anxiety inventory STAI-T, repetitive thinking questionnaires, both groups completed all pre-intervention questionnaires
- course of CBM-I= 7x20min sessions over the course of the week and they were given ambiguous situations that were always resolved positively. sone to train ppts to have an automatic positive bias when interpreting info in day to day life
- completed post CBM-i questionaires
- completed iCBT course which lasted 10 weeks, 6 online sessions as well as regular hwk, and access to additional resources
- completed post-treatment questionaires
- control group did the I-CBT after the study but they completed the questionaires at the same time
11
Q
results of Williams et al
A
- both groups were very similar at the starting points in term of severity
- K10 intervention - baseline: 29.26, post CBM-I: 24.11 and post iCBT: 17.40
