Three comments about electro-convulsive therapy (ECT): 'It was the best thing that my wife could have had at that time; a good decision by the doctors after drugs had failed.' 'It was a positive experience; worked well for my schizophrenia.' 'I was able to go home after five months of inpatient stay as a result of ECT, after years of unsuccessful psychological treatment.'

Mark scheme

Marking points from the official mark scheme (May/June 2021). The mark or mark type is shown in brackets.

1. [1] Muscle relaxant given
2. [1] Electricity applied bilaterally or unilaterally
3. [1] Patient convulses/has seizures (twitches because of muscle relaxant)
4. [1] Patient is unconscious, then wakes and recovers.
5. [1] Applied once or twice a week for several weeks.
6. [1] Biochemical: the giving of drugs/prescribed medication.
7. [1] antipsychotics/neuroleptics e.g. chlorpromazine
8. [1] atypical antipsychotics block dopamine receptors
9. [1] 'third generation' e.g. aripiprazole
10. [1] how these drugs work or 'generations' / credit side effects, such as TDK as elaboration.
11. [1] Drugs are effective / they work / they reduce symptoms of schizophrenia.
12. [1] Use of drugs can help to restore the 'chemical balance'
13. [1] Drugs can be given on a fixed schedule (by the patient or by therapist)
14. [1] Drugs require very little effort by the patient (are 'quick' and 'easy', they just swallow a pill) unlike non-chemical therapies
15. [1] Drugs are cost effective (if explained, e.g., 'compared to ECT, or CBT')
16. [2] token economy (Paul and Lentz, 1977) use of operant conditioning (desirable behaviours positively reinforced) using a token. Behaviours such as self-care, attending therapy and engaging socially. Tokens later exchanged for clothing, TV use, sweets and cigarettes.
17. [2] cognitive-behavioural therapy (Sensky et al., 2000) compared CBT group with control, randomly allocated. 90 patients aged 16-60 received average of 19 sessions. CBT = engaging with patient, discussing disorder, symptoms and challenged beliefs about voices.
18. [1] It is a medical treatment, prescribed by and applied by medical doctors
19. [1] It is necessary for patients where all other medications have not worked
20. [1] It successfully treats many patients both with schizophrenia and depression
21. [1] How ECT works still isn't known
22. [1] ECT can be given to a person to treat schizophrenia without their consent in some countries (person is not 'of sound mind')
23. [1] ECT has side-effects, both long and short term: loss of memory (temporary or worse), aspects of short-term or long-term memory.
24. [1] In people with other conditions it may affect the central nervous system and cardiovascular system.
25. [1] Conclusion: any appropriate conclusion drawn from the discussion that has been presented.