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Drug therapy for schizophrenia

Edexcel IAL Psychology · WPS04 Clinical Psychology and Psychological Skills

Spec 8.1.6 requires drug therapy for schizophrenia. You need to explain how antipsychotics work and evaluate them on effectiveness, side effects, invasiveness, assumptions and patient choice (component guide).

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Typical and atypical antipsychotics

Typical (first-generation) antipsychotics were developed in the 1950s, for example chlorpromazine and haloperidol. They mainly block dopamine D2 receptors, reducing positive symptoms.
Atypical (second-generation) antipsychotics are newer (the NHS describes them as developed in the 1990s), for example clozapine, risperidone, olanzapine and aripiprazole. They block dopamine and also act on other chemicals such as serotonin.

They can reduce anxiety or aggression within hours, but hallucinations and delusions may take several days or weeks to ease (NHS).

How they are given

Tablets, or a slow-release depot injection every 1 to 4 weeks, which helps if someone finds it hard to take tablets daily.
Most people take them for 1 or 2 years after a first episode, longer if the illness returns.
Stopping suddenly is not advised because symptoms may return.
Physical health (cholesterol, blood sugar, blood pressure) is monitored.

Side effects

Type	Side effects named by the NHS
Typical only	Shaking, trembling, muscle twitches and spasms
Both types	Drowsiness, weight gain (especially some atypicals), reduced sex drive, blurred vision, constipation, dry mouth

Evaluation

Effective and fast for positive symptoms, allowing many people to live in the community rather than hospital.
Side effects can be distressing and lead people to stop taking them (non-adherence), so symptoms return.
Less effective for negative symptoms, and some people do not respond.
Treats symptoms, not causes, and rests on the biological assumption that schizophrenia is a chemical imbalance.
Ethics and social control (9.3.9): drugs can be used to manage behaviour, especially when given under compulsion; patient-centred care means discussing choices.
Suzuki et al. (2014): underweight patients were mainly prescribed aripiprazole and standard or overweight ones olanzapine, showing drug choice links to physical health.

Worked example

Varsha has schizophrenia and struggles to leave the house because of frightening voices. Give one strength and one weakness of drug therapy for her.

Strength: antipsychotics can reduce positive symptoms such as voices within days or weeks, so Varsha may soon feel able to leave the house.
Weakness: side effects such as drowsiness and weight gain may make her stop taking them, and if she stops, the voices may return.
A depot injection could help if she finds daily tablets hard.

Answer: Each point is linked to Varsha's situation, as the June 2025 examiners required.

Key idea: Typical antipsychotics (1950s; chlorpromazine, haloperidol) block D2; atypicals (clozapine, olanzapine) act on dopamine and serotonin. Effective for positive symptoms; side effects cause non-adherence; less effect on negative symptoms; treat symptoms not causes.

Check yourself

How do typical antipsychotics reduce positive symptoms?
- By increasing serotonin reuptake
- By blocking NMDA receptors
- By raising dopamine levels
- By blocking dopamine D2 receptors
Show answer
By blocking dopamine D2 receptors. Typicals are D2 antagonists.
Which is an atypical antipsychotic?
- Chlorpromazine
- Clozapine
- Fluoxetine
- Amphetamine
Show answer
Clozapine. Clozapine is atypical; chlorpromazine is typical.
Which side effect does the NHS list for typical antipsychotics only?
- Weight gain
- Dry mouth
- Drowsiness
- Shaking and muscle spasms
Show answer
Shaking and muscle spasms. Movement side effects are listed for typicals; the others occur with both.
A depot injection can be given every 1 to 4 weeks. What is the longest gap in days?
Show answer
28 days. 4 weeks x 7 = 28 days.
Explain why side effects can reduce the effectiveness of drug therapy for schizophrenia.
Show answer
Side effects such as weight gain and drowsiness are unpleasant, so patients may stop taking the medication, and then their symptoms can return.. Side effects, then non-adherence, then relapse.
Which is a limitation of antipsychotics?
- They are generally less effective for negative symptoms
- They never reduce hallucinations
- They cure the cause of schizophrenia
- They have no side effects
Show answer
They are generally less effective for negative symptoms. Negative symptoms respond less well.

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Last updated 8 November 2026. Spotted a mistake? Tell us.