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Summary - Unit 5 - Clinical psychology (9PSO-02)
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A full in-depth summary of content notes following full specification for clinical psychology (including all case studies - GRAVE + SCODA)
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Clinical Psychology:1) Rosenhan – Classical Study
2) 4 Ds of Diagnosis
3) Individual Differences: Cross-cultural perceptions of MH Diagnosis
4) Classification System DSM and ICD-11
5) Reliability of the classification systems
6) Vallentines – Clinical interview
7) Validity of classification system
8) Core Practical
9) Schizophrenia: Features + Symptoms
10) Schizophrenia: Biological Explanation: Neurotransmitters
11) Schizophrenia: Biological Treatment: Antipsychotic drugs
12) Schizophrenia: Non-Biological Treatment: CBT
13) Schizophrenia: Contemporary Study: Carlsson
14) Anorexia Nervosa: Classification, features, symptoms
15) Anorexia Nervosa: Non-biological cause: SLT
16) Anorexia Nervosa: Biological Explanations
17) Anorexia Nervosa: Biological Treatment
18) Anorexia Nervosa: Non-Biological Treatment: CBT
19) Anorexia Nervosa: Contemporary Study: Scott Van Zeeland
20) HCPC Guidelines
21) Case Study: Lavarenne (2013)
, Rosenhan - Classical Study
Aim: • To investigate the reliability of mental health diagnosis by seeing whether 8 pseudo-
patients would be detected as really being 'sane'
• To investigate what the experience of "being insane" in a mental institution is like
Experimental • Field study and naturalistic covert (secret) unstructured observation
Design:
Participants: • Were staff and real patients being observed at the hospitals
Observers: 8 pseudo patients (3 women + 5 men)
• 3 x older established psychologists (incl Rosenhan)
• 1 x painter
• 1 x housewife
• 1 x paediatrician
• 1 x psychiatrist
• 1 x 20-year-old psychology graduate
Ethics: • All pseudo-patients were given 'pseudonyms' and allocated 'pretend' occupations and
places of employment not related to mental health occupations
• All other pseudo-patient details (e.g., significant life events, relationships, parents, kids)
were kept the same
Location: • 12 psychiatric hospitals in 5 US East and West coast states
o They varied (old/new, high, low ratio of staff to patient, private/public, well-
resourced and less well-resourced hospitals)
Procedure 1. Admission to the hospital: all pseudo-patients claimed of hearing voices saying 'empty'
for Study 1: 'hollow' 'thud' from an unfamiliar same-sex person
2. Pseudo-patients experience a short-lived nervousness because of a fear of what might
happen to them (many didn’t believe they would be admitted so easily and for some it
was the first time in a psychiatric hospital)
3. Once admitted, pseudo-patients behaved 'normally' as they would in real-life and stopped
stimulating symptoms for 'abnormality'. E.g., pseudo-patients spoke to other patients and
staff ordinarily and engaged in conversation in the corridors.
4. Discharge from the hospital: pseudo-patients were responsible for convincing doctors they
were 'sane' in order to get released
Results from • All pseudo-patients were not detected
Study 1: • 11/12 hospitals admitted patients with the diagnosis of Sz
• 71% staff in the hospital ignored the pseudo patients
• 7 were labelled with a diagnosis of 'Sz in remission'
• 1 was labelled as manic depressive (bipolar)
• Length of hospital admission was 7-52 days with an average of 19 days
, • 2,100 pills administered to pseud-patients of which only 2 were swallowed
• Both pseudo-patients and normal patients were pocketing or depositing their drugs in the
toilet
• During the first 3 hospitalizations: 35 out of the 119 (30%) 'normal patients on a hospital
ward voiced their opinions about the pseudo-patients being 'sane'
o 'You're not crazy, you're a journalist or professor'
Conclusion The sane cannot be distinguished from the insane at psychiatric hospitals
from Study
1: • Depersonalization and powerlessness
o A lack of eye contact and avoidance of patients
o A hierarchal structure so doctors in senior positions have little contact with
patients
o Medication of patients means contact is not always necessary
• Distortion of normal facts
o To fit psychological context
• (e.g., "patient engages in writing behaviour", as a manifestation of a
disturbance related to compulsive behaviour is seen in Sz patients)
o One pseudo-patient had a close and warm relationship with his wife apart from the
occasional angry exchange, friction was minimal, and children had relied on been
spanked,
• However, this has misrepresented as, "his attempted to control
emotionality with his wife and children are punctuated by angry outburst
and in the case of children, spankings"
• Diagnostic labelling
o Once labelled as Sz, pseudo-patients were stuck with the diagnostic label.
o Doctors have a strong bias towards type 1 errors (false positive diagnosis)
G High:
• Both male and female observers from a range of professional backgrounds and ages (e.g., painter,
housewife, 20-year-old graduate student) were pseudo-patients.
o Therefore, observations are representative of the general population not just
medical professionals like psychiatrists and psychologists.
Low:
• More males than females 5:3, therefore the study is predominantly androcentric and may not be
fully representative of female experiences in psychiatric hospitals.
R High:
• Standardized procedure to try and gain admittance to the psychiatric wards e.g., all pseudo-patients
claimed they were hearing voices ‘’hollow’’
• High inter-rater reliability, as several different wards in different hospitals repeatedly gave the same
misdiagnosis, therefore the misdiagnosis is reliable.
, • The high number of incorrectly identified pseudo-patients in the second study by a variety of different
health professionals means that misdiagnosis can be found reliably in a range of different groups.
• Although the study has never been repeated, the reporting of the study is sufficiently detailed that
replicability would be possible, so it would be possible to test to see how reliable the study was.
Low:
• The bad reputation of the original study means it would be very difficult to replicate and test for
reliability as many clinicians are aware of the study and may be suspicious of pseudo-patients.
A High:
• Findings of this study were used for psychiatric hospitals to review their admission procedures, staff
training for patient interaction and a move away from medicalisation as a treatment for mental
illness.
• The study is taught as part of compulsory training for nurses and psychiatrists at university.
• Clinical diagnosis could be improved by reducing the labelling of patients and type I errors (false
positive).
• Contributed to reform of DSM-IV (1994) ’hearing voices’ for Sz patients was changed from 1 month to
1-6 months repeatedly.
V High:
• As pseudo-patients had to gain release by their own actions not by external intervention the
perception of the pseudo-patients as ‘recovered’ is likely to be valid.
• None of the wards in the first study were aware that someone was trying to gain admittance under
false pretences so their diagnosis and treatment can be seen as being valid
• As the pseudo-patients behaved normally as soon as they were admitted, the interpretation of their
behaviour as ‘abnormal’ could only be due to clinical misinterpretation making the study a valid
measure of clinical diagnosis.
• The pseudo-patients used their own backstories (e.g., relationships, partners, kids) so
their representation would have had high ecological validity.
• The field study was a naturalistic covert (secret) observation, therefore increasing ecological validity
as a range of real psychiatric hospitals were used.
Low:
• Subsequent versions of DSM have improved the standard and accuracy of clinical diagnosis, therefore
results of this study may not be a valid judgement of modern diagnosis.
• Unstructured observations provide rich qualitative data increasing internal validity; however,
interpretations are subjective based on the observers’ viewpoint which could be deemed as an invalid
as some observers were trained psychologists and doctors.
E High:
• The pseudo-patients gave informed consent to partake and be admitted to the psychiatric hospitals,
their confidentiality was maintained by the use of ‘pseudonyms and fake occupations/ employment.
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