WJEC A Level Psychology Schizophrenia Exam Questions

About WJEC A Level Psychology Schizophrenia

Schizophrenia is one of the six WJEC Unit 3 behaviours, and if you choose it you write a structured Section A essay on it alongside two others. You must describe the characteristics, explain the disorder from social psychological, individual differences and biological perspectives, and evaluate antipsychotic drugs and cognitive behavioural therapy for effectiveness, ethics and social implications. This page leads with family and cultural factors before turning to the brain, which helps you build a diathesis-stress conclusion. Useful links back to Unit 1 include drug therapy from the biological approach and CBT from the cognitive approach, so revise those therapies with schizophrenia in mind.

What you need to know

• Symptoms Positive symptoms are experiences added to normal functioning, such as auditory hallucinations and delusions of persecution. Negative symptoms are reductions, such as avolition (lack of motivation), alogia (reduced speech) and blunted emotional expression. Classification uses DSM-5 or ICD criteria.
• Families and expressed emotion Bateson et al.'s (1956) double bind theory proposed that contradictory parental messages leave a child unable to respond correctly. Tienari's Finnish adoption research found genetically at-risk adoptees were more likely to develop the disorder if raised in dysfunctional families. Kavanagh's (1992) review found relapse around 48% in high expressed emotion homes against about 21% in low.
• Culture What counts as a symptom depends partly on cultural norms, since hearing the voice of a dead relative is normal in some cultures. In the UK, African-Caribbean people have been diagnosed at higher rates, which may reflect social adversity, misdiagnosis or both.
• Thought disorder, mothers and sex Thought disorder affects the form of thinking: loose associations, derailment and invented words. Fromm-Reichmann's schizophrenogenic mother was described as cold and controlling, but evidence is weak. Men usually show onset several years earlier than women and more negative symptoms, possibly because oestrogen is protective.
• Dopamine The original hypothesis blamed too much dopamine activity, supported by amphetamine-induced psychosis and by Seeman et al. (1976) showing that the clinical potency of antipsychotics matches how strongly they block dopamine receptors. The revised version adds low prefrontal dopamine to explain negative symptoms.
• Cannabis and brain structure Arseneault et al. (2002) found in the Dunedin cohort that cannabis use by age 15 raised the risk of schizophreniform disorder at 26, possibly through its effects on dopamine. Since Johnstone et al. (1976), CT and MRI studies have found enlarged lateral ventricles in many patients.
• Antipsychotics and CBTp Typical drugs such as chlorpromazine block D2 receptors; atypicals such as clozapine act on dopamine and serotonin. Leucht et al. (2012) found about 27% of patients on maintenance medication relapsed within a year against 64% on placebo. CBT for psychosis helps people reality-test beliefs and cope with voices, though Jauhar et al. (2014) found only small effects.

Common mistakes in Schizophrenia

• Writing that high expressed emotion causes schizophrenia to start. The strongest evidence links it to relapse in people already diagnosed.
• Describing the dopamine hypothesis as simply 'too much dopamine'. Explain the pathways involved and the revised account of low prefrontal dopamine for negative symptoms.
• Treating enlarged ventricles as unique to schizophrenia. They appear in other conditions, are absent in many patients, and may be partly a result of medication.
• Mixing up thought disorder and delusions. Thought disorder concerns the form of thinking (disorganised links between ideas); delusions concern its content (fixed false beliefs).
• Ignoring cultural bias when evaluating diagnosis. Differences in diagnosis rates between ethnic groups raise questions about validity that strengthen an essay.

Try three Schizophrenia exam-style questions