Psychology and abnormality

Mark scheme

Marking points from the official mark scheme (May/June 2018). The mark or mark type is shown in brackets.

1. Treatment and management of schizophrenia and delusional disorder, including the following: 1. biochemical (antipsychotics and atypical antipsychotics) 2. electro-convulsive therapy 3. token economy (Paul and Lentz, 1977) 4. cognitive-behavioural therapy (Sensky, 2000)
2. Biochemical (antipsychotics and atypical antipsychotics): Chloropromazine and other antipsychotics block dopamine and serotonin receptors in the brain. Reduces agitation and hostility in the patient. After 2+ weeks reduces positive symptoms.
3. Electro-convulsive therapy: A general anaesthesia and a drug that relaxes muscles is given. Electrodes are places on the scalp and a finely controlled electric current through those electrodes for a very short time. This will cause a brief seizure in the brain. Can be done unilaterally or bilaterally.
4. Token economy (Paul and Lentz, 1977): Aim was to investigate the effectiveness of operant conditioning by reinforcing appropriate behaviour with schizophrenic patient. Set up token economy system in hospital ward. Patients given tokens as reward when behaved appropriately. Could be exchanged for luxury items. Results - Positive and negative symptoms were significantly reduced. 11% of patients need drug treatment, compared to 100% of the control group. Conclusion – operant conditioning is an effective means of treating people with chronic schizophrenia.
5. Cognitive-behavioural therapy (Sensky, 2000): To compare cognitive behavioural therapy (CBT) with non-specific befriending interventions for patients with schizophrenia. A randomized controlled design. Patients were allocated to one of two groups: a cognitive behavioural therapy group and a non-specific befriending control group. 90 patients. 57 from clinics in Newcastle, Cleveland and Durham and 33 from London. They had diagnoses of schizophrenia that had not responded to medication. Aged 16–60 years. Patients were allocated to one of two groups. Both interventions were delivered by two experienced nurses who received regular supervision. Patients were assessed by blind raters at baseline, after treatment (lasting up to 9 months) and at a 9-month follow-up evaluation. They were assessed on measures including the Comprehensive Psychiatric Rating Scale, the Scale for Assessment of Negative Symptoms, plus a depression rating scale. Patients continued to receive routine care throughout the study. The patients received a mean of 19 individual treatment sessions over 9 months. Both interventions resulted in significant reductions in positive and negative symptoms and depression. After treatment there was no significant difference between the two groups. At the nine-month follow-up evaluation, patients who had received cognitive therapy showed greater improvements on all measures. They had improved, while the befriending group had lost some of the benefits.
6. Mark according to the levels of response descriptors in Table A.
7. Other appropriate responses should also be credited.
8. A range of issues could be used for evaluation here. These include:
9. Named issue - determinism. All of the treatments are deterministic to one extent. The biochemical and ECT treatments are very deterministic as the improvement in symptoms will happen without the patient making any effort to reduce their symptoms (other than taking the medication). Token economies and cognitive behaviour therapy are less deterministic as these therapies require the patient to engage with their treatment and exert their free will. For example, the patient could choose to adopt new thought patterns about their positive symptoms with the support of their cognitive therapist.
10. nature versus nurture debate with reference to the various treatments of schizophrenia and delusional disorders. If the treatment works and it is due to altering the person's biochemistry it is likely to support the idea that the schizophrenia was caused by nature.
11. comparisons of different treatments in terms of appropriate and effectiveness or any other relevant evaluation issue used as a comparison.
12. usefulness (effectiveness) of different treatments. All of the treatments have been shown by research to be effective but none at 100% or even close to this level.
13. reductionist nature of the treatments. The biochemical and ECT treatments are more reductionist as they are putting the explanation for the improvement in treatment just down to the chemical change in the body. Token economies are slightly more complex and the CBT treatment is quite complex explanation of the reason for improvement in symptoms.
14. appropriateness of treatments (e.g. if there are side effects such as with the biochemical or if there are too time consuming or costly for some patients)
15. cost of treatments – biochemical will be cheaper than the other treatments.
16. ethics of treatments - with SZ some treatments can be forced on a patient such as biochemical and ECT if they are committed to a hospital. You cannot force anyone to participate in cognitive and behavioural treatments so they could be considered more ethical.
17. Mark according to the levels of response descriptors in Table B.
18. Other appropriate responses should also be credited.