Transcript SZ A2 mock feedback

A2 Trial Exam
Feedback Schizophrenia
Outline and evaluate one biological therapy for
schizophrenia (4+8)
AO1
• The most likely therapy is the use of antipsychotic
drugs.
1. Typical e.g. phenothiazines like chlorpromazine –
block D2 receptors (dopamine antagonist).
2. Atypical e.g. clozapine - may block serotonin
receptors as well.
• Other biological therapies such as ECT can also gain
credit
A01: Antipsychotic Drugs
• Conventional typical antipsychotic drugs (e.g. phenothiazines, such as
chlorpromazine).
• These drugs work by blocking the receptors in the synapses that absorb
dopamine.
• Effectively they reduce the action of dopamine, and this is done within 48
hours.
• In other words they are dopamine antagonists.
• They bind specifically to D2 receptors but do not stimulate them therefore
blocking their action.
• The effectiveness of these drugs in reducing hallucinations and delusions
led to the dopamine hypothesis of schizophrenia (i.e. the biochemical
explanation of schizophrenia studied earlier in the course).
A01: Antipsychotic drugs
• Newer atypical antipsychotic drugs (e.g.
clozapine).
• These also act on the dopamine system, but
are thought to block serotonin receptors in
the brain too.
A01 Marks
• 4 – knowledge and understanding are
accurate and well-detailed
• 3 – knowledge and understanding are
generally accurate and reasonable detailed
• 2 – basic/superficial knowledge and
understanding
• 1 – rudimentary – knowledge and
understanding brief/muddled
• 0 – no creditworthy material
AO2
• Evaluation is likely to relate to effectiveness and
appropriateness.
• Atypicals most effective i.e. reduce + and – symptoms
• Conventional drugs side effects – tardive dyskinesia
• Atypical side effects.
• 30% do not respond to treatment
• Effective e.g. supporting research evidence
• Palliative therefore relapse occurs
AO2 marks
• 8-7 – effective: Sound analysis and understanding.
Well focussed and coherent elaboration. Consistent
use of psychological terminology.
• 6-5 – Reasonable: Reasonable analysis and
understanding. Generally focussed & reasonable
elaboration. Appropriate use of terminology.
• 4-3 - Basic: basic, superficial understanding.
Sometimes focussed, some elaboration. Lacks
clarity. Limited use of terminology
• 2-1 – Rudimentary: very limited understanding,
weak muddled, incomplete.
• 0 – no creditworthy material
Mark scheme
• “Treatments other than drug therapy will need to be
read carefully to assess the effectiveness of
evaluation. Students who cover ECT as AO1 should
make it clear that this treatment was used
historically but has not been widely used for
schizophrenia or deemed appropriate in recent
years. However, its more recent use in conjunction
with antipsychotics for drug resistant patients could
provide effective evaluation.”
• Answers focussing on these treatments are
likely to be basic.
Chief examiner’s feedback
• “The best route to good AO1 and AO2 marks
was to focus on…currently used
(treatments)…..and to include reference to
outcome studies”
• I.e. studies which show that they reduce
symptoms of SZ/relapse rates
Using research as AO2
• “Research shows that…..”
• “Davis et al analysed 29 studies….”
• Neither of these are going to be effective evaluation as
the reader does not know they are evaluation
• Introduce research as evaluation
• “Research supports that drug therapy is effective. E.g.
Davis found….”
• Use P.E.E.L structure we have practiced!
How would you improve these answers?
• “Another issue is that drugs are palliative and not
a curative treatment. These reduce symptoms
but as soon as the patient is off the drugs it will
reappear. Therefore drug therapy is limited”
• “A strength of the therapy is that it provides
immediate relief which is important if the patient
is a danger to themselves or others. Therefore it
is fast-acting in comparison to psychological
treatments which take weeks”
Q: How would you improve these answers?
A: Relate specifically to schizophrenia! – to achieve
reasonable/effective marks
“Another issue is that drug therapy such as antipsychotics are palliative and not a curative treatment.
These reduce symptoms of schizophrenia but as soon as
the patient is off the drugs schizophrenia will reappear.
Therefore drug therapy is limited”
“A strength of antipsychotics is that they provide
immediate relief which is important if the patient is a
danger to themselves or others e.g. due to delusions
and hallucinations. Therefore it is fast-acting (e.g. 48
hours) in comparison to psychological treatments such
as family therapy which take weeks”
Outline and evaluate one psychological therapy for
schizophrenia (4+8)
AO1
• A variety of options available e.g. CBT-related, familybased interventions and social interventions.
• Behavioural approaches used to ‘manage’ schizophrenia
e.g. token economy is creditworthy.
• Psychodynamic therapies are creditworthy but must
make clear these are no longer used/suitable for most
people.
• NOT biological e.g. ECT!
A01 Marks
• 4 – knowledge and understanding are
accurate and well-detailed
• 3 – knowledge and understanding are
generally accurate and reasonable detailed
• 2 – basic/superficial knowledge and
understanding
• 1 – rudimentary – knowledge and
understanding brief/muddled
• 0 – no creditworthy material
Chief examiner’s feedback
• “Better answers shaped descriptions of CBT
specifically to the symptoms of schizophrenia
(e.g. logical disputing to challenge delusional
beliefs) but weaker answers provided generic
descriptions of AS quality with little attempt to
apply these to the unique symptoms/features
of schizophrenia and were awarded basic
marks. Descriptions of family therapy often
lacked detail.”
AO2 marks
• 8-7 – effective: Sound analysis and understanding.
Well focussed and coherent elaboration. Consistent
use of psychological terminology.
• 6-5 – Reasonable: Reasonable analysis and
understanding. Generally focussed & reasonable
elaboration. Appropriate use of terminology.
• 4-3 - Basic: basic, superficial understanding.
Sometimes focussed, some elaboration. Lacks
clarity. Limited use of terminology
• 2-1 – Rudimentary: very limited understanding,
weak muddled, incomplete.
• 0 – no creditworthy material
AO2
• Likely to cover effectiveness and
appropriateness
• E.g. studies showing that CBT/family therapy
etc. reduce symptoms of
schizophrenia/prevent relapse
• Effective for some symptoms not others e.g.
CBT does not address negative symptoms
• Lengthy in comparison to biological therapy
• Family therapy suitable for 65% who return to
live with family, therefore not suitable for 35%
Chief examiner’s feedback
• “In better answers, evaluation was clearly
organised around three main areas,
appropriateness, effectiveness and ethical issues.
“
• “Weaker students continue to show little
understanding that treatment is free at the point
of delivery in the UK”
• - so it must be in terms of cost to the government
rather than patient!