Observations on the behaviour of patients in a state mental hospital and a general hospital psychiatric unit: A comparative study

The study sought to compare the naturally occurring behaviour of psychiatric patients within a traditional mental hospital ward and a general hospital psychiatric unit. Direct behavioural observations were undertaken to determine the pattern of behaviour exhibited by patients, the amount of time spent in interaction, with whom interaction took place and the content of that interaction. Data were reliably collected by trained observers, using a 10 category behaviour scale. Within each setting 10 psychotic patients, matched for age, sex and diagnosis, were the subjects and 30 min of behaviour was recorded for each subject. Observations revealed that patients in the mental hospital exhibited more disturbed behaviour, and spent less time in interaction, than did those in the general hospital unit. However, the amount of time patients spent interacting with staff was comparable in the two settings, despite marked differences in staffing levels. Analysis of the content of interaction that did occur indicated that the manner in which staff responded to patients' behaviour was not consistent with the application of a behavioural engineering approach to the modification of abnormal behaviour. While staff in both settings were indiscriminate in the way in which they responded to appropriate and inappropriate patient behaviour, a rather more punitive style of interaction was observed in the mental hospital environment. It is concluded that, from a behavioural perspective, neither setting achieved an optimum therapeutic environment.     

Moral Theory in the Fiction of Isabelle de Charrière: The Case of Three Women

Not all those who write philosophy are recognized as philosophers. In this paper I argue that Dutch writer Isabelle de Charrière, usually known as a novelist, is actually engaged in doing moral philosophy. In the second half of the eighteenth century, Charrière wrote novels about characters who endorsed moral theories and commitments. Her novels track the dilemmas that these characters face in trying to live according their moral theories and commitments. I consider the case for treating fiction as philosophically valuable, and argue that Charrière's novels fall into the category of philosophically valuable fiction.     

Bullying among mentally‐ill patients detained in a high‐secure hospital: an exploratory study of the perceptions of staff and patients into how bullying is defined

The present study is the first to explore patient‐to‐patient bullying within a secure psychiatric hospital housing mentally‐ill patients. Its main aim was to provide an outline of the perceptions held by both patients and staff with regards to patient‐to‐patient bullying as opposed to providing an objective study of bullying. The total sample comprised 104 participants, 44 patients and 60 staff. These were sampled from wards housing male patients and wards housing female patients. All participants took part in a semi‐structured interview based on that developed by Ireland and Ireland [2003] and Ireland [2005, 2004]. One quarter of participants stated they had seen a patient being bullied in the previous week, with staff perceiving a higher extent of bullying than patients. Differences between wards were minimal. It was predicted that theft‐related bullying would be reported most frequently, that staff would identify a wider range of bullying behaviours than patients and that direct forms of aggression would be identified more readily as bullying than indirect forms. All predictions were supported. Problems in attempting to obtain a definition of bullying were also identified, with participants operating broader definitions than those found in the school‐based literature. For example, bullying was not generally considered a repeated form of aggression, the severity of the aggression or provocative behaviour of the victim were not defining features, and it was felt bullying could be accidental. In summary, the current study highlights how patient‐to‐patient bullying does occur in services housing mentally‐ill patients and that researching the behaviour may require the adoption of broader hospital‐specific definitions of bullying. Aggr. Behav. 32:1–13, 2006. © 2006 Wiley‐Liss, Inc.     

Routine HIV testing of hospital patients and pregnant women: informed consent in the real world

The Centers for Disease Control and Prevention (CDC) has recommended that HIV testing be routinely offered to certain patients in hospitals with a high prevalence of HIV infection and on all pregnant women. The CDC does not, however, offer implementation level guidelines for obtaining informed consent. We provide a moral justification for requiring informed consent for HIV testing and propose guidelines for securing such consent. In particular we argue that genuine informed consent can be secured without elaborate counseling, such as that currently used at Counseling and Testing Sites, provided that sufficient written notice is given to the patients before testing and that they are specifically asked for permission.     

Alexithymia as a potential source of symptom over‐reporting: An exploratory study in forensic patients and non‐forensic participants

The traditional interpretation of symptom over‐reporting is that it indicates malingering. We explored a different perspective, namely that over‐reporting of eccentric symptoms is related to deficits in articulating internal experiences (i.e., alexithymia). Given that alexithymia has been linked to sleep problems and that fatigue may fuel inattentive responding to symptom lists, we administered measures of alexithymia (TAS ‐20) and symptom over‐reporting (SIMS ), but also sleep quality (SLEEP ‐50) to forensic psychiatric outpatients (n = 40) and non‐forensic participants (n = 40). Forensic patients scored significantly higher on all three indices than non‐forensic participants. In the total sample as well as in subsamples, over‐reporting correlated positively and significantly with alexithymia, with r s being in the 0.50–0.65 range. Sleep problems were also related to over‐reporting, but in the full sample and in the forensic subsample, alexithymia predicted variance in over‐reporting over and above sleep problems. Although our study is cross‐sectional in nature, its results indicate that alexithymia as a potential source of over‐reporting merits systematic research.     

Dimensionality of the hospital anxiety and depression scale (HADS) in cardiac patients: comparison of Mokken scale analysis and factor analysis

The hospital anxiety and depression scale (HADS) measures anxiety and depressive symptoms and is widely used in clinical and nonclinical populations. However, there is some debate about the number of dimensions represented by the HADS. In a sample of 534 Dutch cardiac patients, this study examined (a) the dimensionality of the HADS using Mokken scale analysis and factor analysis and (b) the scale properties of the HADS. Mokken scale analysis and factor analysis suggested that three dimensions adequately capture the structure of the HADS. Of the three corresponding scales, two scales of five items each were found to be structurally sound and reliable. These scales covered the two key attributes of anxiety and (anhedonic) depression. The findings suggest that the HADS may be reduced to a 10-item questionnaire comprising two 5-item scales measuring anxiety and depressive symptoms.     

The Association Between the Attitude of Food‐Waste‐Aversion and BMI: An Exploration in India and the United States

This research proposes the existence of a hitherto undocumented attitude related to food wastage: the attitude of food‐waste‐aversion. We develop a 6‐item scale including affective, cognitive, and conative components to measure this attitude and empirically investigate its properties in two countries using novel datasets. We test for food‐waste‐aversion scale's convergent validity by demonstrating that it is correlated in the expected direction with five theoretically related constructs—frugality, social responsibility, spendthriftness, self‐control, and materialism (Studies 1a and 1b)—and with BMI (Studies 2 and 3). We provide more indirect evidence of the scale's convergent validity by documenting that the link between food‐waste‐aversion and BMI is attenuated among those who practice refrigerating leftovers (Study 3). We also document that the food‐waste‐aversion scale is distinct from general waste aversion and external meal‐cessation rules, thus providing evidence of discriminant validity (Studies 1a, 1b, and 1c). Taken together, these results provide construct validity for the novel construct of food‐waste‐aversion. We discuss the theoretical and substantive contributions of our findings.