Section A

Schizophrenia, depression, phobias, OCD

Overview • Clinical characteristics of XXXX.• Issues surrounding the classification and diagnosis of

XXXX, including reliability and validity.

Explanations • Biological explanations of XXXX, for example, genetics, biochemistry.

• Psychological explanations of XXXX, for example, behavioural, cognitive, psychodynamic and socio-cultural.

Therapy • Biological therapies for XXXX, including their evaluation in terms of appropriateness and effectiveness.

• Psychological therapies for XXXX, for example, behavioural, psychodynamic and cognitive-behavioural, including their evaluation in terms of appropriateness and effectiveness.

Question type no. 1. Clinical characteristics

• Likely to be less than 8 marks.• Must describe more than one

characteristic.• Some depth, not just breadth.• 4 marks = 100 words

DSM-IV-TR CRITERIA for specific phobia

• Marked and persistent fear that is excessive or unreasonable.

• Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response such as a panic attack.

• The person recognises that the fear is excessive or unreasonable. This feature may be absent in children.

• The phobic situation is avoided or endured with intense anxiety or distress.

• The avoidance, anxious anticipation, or distress in the feared situation interferes significantly with the person’s normal routine.

• In individuals under age 18 years the duration is at least six months.

• The anxiety, panic attacks or phobic avoidance is not better accounted for by another mental disorder, such as OCD Reduce ?

The DSM identifies clinical characteristics that differentiate between a clinical phobia and a mere fear. Firstly the individual must recognise that their behaviour is irrational but continue to act in that way. Secondly the phobia must encroach on everyday life, interfering with their day to day, normal activities, such as going out in public. Moreover the individual suffering from the phobic disorder will not feel in control of their actions and the anxiety associated with the disorder will have a substantial longevity – in children the disorder must have lasted for at least 6 months. Lastly panic attacks may accompany the phobia, especially when the individual is presented with situational cues of the phobia or comes into direct contact with it – this especially will lead to irrational behaviour and often crying in children .

132 words (100 words for 4 marks)

Detailed and accurate = 4 out of 4 marks

Phobia

Question type no. 2. Issues surrounding classification and diagnosis

Discuss issues surrounding the classification and diagnosis of phobic disorders. (8 marks + 16 marks)

Issue 1 (50 words)

Critical point 1 (50 words)

Critical point 2

Issue 2 Critical point 3

Critical point 4

Issue 3 Critical point 5

Critical point 6

Issue 4 Critical point 7

Critical point 8

Assess issues surrounding the classification and diagnosis of phobic disorders. (16 marks)

Critical point 1 (50 words)

Critical point 2

Critical point 3

Critical point 4

Critical point 5

Critical point 6

Critical point 7

Critical point 8

IssuesIssue Evaluation

1 (50 words)Three point rule (50 words)

2

3

4

January 2012, examiner’s report:Describe the issue and then consider consequences and/or research evidence to support this.

Paragraphs and lead in phrases

• Each AO2 point in one paragraph – so you can see the elaboration.

• Organisation counts

• Line of argument counts

Tired examiner

Inter-rater reliability • The issue is about

how close raters are in their assessments. If a method of assessment is reliable we would expect ...

RELIABILITY

2. Issues surrounding classification &diagnosis

Research evidence … Skyre et al: three clinicians assessed 54 social phobics using the Structured Clinical Interview (SCID-I). High agreement (+.72). This shows that ..

May be explained …SCID requires extensive training, enhancing reliability.

Test-retest• The issue is

whether a diagnostic test is likely to produce the same results on two separate occasions.

RELIABILITY

2. Issues surrounding classification &diagnosis

Research evidence … Kendler et al: low levels of test-retest, particularly over longer-term intervals. Picon et al. found high but short-term (14 days).

Low reliability may be explained …Poor recall of fears (Kendler et al.).

And for inter-rater might be because interviewers differ in their interpretation of symptoms, concluding it is clinically significant.

2. Issues surrounding classification and diagnosis

Comorbidity • If anxiety

disorder co-occurs with depression this suggests that they are not separate entities and therefore the diagnostic category is not very useful, e.g. when deciding what treatment to advise.

VALIDITY

Research support …

Kendler found high levels of comorbidity between social phobias, animal phobias, generalised anxietydisorder and depression

Eysenck reported up to 66% of patients with one anxiety disorder are also diagnosed with another anxiety disorder.

The implications are that the diagnosis should simply be ‘anxiety disorder’ rather than phobia or obsessive compulsive disorder (OCD).

2. Issues surrounding classification and diagnosis

Construct validity• Demonstrating

the extent to which performance on a test of anxiety measures the underlying construct (phobia).

VALIDITY

Research support …

Beidel et al. found the Social Phobia and Anxiety Inventory (SPAI) correlates well with behavioural measures of social phobia (e.g. ease of public speaking) and lacks association with behaviours unrelated to social phobia.

Not surprising …

Scale items ask participants about what they think and do when in fear-producing situations.

Circularity.

Implications of low reliability and validity for phobias …

CONTEXT

IssuesIssue Evaluation

1 (50 words)Three point rule (50 words)

2

3

4

January 2012, examiner’s report:Describe the issue and then consider consequences and/or research evidence to support this.

AO1 mark scheme

Mark

Knowledge and Understanding

Range of relevant material

Breadth and depth

Organisation and structure

8-7 Sound, accurate and well-detailed

Selected Substantial Coherent

6-5 Reasonable, generally accurate and reasonably detailed

Selected Evidence of breadth and/or depth

Reasonably coherent

4-3 Basic, relatively superficial

Restricted Basic

2-1 Rudimentary, muddled and/or inaccurate

Brief or largely irrelevant

Lacking

0 No creditworthy material

AO2/AO3 mark scheme

Mark Analysis, understanding

and intepretation

Focus Elaboration Line of argument

Issues/debates/

approaches

16-13 Sound Well focused

Coherent Clear Used effectively

12-9 Reasonable Generally focused

Reasonable Evident Reasonably effective

8-5 Basic. superficial

Sometimes focused

Some evidence

Superficial relevance

4-1 Rudimentary, very limited understanding

Weak, muddled, incomplete

Not used effectively

May be mainly irrelevant

Absent, muddled and/or inaccurate

0 No creditworthy material

Quality of written communication also assessed

‘In an important and influential criticism of the diagnosis of mental illness, Rosenhan (1973) showed that healthy ‘pseudopatients’ could gain admission to psychiatric hospital by pretending to have auditory hallucinations. Although systems of classification and diagnosis have changed considerably since the 1970s, many people still have concerns about their accuracy and appropriateness.’

Discuss issues surrounding the classification and diagnosis of schizophrenia. (8 marks + 16 marks)

There are two types of classification system. The first is the DSM, Diagnosis and Statistical Manual of mental disorders. The DSM was published in America so is only available in English. This therefore means that the rest of the world are unable to use this classification system. The DSM is used now as the 4th edition as the first editions were simplistic and vague. The DSM consists of 8 categories which 42 mental disorders fit into.

The second classification system is the ICD International Classification system of mental disorders. This was first published by the WHO in 1990 so it is available world wide for all patients. The ICD is thought to be a better classification system as it is available world wide so isn’t culturally biased. It also diagnoses people with symptoms after seven months while the DSM does after 12. Lastly more people can be fitted into the ICD classification system as it has seven subtypes while the DSM has five.

It is very easy to misdiagnose people with schizophrenia or it is difficult to tell where the normal behaviour starts and the abnormal ends. There have been many cases of misdiagnosis . Diagnosis is the classification and identification of a disorder in terms of its signs and symptoms. Signs are objective tests such as blood tests and symptoms are reports from patients.

A famous case of misdiagnosis when a group of psychologists pretended to be mentally unstable to be admitted into a mental hospital. Once they were admitted they then acted normally and thought the staff would see they were medically sound and let them out. This didn’t happen as the staff believed what they were doing wasn’t right i.e. saying they were sane! After a while and after many letters were sent, the psychologists were let out.

Another case of misdiagnosis was found by a psychologist in the 1960s. He found that there was a significant rise in the amount of people with catatonic schizophrenia. This type of schizophrenia is defined by muscle abnormalities. He then found that sleeping sickness had similar characteristics to this type of schizophrenia so people were being wrongly diagnosed.

Another reason why people are misdiagnosed is down to cultural differences. In some countries schizophrenia is seen as a good thing whereas in England and similar cultures it is seen as different leading to different treatment of people.

A reason why it is hard to diagnose people with schizophrenia is that it is difficult to put people into the subtypes. This is because of individual differences, as some people may have symptoms of more than one subtype of schizophrenia. This is due to schizophrenia being heterogenous, the ability to be linked to other disorders. Schizophrenia is mainly linked to depression, which is why the treatments for the two disorders are similar.

A way the classification systems overcame diagnosis is making it multi-racial. This means that the doctor has to assess 5 different areas before diagnosing the patient.

In evaluation, since 1970 there have been many improvements made on the classification and diagnosis of schizophrenia. There have been many improvements yet still many faults in the systems. For example individual and cultural differences are still not taken into account. A psychologist found more cases of schizophrenia in African and Caribbean cultures than European countries. There are still many areas of misdiagnosis of schizophrenia as it is still a fairly new mental disorder.

So although improvements have been made since 1970 there is still a long way to go until the classification systems are flawless and there are no more cases of misdiagnosis.

600 words

Question type no. 3Explanations and therapies

Evaluate one explanation/therapy of XXXX. (16 marks) Evaluate two or more explanations/therapies of XXXX. (16 marks)

Outline one explanation/therapy of XXXX. (8 marks) Outline two or more explanations/therapies of phobic disorders. (8

marks)

Could specify psychological or biological.

Outline one explanation/therapy of XXXX. (4 marks)

Mix & match

Psychopathology Describe and evaluate 8 + 16 marks, 4 +8 marks

• Clinical characteristics of XXXX

• Issues surrounding the classification and diagnosis of XXXX, including reliability and validity

• Biological explanations of XXXX, for example, genetics, biochemistry

• Psychological explanations of XXXX, for example, behavioural, cognitive, psychodynamic and socio-cultural

• Biological therapies for XXXX, including their evaluation in terms of appropriateness and effectiveness

• Psychological therapies for XXXX, for example, behavioural, psychodynamic and cognitive-behavioural, including their evaluation in terms of appropriateness and effectiveness

1. Clinical characteristics (AO1 only)

2. Issues surrounding the classification and diagnosis of their chosen disorder

3. One biological explanation4. 2nd biological explanations5. One psychological explanation6. Two psychological explanations

7. One biological therapy (appropriateness and effectiveness)

8. Two biological therapies9. One psychological therapy10.Two psychological therapies

10 essays

The 1 ½ theory rule

Wherever the specification says ‘theories’ or explanations this means you have to cover two, BUT …

Describe and evaluate one explanation of … (24 marks)

Describe and evaluate two explanations of … (24 marks)

Student has Theory 18 marks description16 marks evaluation

Student produces cut down Theory 15 marks description10 marks evaluation

Theory 23 marks description6 marks evaluation

Psychological explanation

8 + 16 4 + 8

Biological explanation 8 + 16 4 + 8

Psychological therapy 8 + 16 4 + 8

Biological therapy 8 + 16 4 + 8

What you need to know

2 Range of relevant material• 8 marks AO1• About 10 minutes of

writing (20 minutes for AO2).

• About 200-240 words of writing.

• 8 points of 20-30 words for each possible essay.

• For each point remember one KEYWORD.

For example

8 marks AO11. Genetic explanation

2. Family studies (e.g. Gottesman)

3. Greater the degree of genetic relatedness, greater the risk.

4. Children with two schizophrenic parents have 46% risk of developing the disorder, one schizophrenic parent a 13% risk.

5. Twin studies MZ vs DZ

6. Joseph – MZ concordance 40%, DZ 7%.

7. Adoption studies disentangle genetic and environmental influences.

8. Tienari et al. – 6.7% adopted schizophrenics had biological schizophrenic mothers vs 2% adoptees born to non-schizophrenic mothers.

Genetic explanations propose that an individual inherited a gene or possibly a cluster of genes. These genes are shared with their closest relatives.

23 words 23x 8 = 184Schizophreni

a

For example

8 marks AO1

1. Genetic

2. Family – Gottesman

3. Genetic relatedness

4. 46% vs 13% risk.

5. Twin studies

6. 40% vs 7% - Joseph

7. Adoption studies

8. Tienari et al. – 6.7% vs 2%.

Schizophrenia

For example

8 marks AO11. Neurotransmitter explanation

2. Serotonin low.

3. SRRIs work and they increase serotonin levels.

4. Delgado et al. gave low tryptophan diets and symptoms returned.

5. Amr et al. organophosphate insecticide exposure to serotonin disturbances in the brain.

6. Noradrenaline low.

7. Bunney et al. waste products show low levels.

8. Post-mortem studies show increased densities of receptors in suicide cases, compensatory attempt to pick up whatever signals are available (a process known as ‘up-regulation’).

Depression

For example

8 marks AO11. Neurotransmitter explanation

2. Serotonin low.

3. SRRIs.

4. Delgado et al. tryptophan.

5. Amr et al. organophosphate.6. Noradrenaline low.

7. Bunney et al. waste products.

8. Post-mortem densities of receptors, up-regulation.

Depression

For example

8 marks AO11. Genetic explanation

2. Family studies (e.g. Fryer et al.) 3x as many relatives a normal controls.

3. Solyom et al. 45% phobics have one phobic relative.

4. Relatives have same phobia e.g. 64% blood phobics (Ost).

5. Twin studies MZ vs DZ

6. Torgersen – 5x more in MZ than DZ.

7. What is inherited? Oversensitive fear response (adrenogenic theory).

8. Some people more readily conditioned (higher dopamine levels).

Phobia

For example

8 marks AO11. Genetic explanation

2. Family (e.g. Fryer et al.) 3x

3. Solyom et al. 45%

4. 64% blood phobics (Ost)

5. Twin studies MZ vs DZ

6. Torgersen – 5x

7. Adrenogenic theory

8. Conditioning and dopamine

Phobia

29

Why it works

• Produces a précis of text.

• Gives you the coat pegs.

• Ensures you learn just the right amount (not too much or too little).

A prècis is a summary where one cuts out less important

material leaving the key bits. golden nuggets.

Why it works

YOU select your points Levels of processing theory E.g. Mandler (1967) Processing increases recall. Processing increases

understanding. Cues help recall (cue retrieval

theory). Organises your exam answer. Revise by rehearsal (MSM) and

elaborating the points (leads to enduring memories).

Your turn

8 marks AO1 One psychological explanation of XXXX.

1.

2.

3.

4.

5.

6.

7.

8.

Approach 1 Six ELABORATED critical points would get you a Grade A.

8 x 25 words = 200 words

AO1

1

2

3

4

5

6

7

8

AO2

1

2

3

4

5

6

7

8

8 x 50 words = 400 words

Approach 2

A2 Exam Companion

An alternative psychological explanation is that stressful life events cause the onset of schizophrenia. Events such as the death of a close relative act as a trigger. The individual may have a biological predisposition for schizophrenia but only some people with such a predisposition will develop the disorder – those who experience stressors.

52 words

50 words x 12 = 600 words

In general the biological explanations probably have better research support than psychological ones. There is a large body of evidence, for example, supporting the role of genetic factors such as the research by Gottesman (1991) which showed that the greater the degree of genetic relatedness, the greater the risk of schizophrenia.

51 words

AO2/AO3 skills

Evaluation

Range of relevant material

16 marks AO2

• About 20 minutes of writing.

• About 400-480 words of writing.

• About 8 ELABORATED critical points (50-60 words).

8 marks AO1

• About 10 minutes of writing.

• About 200-240 words of writing.– 8 points of 25-30 words.– OR 4 paragraphs of about 50

words.

• For each point/paragraph remember one KEYWORD.

FOUR POINT RULETop and bottom your paragraphs.

POINTThere is physiological evidence to support the cognitive explanation of schizophrenia.

LINKThis shows that the cognitive explanation

makes sense even at a physiological level.

EVIDENCEMeyer-Linderberg et al. found a link

between excess dopamine in the prefrontal cortex and working memory.

Psychological explanations

51 words

EXAMPLE / EXPLAINWorking memory dysfunction is

associated with the cognitive disorganisation typically found in schizophrenics.

AO1 mark scheme

Mark

Knowledge and Understanding

Range of relevant material

Breadth and depth

Organisation and structure

8-7 Sound, accurate and well-detailed

Selected Substantial Coherent

6-5 Reasonable, generally accurate and reasonably detailed

Selected Evidence of breadth and/or depth

Reasonably coherent

4-3 Basic, relatively superficial

Restricted Basic

2-1 Rudimentary, muddled and/or inaccurate

Brief or largely irrelevant

Lacking

0 No creditworthy material

AO2/AO3 mark scheme

Mark Analysis, understanding

and intepretation

Focus Elaboration Line of argument

Issues/debates/

approaches

16-13 Sound Well focused

Coherent Clear Used effectively

12-9 Reasonable Generally focused

Reasonable Evident Reasonably effective

8-5 Basic. superficial

Sometimes focused

Some evidence

Superficial relevance

4-1 Rudimentary, very limited understanding

Weak, muddled, incomplete

Not used effectively

May be mainly irrelevant

Absent, muddled and/or inaccurate

0 No creditworthy material

Quality of written communication also assessed

Outline and evaluate one biological therapy for schizophrenia and one psychological therapy for schizophrenia. (8 marks + 16 marks)

One biological therapy used for schizophrenia is the use of drugs. A schizophrenia patient is likely to have hallucinations and other delusions, 73% of schizophrenics do. Research findings indicate that the cause of this is too much dopamine in the brain that the individual cannot deal with. The drug that the patient takes blocks some of the dopamine receptors and therefore reduces the amount of dopamine that the brain receives. The delusions and hallucinations are reduced or stopped in an easy and short time space.

A major strength of this approach is that it can be tried and used if other methods have not worked such as ECT.

There is large evidence that this method of treating schizophrenia works in 90% of cases. This therapy reduces the level of hallucinations the patient experiences.

This therapy is used worldwide, in many cultures and therefore it does not suffer from a cultural bias but can be applied to everyone.

However, these drugs have shown that tardive dyskinesia is a common result of this kind of therapy, 78% of patients are permanently damaged and cannot be reversed.

Further criticism is that the drugs, if they block other receptors, other problems could happen. If this happens weight gain will be a result and symptoms similar to Parkinson’s disease.

Drugs are the most up-to-date and reliable method of treating schizophrenia and do not suffer from a historical bias.

This therapy does not take into account any biological or individual differences between schizophrenia patients and therefore should not be administered to everyone.

One psychological therapy for treating schizophrenia is carried out by Tarrier (1971). He conducted what is known in the psychological profession as CBT, cognitive behavioural therapy. During this therapy the patient is asked to think of thoughts and ideas they have in their head and locate the cause. The therapist helps the patient change the way the patient interprets these thoughts into a much more productive way. An example of this and applying it to schizophrenic patients would be looking at a thought they get e.g. ‘Everybody hates me’. The therapist would help the patient to see that this really means ‘Even people who like me sometimes get made at me’.

This therapy has been ongoing since 1971 and has developed in ways on conducting this therapy and making it more reliable. Although it originated back in the 70s there is not historical bias here because the process has been used in to the 21st century.

A major strength of this type of therapy is that there are no negative effects in the outcome, unlike other therapies such as ECT and drugs. CBT has no memory impairment or long term damage.

However weaknesses of this therapy are, it does not account for hallucinations. It cannot explain why people hallucinate or have delusions and cannot focus on reducing these symptoms.

This therapy has face validity, it makes sense, the patient has negative thoughts, the thoughts are changed, the patient no longer has negative thoughts.

499 words

A* AO2• A major strength of this

approach is that it is a useful alternative to psychotherapy.

• Many people prefer drugs because they don’t require the same effort on the patient’s part.

• You just have to remember to take the drug each day instead of attending weekly sessions where you have to think about your behaviour and take control.

• This means that many people opt for drugs even though they have to tolerate unpleasant side effects.

A major strength of this approach is that it can be tried and used if other methods have not worked such as ECT.

There is large evidence that this method of treating schizophrenia works in 90% of cases. This therapy reduces the level of hallucinations the patient experiences.

This therapy is used worldwide, in many cultures and therefore it does not suffer from a cultural bias but can be applied to everyone.

A* AO2• There is large evidence that

antipsychotics work.• In one study using placebos

55% relapsed if they were using placebos compared to 19% using conventional antipsychotics (Davis et al.).

• A particular strength of conventional antipsychotics is that they reduce the level of hallucinations the patient experiences.

• Such effectiveness increases the appeal of antipsychotic drugs.

A major strength of this approach is that it can be tried and used if other methods have not worked such as ECT.

There is large evidence that this method of treating schizophrenia works in 90% of cases. This therapy reduces the level of hallucinations the patient experiences.

This therapy is used worldwide, in many cultures and therefore it does not suffer from a cultural bias but can be applied to everyone.

A* AO2• This therapy is used worldwide,

in many cultures.• Studies that compare success

rates show that they are broadly similar in many different countries.

• For example, the study by Davis et al. concerned mainly American sample.

• A study by Avasthi et al. looked at data from Indian samples and reported the usefulness of antipsychotics there.

• This supports the view of a biological, universal disorder.

A major strength of this approach is that it can be tried and used if other methods have not worked such as ECT.

There is large evidence that this method of treating schizophrenia works in 90% of cases. This therapy reduces the level of hallucinations the patient experiences.

This therapy is used worldwide, in many cultures and therefore it does not suffer from a cultural bias but can be applied to everyone.