OxfordAQA International A-level Psychology (9685): 3.3.2 Schizophrenia – Practice Questions

These are original questions written for Marlbridge, for revision and practice on this content. They are not reproduced past-paper questions, and they do not replicate the exam’s exact structure, question count or mark tariffs – examination boards hold copyright in their own papers. Use these alongside the official past papers from your board or school.

These questions cover section 3.3.2 Schizophrenia in the OxfordAQA International AS and A-level Psychology (9685) specification, Version 3.1 (International A-level exams May/June 2020 onwards). The specification assesses this content in Section B of Unit 3: Advanced topics and research methods 2, a 1 hour 30 minute written exam of 90 marks, with 30 marks for Schizophrenia. Because research methods are also assessed in Unit 3, some questions use invented data. All people, places and data below are fictional.

Revise first with the Schizophrenia study guide and the schizophrenia revision notes. See the 9685 course hub and the 9685 checklist.

Questions

1. Outline what is meant by avolition. [2]

2. Explain the difference between positive and negative symptoms of schizophrenia. Use hallucinations and speech poverty as your examples. [4]

3. Read the description below.

Tomasz, 26, tells his doctor that a television presenter has been sending him coded messages about a plan to harm him. His sister says he has stopped going to his evening classes, no longer washes or changes his clothes unless reminded, and sits at home for most of the day.

Identify one positive and one negative symptom shown by Tomasz. Explain your choice of each. [4]

4. At a fictional clinic in the town of Harwick, two psychiatrists independently assessed the same 60 patients. The table shows their decisions about schizophrenia.

	Psychiatrist B: schizophrenia	Psychiatrist B: not schizophrenia
Psychiatrist A: schizophrenia	18	9
Psychiatrist A: not schizophrenia	6	27

(a) Calculate the percentage of patients on whom the two psychiatrists agreed. Show your working. [2] (b) Explain what this result suggests about the reliability of diagnosis at the clinic. [2] (c) Several of the patients on whom the psychiatrists disagreed also had depression. Explain how co-morbidity and symptom overlap could account for the disagreement. [3]

5. Explain one way in which gender bias might reduce the validity of diagnosing schizophrenia. Refer to research in your answer. [4]

6. Outline the dopamine hypothesis of schizophrenia, including how it has been revised. [4]

7. A fictional twin register in the country of Westmoor records 120 identical (MZ) twin pairs and 150 non-identical (DZ) twin pairs in which at least one twin has schizophrenia. Both twins have schizophrenia in 36 MZ pairs and 12 DZ pairs.

(a) Calculate the concordance rate for MZ and for DZ twins. [2] (b) Explain what these results suggest about the role of genetics in schizophrenia. [4]

8. Read the description below.

Lena, 31, says a man’s voice comments on everything she does. She believes her neighbour can put thoughts into her head. When her support worker asks how her week went, she pauses for a long time and replies, “Fine.”

Use the cognitive explanation of dysfunctional thought processing to explain Lena’s symptoms. [6]

9. Distinguish between typical and atypical anti-psychotic drugs. [4]

10. A team in the fictional city of Corvale ran a 16-week trial with 80 adults with schizophrenia. Forty took an atypical anti-psychotic only (Group A). Forty took the same drug plus weekly cognitive therapy (Group B). Symptom severity was rated on a scale where higher scores mean more severe symptoms. Both groups had a mean of 72 at the start. At 16 weeks, Group A’s mean was 60 and Group B’s was 54.

(a) Calculate the percentage reduction in mean symptom score for each group. [2] (b) The raters knew which group each participant was in. Explain why this is a problem. [2] (c) Explain one ethical issue the researchers should consider. [2]

11. Evaluate anti-psychotic drugs and cognitive therapy as therapies for schizophrenia. [12]

12. Discuss reliability and validity in the diagnosis of schizophrenia. Refer to culture and gender bias, co-morbidity and symptom overlap in your answer. [16]

Answers

1. Avolition is a severe loss of motivation [1] to start and keep up goal-directed activities, such as work, study or personal hygiene [1]. [2] Examiner insight: “being lazy” earns nothing; the mark needs the idea of reduced motivation for goal-directed activity.

2. Positive symptoms are experiences added to normal functioning [1]. For example, hallucinations are perceptions, such as hearing voices, with no external stimulus [1]. Negative symptoms are normal abilities that are reduced or lost [1]. For example, speech poverty means the person speaks less, or gives brief replies with little content [1]. [4] Examiner insight: “positive” does not mean good; define each type as added or lost before giving the example.

3. Positive symptom: a delusion of persecution [1], because Tomasz firmly believes the presenter is sending coded messages about a plan to harm him, which is false [1]. Negative symptom: avolition [1], because he has stopped attending classes and does not wash unless reminded, showing loss of motivation for goal-directed activity [1]. [4] Examiner insight: each explanation mark needs a detail quoted from the description, not a textbook definition.

4. (a) Agreements = 18 + 27 = 45 [1]; 45 ÷ 60 × 100 = 75% [1]. [2] (b) The psychiatrists disagreed on 15 of 60 patients (25%) [1], so inter-rater reliability is only moderate and a patient’s diagnosis may depend on which psychiatrist they see [1]. [2] (c) Co-morbidity means these patients have depression as well as possible schizophrenia, so it is hard to decide which disorder explains each symptom [1]. Symptom overlap means features such as low motivation appear in both depression and schizophrenia (avolition) [1]. One psychiatrist may therefore attribute the symptoms to depression and the other to schizophrenia, producing disagreement [1]. [3] Examiner insight: in (a), agreement includes both cells where the psychiatrists agreed; using only the 18 “both schizophrenia” patients loses the mark.

5. Gender bias means a person’s gender, not their symptoms, influences the diagnosis [1]. Cotton et al. (2009) found that males with first-episode psychosis had more severe symptoms and lower functioning than females [1]. Women who function better day to day may therefore have schizophrenia missed, or diagnosed as a mood disorder [1]. Loring and Powell (1988) found that changing only the client’s sex in case studies changed psychiatrists’ diagnoses, so the diagnosis did not accurately reflect the symptoms, which lowers validity [1]. [4] Examiner insight: the final mark comes from saying why bias is a validity problem, not just that bias exists.

6. The original hypothesis says positive symptoms are caused by excess dopamine activity (hyperdopaminergia) in subcortical areas [1], linked to too many or oversensitive D2 receptors [1]. Davis et al. (1991) revised it to propose low dopamine activity in the prefrontal cortex, causing negative symptoms [1], alongside high activity in mesolimbic pathways, causing positive symptoms [1]. [4] Examiner insight: name a receptor or brain area; “a chemical imbalance” alone is too vague to score.

7. (a) MZ: 36 ÷ 120 × 100 = 30% [1]. DZ: 12 ÷ 150 × 100 = 8% [1]. [2] (b) MZ concordance (30%) is much higher than DZ concordance (8%) [1]. MZ twins share all their genes and DZ twins share about half, so the difference suggests a genetic contribution [1]. However, 70% of MZ co-twins do not have schizophrenia despite identical genes, so genes cannot be the whole cause [1]. This fits a diathesis-stress view, in which a genetic vulnerability is triggered by environmental stress [1]. [4] Examiner insight: top answers use the gap between 30% and 100%; comparing MZ with DZ alone earns only half the marks.

8. Frith’s model says symptoms arise from faulty information processing [1]. Faulty metarepresentation means Lena cannot recognise her own inner speech as her own [1], so it is experienced as a man’s voice commenting on her actions, an auditory hallucination [1]. The same failure of self-monitoring means her own thoughts do not feel like hers, which explains her belief that her neighbour inserts them, a delusion of control [1]. Faulty willed action means she struggles to start and produce deliberate, self-generated speech [1], which explains the long pause and the one-word reply, showing speech poverty [1]. [6] Examiner insight: each process must be tied to one of Lena’s symptoms; describing the model without the scenario caps the marks.

9. Typical anti-psychotics are first-generation drugs, such as chlorpromazine [1], which act mainly as dopamine antagonists by blocking D2 receptors, reducing positive symptoms [1]. Atypical anti-psychotics are second-generation drugs, such as clozapine [1], which act on dopamine and other neurotransmitters such as serotonin, and are generally less likely to cause movement side effects [1]. [4] Examiner insight: a distinction needs a contrast in action or effect; naming one drug of each type alone earns half.

10. (a) Group A: (72 − 60) ÷ 72 × 100 = 16.7% [1]. Group B: (72 − 54) ÷ 72 × 100 = 25% [1]. [2] (b) Raters who know the group may expect cognitive therapy to help, so their ratings could be biased towards lower scores for Group B [1]. The difference between groups could then reflect investigator bias, not the therapy; raters should be kept blind to group [1]. [2] (c) Informed consent: some participants may have reduced insight because of delusions or avolition [1], so researchers must check each person can understand the trial and make sure they can withdraw at any time, perhaps involving a family member or advocate [1]. [2] Examiner insight: in (b), say what the bias would do to the results; naming “researcher bias” without a direction earns one mark at most.

11. The real exam marks extended answers using levels of response, not point by point. These are indicative creditworthy points.

Drugs. Typical drugs such as chlorpromazine block D2 receptors and reduce positive symptoms [1]. A Cochrane review (Adams et al., 2014) found chlorpromazine reduced relapse compared with placebo [1], but rated the evidence as very low quality, which weakens confidence [1]. Atypical drugs such as clozapine act on dopamine and serotonin [1]. Kane et al. (1988) found 30% of treatment-resistant patients responded to clozapine against 4% on chlorpromazine, showing value where other drugs fail [1]. However, clozapine carries a risk of agranulocytosis, so regular blood tests are needed [1]. Typical drugs can cause tardive dyskinesia, and side effects reduce adherence [1].

Cognitive therapy. It uses normalisation, reality testing and re-attribution of voices to inner speech, alongside medication [1]. Jauhar et al. (2014) found a small effect on symptoms that was smaller still when assessors were masked [1]. It needs insight and motivation, which avolition reduces, so it may not suit everyone [1].

Judgement. Drugs manage symptoms quickly but do not cure, while cognitive therapy targets distress without physical side effects [1]. Combining them fits a diathesis-stress view, so neither alone is the best option for most people [1]. [12] Examiner insight: evaluation needs evidence on effectiveness as well as side effects; a list of side effects alone stays in the lower bands.

12. The real exam marks extended answers using levels of response, not point by point. These are indicative creditworthy points.

Knowledge. Reliability is consistency between clinicians (inter-rater) or over time (test-retest) [1]. Validity is whether the diagnosis identifies a real, distinct disorder [1]. Cheniaux et al. (2009) found schizophrenia was diagnosed more often under ICD-10 than DSM-IV in the same 100 inpatients [1].

Culture bias. Luhrmann et al. (2015) found violent commands were reported more often in the USA, and rich relationships with voices more often in India and Ghana [1], so a clinician may misjudge a culturally accepted experience as a symptom, lowering validity [1]. Loring and Powell (1988) found the race of client and psychiatrist influenced diagnosis even with clear criteria [1].

Gender bias. Loring and Powell also found the client’s sex influenced diagnosis [1]. Cotton et al. (2009) found males had more severe symptoms and poorer functioning, so women’s schizophrenia may be under-recognised [1].

Co-morbidity and symptom overlap. Buckley et al. (2009) estimated about 50% of patients have comorbid depression [1], which questions whether schizophrenia is a single, distinct disorder [1]. Avolition overlaps with depression, and hallucinations and delusions occur in bipolar disorder, so different clinicians can reach different diagnoses [1].

Evaluation. Rosenhan (1973) suggested diagnosis could not tell sane from insane [1], but the study used manuals since revised, and later evidence casts serious doubt on it [1]. Vignette studies lack the realism of meeting a patient over time [1]. Modern operational criteria improve reliability, but reliable diagnosis is not necessarily valid [1]. Overall, reliability has improved more than validity [1]. [16] Examiner insight: keep reliability and validity separate in your paragraphs and say which one each piece of evidence affects.

Where marks are usually lost

• Writing a general definition when the question gives a scenario with details to use.
• Counting only “both schizophrenia” cases when calculating agreement between raters.
• Treating positive symptoms as good symptoms.
• Confusing co-morbidity with symptom overlap.
• Using twin data as proof that schizophrenia is entirely genetic.
• Describing Frith’s model without linking each process to a symptom.
• Describing the dopamine hypothesis with no receptor type or brain area.
• Naming a research problem without saying how it would affect the results.
• Evaluating therapies only through side effects.

Next steps

• Check gaps with the schizophrenia revision notes and the 9685 exam preparation guide.
• Practise the methods side of Unit 3 with the Research methods 2 practice questions.
• Find your weaker topics with our diagnostics.
• Want a teacher to mark your extended answers? Book a free trial class.

Official syllabus

OxfordAQA International AS and A-level Psychology (9685) specification, Version 3.1 (International A-level exams May/June 2020 onwards), section 3.3.2 Schizophrenia; Unit 3 details in section 2.3.