Sample Question (And Answer) on Schizophrenia

Sample question (and answer) on schizophrenia

(a) Outline clinical characteristics of schizophrenia. (5 marks)

Examiner notes The term ‘clinical characteristics’ does not have one specific meaning, so could be a brief outline of the different forms of schizophrenia and their characteristics, although it is most likely to mean the ‘symptoms’ of schizophrenia. As this question is only worth five marks, you would not be expected to cover all the possible symptoms of schizophrenia, so perhaps it is best to illustrate the concept of positive symptoms with a couple of examples and the same with negative symptoms. Remember this is only worth five marks, so probably 150 words would suffice.

5 – 4 marks Outline is accurate and coherent 3 – 2 marks Outline is limited, generally accurate and reasonably coherent 1 mark Outline is weak and muddled or very limited 0 mark No creditworthy material

There are two main types of clinical characteristic in schizophrenia. These are the positive and negative symptoms. Positive clinical characteristics are symptoms like hearing voices or seeing hallucinations. A person who sees things that aren’t there, or hears things that aren’t there is experiencing hallucinations. Another important positive symptom is experiencing delusions, like a delusion of grandeur, e.g. a person imagining that they are famous. Negative symptoms include things like not being able to experience pleasure or responding to questions using a meaningless phrase.

(b) Explain issues associated with the classification and/or diagnosis of schizophrenia. (10 marks)

Examiner notes Questions that use the term ‘explain’ can be hard to decipher as sometimes explain can be AO1 and AO2 and sometimes (as here), it is AO2 only. It is examination board advice to simply ignore the injunction and answer the question, and this is perhaps one of the rare occasions where that advice is helpful. Identifying the issues (remember to cover at least two) would be considered the product of analysis (and therefore AO2), and further elaboration of those issues would push the mark up into the higher mark bands. Reliability and validity are the usual issues although there are others such as labelling and stigmatising, overlap with other disorders and so on. Note that this question is about schizophrenia and should be restricted to this disorder.

AO2/AO3 mark allocation 10-9 marks Effective Explanation demonstrates sound analysis and understanding. The answer is well focused and shows coherent elaboration and/or a clear line of argument. Ideas are well structured and expressed clearly and fluently. Consistently effective use of psychological terminology. Appropriate use of grammar, punctuation and spelling. 8-6 marks Reasonable Explanation demonstrates reasonable analysis and understanding. The answer is generally focused and shows reasonable elaboration and/or a line of argument is evident. Most ideas appropriately structured and expressed clearly. Appropriate use of psychological terminology. Minor errors of grammar, punctuation and spelling only occasionally compromise meaning. 5-3 marks Basic Explanation demonstrates basic, superficial understanding. The answer is sometimes focused and shows some evidence of elaboration. Expression of ideas lacks clarity. Limited use of psychological terminology. Errors of grammar, punctuation and spelling are intrusive. 2-1 marks Rudimentary Explanation is rudimentary demonstrating very limited understanding. The answer is weak, muddled and incomplete. Material is not used effectively and may be mainly irrelevant. Deficiency in expression of ideas results in confusion and ambiguity. The answer lacks structure, often merely a series of unconnected assertions. Errors of grammar, punctuation and spelling are frequent and intrusive. 0 marks No creditworthy material is presented

There are several issues that could affect the diagnosis and classification of schizophrenia. The first of these is reliability. Reliability means that if a classification system is used by different people, then they should produce the same outcome. If they do produce the same outcome (i.e. a diagnosis of schizophrenia), then they have inter-rater reliability. Early versions of the DSM were less reliable than later versions such as DSM-IV, therefore are considered to be of more use to psychiatrists. The second issue is validity, whether classifying someone as schizophrenic means that the symptoms that they experience are the same and that they respond to treatment in the same way. If different patients respond to treatment in the same way (e.g. through drug treatments) then diagnosis has predictive validity. However, evidence suggests this is not the case, as drug treatments are not successful with all patients, and some people never recover from schizophrenia, whereas others recover more or less completely. A third issue is the ethics of diagnosis. Some psychologists believe that by diagnosing someone with schizophrenia they are being stigmatised, which will change their life for the worse because of the way other people will react towards them. However, others disagree, claiming that by diagnosing someone with schizophrenia it makes their condition less frightening for them.

Examiner notes This question indicates the number of marks available for AO1 (4) and for AO2 (6). As is always the case, this should dictate how much you write for each in response. Note also that the therapy must be biological and that you should only write about one. The most likely therapy would be drug therapy and this might be restricted to conventional antipsychotics or may also include a brief outline (most probably their mode of action) of atypical antipsychotics. Evaluation might include a consideration of their effectiveness, ethical issues in the use of drug treatments and so on.

AO1 mark allocation 4 marks Outline is reasonably thorough, accurate and coherent 3-2 marks Outline is limited, generally accurate and reasonably coherent 1 mark Outline is weak and muddled or very limited 0 marks No creditworthy material

AO2/AO3 mark allocation 6 marks Effective Commentary demonstrates sound analysis and understanding. Application of knowledge is effective and shows coherent elaboration. Ideas are well structured and expressed clearly and fluently. Consistently effective use of psychological terminology. Appropriate use of grammar, punctuation and spelling. 5-4 marks Reasonable Commentary demonstrates reasonable analysis and understanding. Application of knowledge is reasonably effective and shows some elaboration. Most ideas appropriately structured and expressed clearly. Appropriate use of psychological terminology. Minor errors of grammar, punctuation and spelling only occasionally compromise meaning. 3-2 marks Basic Commentary demonstrates basic, superficial understanding. Application of knowledge is basic. Expression of ideas lacks clarity. Limited use of psychological terminology. Errors of grammar, punctuation and spelling are intrusive. 1 mark Rudimentary Commentary is rudimentary demonstrating very limited understanding. Application of knowledge is weak, muddled and may be mainly irrelevant. Deficiency in expression of ideas results in confusion and ambiguity. The answer lacks structure, often merely a series of unconnected assertions. Errors of grammar, punctuation and spelling are frequent and intrusive. 0 marks No creditworthy material is presented.

A common biological therapy used in the treatment of schizophrenia is anti-psychotic drugs. These work by blocking the action of dopamine. Schizophrenia is thought to be caused by too much dopamine activity in the brain, which leads to the positive symptoms such as delusions and hallucinations. Anti-psychotic drugs block the receptors that receive dopamine, so that the symptoms are reduced. Drug treatments of schizophrenia are widely used because they are effective in reducing the positive symptoms. However, they are not effective in the treatment of negative symptoms, where psychological treatments are more likely to be used. Drug treatments are also more likely to have side effects. For example, they can become addictive if taken continuously. Drug treatments also tend to have side effects, which are often disturbing enough to stop the patient taking the drug. Drug treatments may not offer a complete cure, and may only have a positive effect on the symptoms of schizophrenia so long as the patient is taking the drugs. As soon as they stop taking the drug, the symptoms (and thus the schizophrenia) reappears. Finally, there are ethical issues in the use of drugs for the treatment of schizophrenia. The use of anti-psychotics has been likened to a chemical straitjacket, and they also take away the personal responsibility of the schizophrenic for their own recovery.