‘Symptoms of Psychosis in Mental Health Professional’ by Fleming & Martin

Psychosis is a condition caused by various types of illnesses that interfere with the normal functioning of the brain. It is characterized by the development of beliefs about things that are false (delusions) and hallucinating, which is characterized by experiencing things that others are not experiencing (Beck 2008 p 334). There are many types of psychotic disorders, but the one that is more widespread than all the other disorders is Schizophrenia. It is a psychotic disorder characterized by a lack of ability to distinguish between what is real and what is imagined, and this adversely affects the person’s personality and the way in which one behaves (Hirsch 2003, p 56).

Schizophrenia does not discriminate on grounds of gender or race, but for almost all people it typically starts from between mid-teenage to mid-twenties (Whitfield 2004, p 102). Men tend to develop schizophrenia a bit earlier than women, but symptoms in women start showing a bit late (Comer 2009 p 76). The average age in which Schizophrenia starts or is detected in men at about eighteen years but twenty-five years in women (Martindale 2000, pp 45). Its onset is considerably rare for people under teenage or for those above forty years of age (Amador 2004 p 19-21). The purpose of this paper is to critique the research study which was done in the year 2009 by Fleming & Martin entitled: ‘a preliminary investigation into the experience of symptoms of psychosis in mental health professional: implications for the psychiatric classification model of schizophrenia.’

The above-mentioned study sought to examine the legitimacy of the psychiatric classification of the category of Schizophrenia under psychosis and to probe this classification system by studying the occurrence of symptoms of psychosis in the health workers who perform therapy for patients diagnosed with Schizophrenia. The general hypothesis submitted in the study stated that there is a cline model of experiencing symptoms of psychosis as opposed to the conventional way of classifying the disorder as a single entity condition that is discreet (Fleming & Martin 2009, p 476).

The Fleming and Martin study was conducted in a nonrandom way, using one hundred and twenty-one psychosocial part-time students who were practitioners of mental health after they gave consent to take the tests to completion. Ethical permission was obtained from the committee of ethics of the university in which these part-time students were enrolled. The participants were well counseled on the sensitivity of the information that was to be collected, and they were given an assurance of anonymity and the freedom of withdrawal from participation in the study. The sample size was reasonably good, but the sample distribution was found wanting. The one hundred and twenty-one students who were used in this study were chosen from the same university, hence limiting the analysis of data that was not skewed towards one geographical zone (Fleming & Martin 2009, p 476).

The data that is reported in the study was done by utilizing two scales namely: the Hospital Anxiety and Depression Scale (HADS) developed by Zigmond and Snaith in 1983 and the Psychotic Symptom Rating Scales (PSYRATS). The HADS scale was used to get rid of all conditions for example fatigue and insomnia that would interfere with the results. The scale, which comprised of fourteen items; seven items for depression and seven for anxiety, was administered to each volunteer and subscores for both parameters were separately recorded and calculated (Fleming & Martin 2009, p 476).

The PSYRATS is a 17-item interview structured to quantify subjective aspects of delusions experienced and of hallucinations heard. The first six items which included the frequency, duration and the obsession of the belief were used to assess the experience of delusions, while the other eleven items which included the volume, content, location and ability to control were used for audible hallucinations (Miller 2002, pp 223). Each item had a 0-4 scale of severity that allowed one to make an accurate comparison between the experience and the time it took or happened. The validity of the PSYRATS was stated as good with sensitivity, consistency and reliability to test and retest a particular sample of people who have had psychosis for the first time (Comer 2009, p 98).

This study had three well-stated research questions which were: to determine the comparative presence of these psychosomatic symptoms in practitioners of mental health, to analyze the possibility of the fact that transmission of these symptoms can occur by having therapeutic closeness with the clients and finally to evaluate what may be implied by any observation of symptoms present in this group relative to the schizophrenia biological model that is dominant. The main symptoms of schizophrenia considered in the study were experiencing delusions and audible hallucinations (Panksepp 2004, p 77).

Sixteen percent of the participants were found to be hallucinating with audible voices while 21% were found to have experiences of delusion. Though the Pearson’s correlation coefficient showed that there was a close correlation between the results given by the HADS for anxiety and those given by the PSYRATS for experiences of delusion, these results had a very wide difference with previous studies conducted in 2002 by Verdoux and van Os which showed a prevalence range of 2-15% (Castle 2004, pp 75). This wide difference could be accounted for because of the poor nonrandom sampling that was done. Participants chosen from different locations, backgrounds and beliefs would have given more substantial findings.

Different methods of quantification would have been used so as to have a basis for comparative study. If finding participants from different locations and backgrounds was challenging to those undertaking the study, they would have considered an option like finding more participants from the same university and then dividing them into three equal groups or so. They would then do totally different tests on the three groups, after which they would have results to do a comparison with. This would have ruled out most of the possibility of errors owing to the sampling method or bias.

Obtaining a sample of more than one hundred and twenty people proved to be challenging, another possible way would be to subdivide the sample as above and to perform different tests on the three subgroups. These subgroups, without allowing any contact between the subgroups, would then undergo the second test. The aim would be to ensure that each of the three subgroups undergoes the three different tests separately. The findings would then be compared to each other and errors would be minimized thus.

Whilst this study by Fleming and Martin has its numerous strengths, the methods of sampling and data collection need to be revised. There is a need to change the sampling method from nonrandom to random and to multiply the sample size so as to minimize errors. There is a need to address and ensure minimal potential limiting factors to more internal and experimental validity. It would also give more meaningfulness to this study if data that concerns the validity of bodies like the World Health Organization, the American Association of Psychology and other trusted organizations was given.


Amador, X. F., & David, A.S. (2004). Insight and psychosis: awareness of illness in schizophrenia and related disorders. London: Oxford University Press.

Beck, A.T., Rector, N.A., Neal, N., & Grant, P. (2008). Schizophrenia: Cognitive Theory, Research, and Therapy. New York: Guilford Press.

Castle, D.J., & Murray, R. (2004). Marijuana and madness: psychiatry and neurobiology. Cambridge: Cambridge University Press.

Comer, R.J. (2009). Abnormal Psychology. New York: Worth Publishers.

Fleming, M. P., & Martin, R. C (2009). A preliminary investigation into the experience of symptoms of psychosis in mental health professionals; implications for the psychiatric classification model of schizophrenia. Journal of psychiatric and mental health nursing, 126 743-480

Hirsch, R.S., & Weinberger, D.R. (2003). Schizophrenia. Massachusetts: Blackwell Publishing Co.

Martindale, B. (2000). Psychosis: Psychological approaches and their effectiveness: putting psychotherapies at the center of treatment. London: RCPsych Publications.

Miller, R., & Mason, S. E. (2002). Diagnosis: Schizophrenia: a comprehensive resource for patients, families, and helping professionals. New York: Columbia University Press.

Panksepp, J. (2004). Textbook of biological psychiatry. New York: Wiley Publishers.

Whitfield, C.L. (2004). The truth about mental illness: choices for healing. New York: HCL Publishers.

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