Atypical antipsychotics | AQA A-Level Psychology Revision

For 7182 specification, first teach in September 2025

AQA A-Level Psychology | Free Revision Notes

Estimated study time: 60 minutes

Atypical antipsychotics are newer biological treatments used to manage schizophrenia. These Atypical antipsychotics A-Level Psychology revision notes explain how drugs such as clozapine and risperidone affect dopamine and serotonin systems, how they are administered and why they may be selected instead of older medications.

You will compare atypical drugs with first-generation dopamine antagonists and evaluate effectiveness, side effects, adherence and ethical concerns. AQA explicitly requires both typical and atypical antipsychotics as drug therapies for schizophrenia.

Learning Objectives 🎯

By the end of this revision page, you should be able to:

• Explain how atypical antipsychotics are used to treat schizophrenia.

• Describe the actions of clozapine and risperidone.

• Link atypical antipsychotics with dopamine and serotonin activity.

• Compare atypical and typical antipsychotics directly.

• Apply knowledge of drug therapy to unfamiliar treatment scenarios.

• Evaluate the effectiveness and appropriateness of antipsychotic medication.

Revision Notes 📚

Atypical antipsychotics overview

Atypical antipsychotics are a newer, second-generation class of drugs used to reduce symptoms associated with schizophrenia.

Examples commonly studied at A-Level include:

• Clozapine

• Risperidone

• Olanzapine

Atypical antipsychotics were developed partly to:

• Treat patients who did not respond sufficiently to typical drugs.

• Act on a broader range of neurotransmitter systems.

• Reduce some of the severe movement-related side effects associated with older drugs.

• Improve treatment of a wider range of symptoms.

The word atypical does not mean unusual or rarely used. It distinguishes these drugs from the older typical antipsychotics.

Specification scope

The AQA specification names typical and atypical antipsychotics as required drug therapies but does not prescribe a fixed list of individual drugs or receptor details. Clozapine, risperidone and olanzapine are standard examples used to explain and evaluate this treatment class. AQA mark schemes have explicitly accepted risperidone and olanzapine in the evaluation of antipsychotic therapy.

What do atypical antipsychotics treat?

Atypical antipsychotics may be used to manage symptoms such as:

Positive symptoms

• Hallucinations.

• Delusions.

• Disturbed or disorganised thinking.

Negative symptoms

• Avolition.

• Speech poverty.

• Reduced engagement in ordinary activities.

The distinction between these experiences is covered in added and reduced psychological functioning.

Atypical drugs may sometimes offer a broader effect than typical medication, although their effectiveness differs between:

• Drugs.

• Patients.

• Symptoms.

• Stages of treatment.

They should not be described as equally effective for every person or every symptom.

How atypical antipsychotics are used

Atypical antipsychotics may be prescribed:

• During an acute psychotic episode.

• As continuing maintenance treatment.

• When a typical antipsychotic has not worked sufficiently.

• When the side effects of a typical drug are unacceptable.

• As part of a treatment programme combining medication with psychological therapy.

Acute treatment

During an acute episode, the immediate goal may be to reduce:

• Severe hallucinations.

• Intense delusions.

• Psychological distress.

• Disorganised behaviour.

Reducing symptoms may allow the person to:

• Communicate more effectively.

• Return to community care.

• Participate in therapy.

• Manage ordinary activities more safely.

Maintenance treatment

Medication may continue after symptoms improve to reduce the risk of relapse.

Maintenance treatment can support:

• Stability.

• Reduced readmission.

• Continued participation in education or employment.

• Engagement with psychological and social support.

The benefits of continued treatment must be balanced against:

• Long-term side effects.

• The person’s preferences.

• Previous treatment response.

• Relapse history.

• The availability of alternatives.

How atypical antipsychotics are administered

Oral medication

Many atypical antipsychotics are taken as:

• Tablets.

• Dissolvable tablets.

• Liquid medication.

Oral medication allows:

• Dosage adjustments.

• Treatment at home.

• Relatively easy switching between medications.

However, its effectiveness depends partly on adherence.

Long-acting injections

Some atypical antipsychotics can be administered through long-acting injections.

These may:

• Reduce forgotten doses.

• Provide a steadier medication level.

• Make adherence easier to monitor.

• Reduce abrupt discontinuation.

However:

• The injection is more invasive.

• Side effects cannot be stopped immediately once the drug has been administered.

• Some patients may experience injections as controlling.

• Meaningful informed consent remains important.

Neurotransmitter action

Dopamine

Dopamine is a neurotransmitter involved in:

• Motivation.

• Reward.

• Movement.

• Attention.

• Assigning importance to events.

The revised dopamine hypothesis proposes that excessive dopamine activity in some subcortical pathways contributes to positive symptoms.

Antipsychotic medication reduces the effects of this excessive activity.

The relationship between neurotransmitter activity and symptoms is explained fully in regional dopamine activity and schizophrenia.

Serotonin

Serotonin is another neurotransmitter involved in a range of psychological and physiological functions.

Many atypical antipsychotics act on both:

• Dopamine receptors.

• Serotonin receptors.

This broader receptor action distinguishes them from the simplified description of typical antipsychotics as primarily strong dopamine D2 antagonists.

Antagonist action

An antagonist reduces the effect of a neurotransmitter.

When an atypical antipsychotic blocks a receptor:

1. The drug occupies the receptor site.

2. The neurotransmitter has fewer available sites to bind with.

3. Postsynaptic stimulation is altered or reduced.

4. Activity in the relevant neural pathway changes.

5. Symptoms may become less severe.

Different atypical drugs have different receptor profiles, so they should not all be described as working in precisely the same way.

Clozapine

What is clozapine?

Clozapine is an atypical antipsychotic.

It is particularly important for patients whose symptoms have not responded adequately to other antipsychotic medication.

This is sometimes described as treatment-resistant schizophrenia.

Clozapine’s action

Clozapine acts on several neurotransmitter receptor systems, including:

• Dopamine receptors.

• Serotonin receptors.

It reduces dopamine activity without producing exactly the same pattern of strong, continuous D2 blockade associated with many typical antipsychotics.

Its broader action may help explain why it can benefit some patients who have not improved sufficiently with older drugs.

Clozapine and symptoms

Clozapine may reduce:

• Hallucinations.

• Delusions.

• Some disturbed thinking.

• Some negative or mood-related difficulties in certain patients.

It should not be presented as a guaranteed treatment for every negative symptom.

When clozapine may be considered

A clinician may consider clozapine where:

• Other antipsychotics have not produced sufficient improvement.

• Severe symptoms continue.

• The expected benefits justify the additional monitoring.

• The person understands and agrees to the treatment plan.

Clozapine and blood monitoring

Clozapine can produce a rare but potentially serious reduction in white blood cells.

This is commonly referred to in A-Level materials as agranulocytosis.

White blood cells are important in defending the body against infection.

A serious reduction may leave the person vulnerable to illness.

Patients prescribed clozapine therefore require regular blood monitoring.

Why monitoring matters

Blood tests allow professionals to:

• Check white-blood-cell levels.

• Identify a dangerous change early.

• Stop or alter treatment where necessary.

• Balance continuing benefit against medical risk.

Effect on appropriateness

Clozapine may be effective but less convenient because it requires:

• Regular blood tests.

• Continuing medical supervision.

• Reliable attendance.

• Rapid reporting of possible physical illness.

This illustrates an important distinction:

A treatment can be effective but demanding or unsuitable for a particular patient.

Risperidone

What is risperidone?

Risperidone is an atypical antipsychotic that acts on dopamine and serotonin receptor systems.

It is used to manage positive symptoms and may be selected because its receptor action and side-effect profile differ from those of older typical drugs.

Risperidone’s action

Risperidone blocks:

• Dopamine D2 receptors.

• Particular serotonin receptors.

The balance between these actions is intended to reduce symptoms without producing the same degree of movement-related side effects associated with strong dopamine blockade in every pathway.

Dosage

Risperidone can be effective at relatively low doses for some patients.

A lower effective dose may reduce some unwanted effects.

However, risperidone can still produce:

• Movement-related side effects.

• Weight gain.

• Sedation.

• Other physical effects.

Atypical does not mean free from side effects.

Evidence involving risperidone

AQA’s June 2022 mark scheme identifies Bagnall’s research as evidence that atypical drugs such as risperidone may be more effective than typical antipsychotics.

This evidence supports the use of atypical medication, but a broad conclusion needs caution because:

• Studies may use different drugs.

• Doses may vary.

• Patients may have different symptom profiles.

• Effectiveness can be measured in different ways.

• A group advantage does not guarantee individual improvement.

Olanzapine

Olanzapine is another atypical antipsychotic acting on dopamine and serotonin systems.

It may be used for:

• Acute symptom reduction.

• Maintenance treatment.

• Relapse prevention.

AQA’s 2022 mark scheme also recognises the preventative use of olanzapine with high-risk individuals as a possible evaluation point.

This does not mean that everyone considered at risk should automatically receive medication.

Preventative treatment raises questions involving:

• Accuracy of risk identification.

• Exposure to side effects.

• Informed consent.

• Treating people who may never develop severe symptoms.

Atypical antipsychotics and the dopamine hypothesis

Atypical drugs provide evidence that dopamine is involved in schizophrenia because they alter dopamine transmission and can reduce symptoms.

However, their action on additional neurotransmitters suggests that schizophrenia cannot be explained through dopamine alone.

A possible interpretation is:

dopamine contributes to symptoms, but its effects operate within wider interacting neurotransmitter systems

This supports the revised rather than the simplest original dopamine hypothesis.

Treatment does not prove cause

The reasoning:

a drug changes dopamine and symptoms improve

supports dopamine involvement.

It does not prove:

dopamine dysfunction was the original cause of schizophrenia

A medication can interrupt one process involved in symptoms without removing:

• Genetic vulnerability.

• Environmental stress.

• Dysfunctional cognition.

• Difficult family interactions.

• Wider social causes.

Comparing atypical and typical antipsychotics

Feature	Typical antipsychotics	Atypical antipsychotics
Generation	Older, first-generation drugs	Newer, second-generation drugs
Examples	Chlorpromazine	Clozapine, risperidone, olanzapine
Main simplified action	Strong dopamine D2 receptor blockade	Dopamine and serotonin receptor action
Positive symptoms	Often effective	Often effective
Negative symptoms	Usually more limited effect	May offer broader benefits for some patients
Movement side effects	Generally greater concern	Often reduced, but still possible
Other side effects	Sedation, movement difficulties and others	Weight gain, metabolic effects, sedation and others
Treatment resistance	May be ineffective for some patients	Clozapine may be used after other drugs fail
Monitoring	Standard medication monitoring	Clozapine requires additional blood monitoring
Administration	Oral or depot forms	Oral and some long-acting forms
Individual response	Varies	Varies

📌 Exam tip: Avoid writing that atypical antipsychotics simply “have no side effects”. Their side-effect profile is different, not absent.

Similarities between typical and atypical drugs

Both treatment classes:

• Are biological therapies.

• Affect neurotransmitter activity.

• Can reduce positive symptoms.

• May be used acutely or for maintenance.

• Can be taken orally or, for some drugs, by injection.

• Can cause side effects.

• Require medical supervision.

• May reduce relapse when taken consistently.

• Can raise ethical questions about consent and control.

• May be combined with psychological therapy.

A comparison should include similarities as well as differences.

Differences in receptor action

Typical drugs

Typical antipsychotics are usually explained as strong D2 dopamine antagonists.

They reduce dopamine stimulation by blocking receptor sites.

AQA directly assessed this mechanism in 2024.

Atypical drugs

Atypical drugs generally act across dopamine and serotonin systems.

Different drugs vary in:

• Receptor affinity.

• Strength of blockade.

• Duration of receptor occupation.

• Effects in different neural pathways.

The broader mechanism may produce:

• A different range of therapeutic effects.

• A different pattern of side effects.

• Benefits for some patients unresponsive to typical drugs.

Differences in symptoms treated

Typical antipsychotics

Typical drugs are particularly associated with reducing positive symptoms.

These include:

• Hallucinations.

• Delusions.

They are generally less successful for negative symptoms.

AQA identifies this relative effectiveness for positive symptoms as an important evaluative point.

Atypical antipsychotics

Atypical drugs may help a broader symptom range for some patients.

Possible benefits may include:

• Reduction in positive symptoms.

• Improvement in some negative symptoms.

• Improved engagement or mood.

• Benefit when typical drugs have not worked.

However, this broader effect must not be exaggerated.

Some patients continue to experience:

• Avolition.

• Speech poverty.

• Cognitive difficulty.

• Social impairment.

even when positive symptoms improve.

Differences in side effects

Typical-drug side effects

Typical drugs are strongly associated with movement-related side effects because dopamine is blocked in pathways involved in motor control.

Possible effects include:

• Tremors.

• Muscle stiffness.

• Restlessness.

• Involuntary movements.

• Tardive dyskinesia.

Atypical-drug side effects

Atypical drugs are often less likely to produce severe movement effects, particularly at suitable doses.

However, they may cause:

• Weight gain.

• Sedation.

• Changes in physical health.

• Movement effects in some patients.

• Drug-specific risks such as the blood-cell problem associated with clozapine.

The choice is not:

side effects versus no side effects

It is:

one pattern of benefits and risks versus another pattern

Atypical antipsychotics and adherence

Why adherence matters

A medication cannot produce its continuing biological effect when it is not taken as prescribed.

Non-adherence may lead to:

• Loss of symptom control.

• Increased relapse risk.

• Hospital readmission.

• Disrupted psychological treatment.

Why atypical drugs might improve adherence

Some patients may be more willing to continue an atypical antipsychotic if:

• Positive symptoms improve.

• Movement-related effects are less severe.

• The medication feels more tolerable.

• A long-acting preparation simplifies the regimen.

Why adherence may still be poor

Atypical drugs can still produce effects that lead to discontinuation, such as:

• Weight gain.

• Sedation.

• Physical-health concerns.

• Unpleasant emotional or cognitive changes.

• The inconvenience of monitoring.

• Lack of perceived benefit.

The June 2024 examiner report highlighted that side effects become a stronger evaluation point when connected with treatment discontinuation and reduced effectiveness.

Effectiveness of atypical antipsychotics

What does effectiveness mean?

Effectiveness can be measured through:

• Reduction in positive symptoms.

• Reduction in negative symptoms.

• Lower relapse rates.

• Reduced hospital readmission.

• Improved everyday functioning.

• Increased quality of life.

• Ability to remain in treatment.

Different measures may produce different conclusions.

For example, a patient’s hallucination score may improve while:

• Severe weight gain reduces quality of life.

• Avolition remains.

• Employment does not improve.

A complete judgement must consider more than one outcome.

Research support

AQA identifies evidence that atypical drugs such as risperidone may be more effective than typical medication.

This provides support because:

• A comparison with an established treatment is more informative than showing that symptoms change over time.

• It suggests the benefit is not simply due to receiving any medication.

• It may justify selecting an atypical drug where a typical drug has been unsuccessful.

Individual differences

An average advantage does not mean that atypical drugs are superior for every patient.

One person may respond well to:

• Chlorpromazine.

Another may respond better to:

• Risperidone.

• Olanzapine.

• Clozapine.

Another may show limited improvement with several drugs.

Treatment selection should therefore consider:

• Previous response.

• Dominant symptoms.

• Side-effect sensitivity.

• Physical health.

• Patient preference.

• Ability to attend monitoring.

Strength: treatment-resistant schizophrenia

Clozapine has particular practical value because it may help some patients whose symptoms have not responded to other antipsychotics.

This is a significant strength because treatment-resistant patients may otherwise continue to experience:

• Severe hallucinations.

• Persistent delusions.

• Repeated hospitalisation.

• Major disruption to everyday life.

The benefit must be balanced against the need for blood monitoring and the risk of serious side effects.

Strength: broader neurochemical action

Atypical antipsychotics act on more than one neurotransmitter system.

This may offer a broader therapeutic effect than relying only on strong dopamine blockade.

It also supports a more complex biological understanding of schizophrenia involving interacting:

• Dopamine pathways.

• Serotonin systems.

• Brain regions.

However, broader action also means that several bodily and psychological processes may be affected, creating different side effects.

Strength: potentially fewer movement-related effects

Reduced risk of some movement effects may make atypical medication:

• More tolerable.

• More appropriate for long-term use.

• Less disruptive to daily functioning.

• More likely to be taken consistently.

This may indirectly improve effectiveness because a treatment that is tolerated is more likely to be continued.

Counterpoint

Atypical drugs are not free from movement effects.

Risk depends on:

• The individual drug.

• Dosage.

• Length of treatment.

• Individual sensitivity.

The comparison should therefore use terms such as “generally lower risk” rather than “never causes”.

Limitation: serious side effects remain

Atypical drugs can produce significant physical effects.

These can reduce:

• Quality of life.

• Willingness to continue treatment.

• Long-term appropriateness.

• Physical health.

Clozapine’s effect on white blood cells is particularly important because it requires ongoing blood testing.

A drug may therefore offer strong symptom reduction but remain inappropriate for someone who:

• Cannot attend monitoring.

• Develops a dangerous blood result.

• Finds the monitoring unacceptable.

• Experiences side effects outweighing the benefit.

Limitation: weight gain and physical health

Weight gain can have consequences for:

• Self-esteem.

• Physical health.

• Mobility.

• Social confidence.

• Adherence.

A patient may reasonably decide that the cost is too high, especially where symptom improvement is limited.

Professionals should not treat symptom scores as more important than the person’s overall health and experience.

Limitation: medication may mask symptoms

AQA’s 2024 mark scheme accepts the criticism that drug therapy may mask symptoms rather than address their cause.

Atypical antipsychotics may reduce:

• Hallucinations.

• Delusional intensity.

• Agitation.

They may not address:

• Stressful relationships.

• Social isolation.

• Trauma.

• Dysfunctional interpretations.

• Poverty or housing problems.

• Genetic vulnerability.

Medication may therefore manage one biological pathway while leaving wider causes or maintaining factors unchanged.

Counterpoint

Reducing symptoms still has major value.

When hallucinations and delusions become less intense, a patient may be better able to:

• Sleep.

• Communicate.

• Participate in therapy.

• Rebuild relationships.

• Live outside hospital.

A treatment does not need to remove every cause to provide meaningful benefit.

Limitation: relapse following discontinuation

Symptoms may return when medication is stopped.

This raises questions about whether the drug:

• Produces recovery.

• Suppresses symptoms temporarily.

• Requires indefinite use.

• Creates a long-term balance between benefit and side effects.

The June 2022 mark scheme identifies short-term versus long-term benefits, relapse and the revolving-door pattern as relevant evaluation of antipsychotics.

Revolving-door pattern

A possible cycle is:

1. Medication reduces symptoms.

2. The person leaves hospital.

3. Side effects lead to discontinuation.

4. Symptoms return.

5. The person is readmitted.

6. Medication is restarted.

This may indicate problems with:

• Appropriateness.

• Adherence support.

• Psychological care.

• Long-term recovery planning.

Limitation: drug therapy is biologically reductionist

Drug treatment reduces schizophrenia to the action of neurotransmitters and receptors.

This has scientific value because:

• Biological mechanisms can be measured.

• Drug action can be tested.

• Clear predictions can be made.

• Treatments can be compared experimentally.

However, the treatment may overlook:

• Thoughts and interpretations.

• Family interaction.

• Culture.

• Social adversity.

• The meaning of the person’s experiences.

This connects with biological and psychological levels of explanation.

Limitation: ethical issues

Consent

The person should understand:

• Why the drug is recommended.

• Expected benefits.

• Possible side effects.

• Alternatives.

• Monitoring requirements.

Severe psychosis may sometimes affect a person’s ability to make a fully informed decision.

This creates tension between:

• Protecting health and safety.

• Respecting autonomy.

Control

Medication may be experienced as controlling when:

• It is compulsory.

• It is administered by long-acting injection.

• The patient is not involved meaningfully in decisions.

• Side effects are dismissed.

• Medication is used mainly to make behaviour easier to manage.

AQA identifies ethical concerns involving control as a valid criticism of drug therapy.

Blood monitoring and privacy

Clozapine monitoring requires continuing medical information and appointments.

Although necessary for safety, it can be:

• Inconvenient.

• Intrusive.

• Anxiety-provoking.

• Difficult to access.

Treatment remains more ethical when the reasons for monitoring are clearly explained and the patient is involved in decisions.

Limitation: treatment research may be biased

Attrition

Participants may leave drug trials because:

• Side effects are severe.

• The drug is ineffective.

• They do not wish to continue.

• Their condition deteriorates.

If researchers analyse only participants who finish treatment, the drug may appear more effective and acceptable than it is in ordinary practice.

Publication bias

Studies finding a clear benefit may be more likely to be published than studies finding:

• Little difference.

• No benefit.

• Greater harm.

A meta-analysis based mainly on published evidence could therefore overestimate effectiveness.

Different outcome measures

Studies may define success through:

• Lower symptom ratings.

• Reduced relapse.

• Hospital discharge.

• Treatment completion.

• Quality of life.

A drug may appear successful on one outcome but not another.

Evaluating drug therapy more broadly

The 2022 AQA question required students to evaluate antipsychotics and allocated all eight marks to AO3. Relevant areas included:

• Evidence of effectiveness.

• Relative effects on different symptoms.

• Side effects.

• Preventative use.

• Historical benefits.

• Relapse.

• Alternative therapies.

• Economic implications.

A strong answer should therefore develop arguments rather than spend most of the response describing receptor action.

Placebo-controlled trials

Placebo

A placebo is an inactive treatment resembling the real drug.

A placebo comparison helps distinguish pharmacological effects from:

• Patient expectations.

• Attention from professionals.

• Natural symptom changes.

• Passage of time.

Double-blind procedure

In a double-blind procedure:

• Patients do not know whether they receive the active drug or placebo.

• Assessors do not know which treatment each patient received.

This reduces:

• Demand characteristics.

• Expectancy effects.

• Investigator bias.

Ethical concerns

Withholding established treatment from a person with severe symptoms can be ethically problematic.

Researchers may instead compare:

• An atypical drug with a typical drug.

• Two atypical drugs.

• Standard medication with medication plus therapy.

Meta-analysis

A meta-analysis statistically combines findings from several studies.

AQA identified meta-analysis as the appropriate technique for combining drug-treatment results in 2024.

Advantages

• Produces a large combined sample.

• Increases statistical power.

• Reduces dependence on one study.

• Allows an overall treatment effect to be calculated.

• Can compare different drug classes.

Limitations

• Original studies may differ in quality.

• Drugs and doses may vary.

• Symptom measures may differ.

• Patient groups may not be comparable.

• Publication bias may affect the available evidence.

Cost-effectiveness

Possible economic benefits

Atypical antipsychotics may:

• Reduce hospital admission.

• Support community care.

• Allow some people to return to work or education.

• Require less therapist time than intensive psychological treatment.

• Reduce crisis-service use.

Possible economic costs

Costs may include:

• Continuing prescriptions.

• Physical-health monitoring.

• Blood testing for clozapine.

• Treatment of side effects.

• Hospital care following relapse.

• More expensive newer medication.

• Support where negative symptoms remain.

AQA guidance expects economic arguments to be reasoned. Writing only that drugs are “cheap” or “save time” is not sufficient.

Historical and practical value

Antipsychotic drugs transformed the treatment of severe psychosis.

Their use contributed to:

• Reduced long-term institutionalisation.

• Less reliance on physical restraint.

• Greater use of community care.

• Increased access to psychological treatment.

AQA recognises this historical transformation as an important strength of drug therapy.

However, leaving hospital is not identical to full recovery.

Effective community care may also require:

• Housing.

• Family support.

• Psychological therapy.

• Employment support.

• Physical-health care.

Combining atypical drugs with CBT

Medication may reduce the intensity of psychotic symptoms.

Examining beliefs and developing coping strategies may then help the person:

• Consider alternative interpretations.

• Respond differently to voices.

• Reduce distress.

• Improve coping.

• Develop personal explanations of experiences.

The treatments address different levels:

Atypical medication	CBT
Alters neurotransmitter activity	Addresses thoughts and interpretations
May reduce symptom intensity	May reduce distress and improve coping
Biological treatment	Psychological treatment
Requires medication adherence	Requires active participation
Can produce physical side effects	Can be emotionally demanding

Combining atypical drugs with family therapy

Reducing criticism and improving communication may complement medication by:

• Lowering family stress.

• Reducing expressed emotion.

• Supporting adherence.

• Reducing relapse risk.

• Helping relatives understand symptoms.

Medication addresses biological processes, while family therapy addresses the social environment.

Interactionist treatment

A combined approach recognises that schizophrenia may involve:

• Biological vulnerability.

• Neurotransmitter functioning.

• Cognitive interpretation.

• Family stress.

• Wider environmental factors.

Treatment may therefore combine:

atypical antipsychotic + psychological therapy + social support

This is developed fully in combined biological and psychological treatment.

Applying atypical antipsychotics

Scenario 1: treatment resistance

Isaac continues to experience severe hallucinations after trying two other antipsychotic drugs. His psychiatrist recommends clozapine.

A developed answer would state:

• Clozapine is an atypical antipsychotic.

• It may be used where other antipsychotics have not produced sufficient improvement.

• It acts on dopamine and serotonin receptor systems.

• Its broader receptor action may reduce Isaac’s symptoms.

• Regular blood monitoring will be required because of a rare but serious white-blood-cell risk.

Scenario 2: risperidone

After changing from a typical drug to risperidone, Safiya’s delusions remain controlled and her severe muscle tremors decrease.

This suggests that:

• Risperidone is an atypical antipsychotic.

• It acts on dopamine and serotonin systems.

• It continues to control positive symptoms.

• Its side-effect profile may be more appropriate for Safiya.

• The result should not be generalised to every patient.

Scenario 3: weight gain

Daniel experiences fewer voices after starting an atypical antipsychotic but gains considerable weight and wants to stop taking it.

This demonstrates:

• Effectiveness against a positive symptom.

• A serious cost affecting physical health and quality of life.

• Reduced treatment appropriateness.

• Possible non-adherence.

• An increased risk of relapse if medication is stopped without an alternative plan.

Scenario 4: negative symptoms remain

Priya’s hallucinations improve after taking olanzapine, but she continues to experience severe avolition.

This shows that:

• The drug has reduced a positive symptom.

• It has not treated every aspect of schizophrenia.

• Atypical drugs do not guarantee improvement in negative symptoms.

• Additional psychological and practical support may be needed.

Scenario 5: long-acting medication

Kai frequently forgets tablets, and his symptoms repeatedly return. His care team suggests a long-acting atypical injection.

Possible benefits include:

• Fewer missed doses.

• More stable medication delivery.

• Reduced relapse caused by accidental non-adherence.

Possible concerns include:

• Invasiveness.

• Loss of control.

• Side effects continuing after injection.

• The need for informed consent.

A direct comparison strategy

When asked to compare, do not write two unconnected descriptions.

Weak:

Typical drugs block dopamine. Atypical drugs affect serotonin.

Stronger:

Typical antipsychotics primarily use strong D2 dopamine-receptor blockade, whereas atypical drugs generally act across dopamine and serotonin systems. Both can reduce positive symptoms, but atypical drugs often produce a different side-effect profile and may benefit some patients who do not respond to typical medication.

Useful comparison words include:

• Both.

• Whereas.

• In contrast.

• Similarly.

• Unlike.

• However.

Structuring an eight-mark evaluation

Because AQA’s 2022 antipsychotic question was entirely AO3, an effective answer could contain four developed evaluation paragraphs.

Paragraph 1: effectiveness

• Evidence involving risperidone or drug comparisons.

• Explain what improved.

• Consider whether all patients respond.

Paragraph 2: symptom specificity

• Positive symptoms may respond more successfully.

• Negative symptoms may remain.

• Define what counts as successful treatment.

Paragraph 3: side effects and adherence

• Identify a specific side effect.

• Explain its effect on quality of life.

• Connect it to discontinuation and relapse.

Paragraph 4: broader appropriateness

• Masking symptoms.

• Ethical control.

• Comparison with CBT or family therapy.

• Reach a balanced conclusion.

Overall conclusion

Atypical antipsychotics are second-generation biological treatments that act on dopamine and serotonin receptor systems.

Clozapine may benefit some people whose symptoms have not responded to other medication, although its serious white-blood-cell risk requires regular monitoring. Risperidone and olanzapine provide alternative receptor and side-effect profiles.

Compared with typical medication, atypical drugs may:

• Treat a broader range of symptoms for some patients.

• Produce fewer severe movement effects.

• Improve adherence where they are better tolerated.

However, they can still cause:

• Weight gain.

• Sedation.

• Physical-health risks.

• Movement effects.

• Relapse following discontinuation.

The most appropriate treatment depends on the individual balance of:

symptom reduction + side effects + physical health + consent + adherence + quality of life

Atypical medication is most convincing as one part of an interactionist care plan rather than a complete cure for schizophrenia.

Hints from the Examiner Reports 💡

Examiner hint: When a question asks you to evaluate antipsychotics, prioritise AO3.

The June 2022 question allocated all eight marks to evaluation. Spending most of the answer describing receptors would therefore miss the command.

Examiner hint: Use specific comparative evidence.

AQA’s mark scheme accepts Bagnall’s finding concerning risperidone being more effective than typical antipsychotics. Explain the implication rather than merely naming the study.

Examiner hint: Do not claim atypical drugs have no side effects.

Compare the type or likelihood of side effects rather than writing:

“Typical drugs cause side effects, but atypical drugs do not.”

Examiner hint: Distinguish drug classes precisely:

• Chlorpromazine is typical.

• Clozapine, risperidone and olanzapine are atypical.

Examiner hint: Develop side-effect evaluation:

side effect → effect on quality of life → non-adherence → possible relapse

A list of side effects without consequences is less effective.

Examiner hint: AQA accepts masking symptoms rather than addressing causes as a criticism of drug therapy. Explain which psychological or social factors remain untreated.

Examiner hint: Use cautious claims about effectiveness.

A study finding an average advantage for risperidone does not demonstrate that it will be superior for every patient.

Examiner hint: Compare directly rather than writing two separate mini-essays.

Use phrases such as:

“Both drugs reduce dopamine activity, whereas atypical drugs generally have a broader action involving serotonin.”

Examiner hint: Meta-analysis is the appropriate technique for combining findings from several drug studies.

Examiner hint: Explain economic points. Avoid unsupported statements such as “drugs are cheap”. Discuss prescription costs, blood monitoring, hospital admission or treatment of side effects.

Examiner hint: Balance effectiveness with appropriateness. A drug may reduce hallucinations but remain unsuitable because of serious physical effects or unacceptable monitoring.

Common Mistakes ⚠️

Mistake: Saying atypical means unusual or rarely prescribed

Why this is incorrect:

The term identifies the newer second-generation class.

How to improve:

Contrast atypical with older first-generation typical drugs.

Mistake: Calling chlorpromazine an atypical drug

Why this is incorrect:

Chlorpromazine is a typical antipsychotic.

How to improve:

Remember:

chlorpromazine = typicalclozapine = atypical

Mistake: Confusing clozapine and chlorpromazine

Why this is incorrect:

They belong to different drug classes and have different risk profiles.

How to improve:

Use the drug-class comparison table when revising.

Mistake: Saying all atypical drugs work identically

Why this is incorrect:

Clozapine, risperidone and olanzapine have different receptor and side-effect profiles.

How to improve:

Use “atypical drugs generally…” and identify drug-specific features where relevant.

Mistake: Saying atypical drugs increase dopamine

Why this is incorrect:

Their antipsychotic effects involve reducing or modifying dopamine activity.

How to improve:

Explain antagonism at dopamine receptors.

Mistake: Saying atypical drugs act only on serotonin

Why this is incorrect:

They also affect dopamine receptors.

How to improve:

Refer to combined dopamine and serotonin receptor action.

Mistake: Saying serotonin is the positive-symptom neurotransmitter

Why this is oversimplified:

Positive symptoms are strongly linked with excessive dopamine activity in the revised dopamine hypothesis.

How to improve:

Use serotonin to explain the broader action of atypical medication.

Mistake: Saying clozapine is always prescribed first

Why this is inaccurate:

Its serious blood-related risk and monitoring requirements limit its suitability.

How to improve:

Explain its value where other drugs have not worked sufficiently.

Mistake: Saying agranulocytosis means weight gain

Why this is incorrect:

It refers to a serious reduction in white blood cells.

How to improve:

Connect it with infection risk and blood monitoring.

Mistake: Saying a blood test makes clozapine completely safe

Why this is too strong:

Monitoring reduces risk by detecting dangerous changes but cannot remove every possible side effect.

How to improve:

Describe monitoring as risk management.

Mistake: Saying atypical drugs cause no movement effects

Why this is incorrect:

The risk is often lower, not absent.

How to improve:

Use comparative language.

Mistake: Saying atypical drugs cure negative symptoms

Why this is too absolute:

Some patients may experience broader improvement, while negative symptoms often remain.

How to improve:

State that effectiveness varies by drug, patient and symptom.

Mistake: Assuming fewer side effects automatically means greater effectiveness

Why this is incorrect:

Tolerability and symptom reduction are separate outcomes.

How to improve:

Evaluate effectiveness and appropriateness independently.

Mistake: Claiming risperidone evidence proves all atypicals are superior

Why this is incorrect:

One drug or study cannot represent every atypical medication and patient.

How to improve:

Use it as supporting rather than conclusive evidence.

Mistake: Listing side effects without explaining adherence

Why this is incomplete:

The examiner needs the consequence for treatment.

How to improve:

Explain how an unwanted effect may cause discontinuation and relapse.

Mistake: Saying drug therapy addresses family dysfunction

Why this is incorrect:

Medication acts biologically.

How to improve:

Use improving family interaction for family stress.

Mistake: Saying successful medication proves dopamine caused schizophrenia

Why this is incorrect:

Treatment may interrupt a symptom pathway without identifying the original cause.

How to improve:

State that effectiveness supports dopamine involvement.

Mistake: Discussing only benefits when asked to evaluate

Why this is incomplete:

Evaluation requires a balanced assessment.

How to improve:

Include evidence, side effects, adherence, ethics and alternative treatments.

Exam-Style Questions ✍️

Questions

1. Name one atypical antipsychotic used in the treatment of schizophrenia.[1 mark]

2. Explain one way in which atypical antipsychotics differ from typical antipsychotics.[3 marks]

3. Explain why clozapine requires regular blood monitoring.[3 marks]

4. Explain how atypical antipsychotics are linked with biological explanations of

schizophrenia.[4 marks]

5. A patient continues to experience severe hallucinations despite taking two other antipsychotic drugs. A psychiatrist recommends clozapine.

Explain why clozapine might be selected and identify one issue affecting its appropriateness.[5 marks]

6. Imogen changes from a typical antipsychotic to risperidone. Her delusions remain controlled, and her severe muscle tremors become less noticeable.

Explain two possible advantages of risperidone in Imogen’s case.[4 marks]

7. Explain two differences and one similarity between typical and atypical antipsychotics.[6 marks]

8. Researchers compare an atypical and a typical antipsychotic. After six months, they record the following results:

Treatment	Patients showing substantial symptom improvement	Number beginning treatment
Atypical antipsychotic	42	60
Typical antipsychotic	33	60

a) Calculate the percentage showing substantial improvement in the atypical group.[2 marks]

b) Calculate the percentage showing substantial improvement in the typical group.[2 marks]

c) Explain one conclusion and one limitation of these results.[4 marks]

9. Outline one strength and one limitation of atypical antipsychotics as a treatment for

schizophrenia.[6 marks]

10. Evaluate drug therapy as a treatment for schizophrenia.[8 marks]

11. Discuss atypical antipsychotics as a treatment for schizophrenia. Refer to the following scenario in your answer.

Marcus continues to hear distressing voices after taking a typical antipsychotic. Clozapine reduces the voices, but Marcus dislikes attending regular blood tests and gains a considerable amount of weight. He begins missing doses. His care team recommends combining medication with cognitive behaviour therapy.

[16 marks]

Answers and Mark Scheme

Question 1

Award one mark for one suitable example:

• Clozapine.

• Risperidone.

• Olanzapine.

Question 2

Award up to three marks for one developed difference.

Possible answer:

• Typical antipsychotics are mainly described as strong dopamine D2 antagonists.

• Atypical antipsychotics generally act on dopamine and serotonin receptor systems.

• Their broader receptor action produces a different pattern of therapeutic effects and side effects.

Alternative differences include:

• Generation.

• Treatment-resistant use.

• Movement-side-effect risk.

• Blood monitoring for clozapine.

• Possible effects on a broader symptom range.

Question 3

Award up to three marks:

• Clozapine can cause a rare but serious reduction in white blood cells.

• White blood cells help protect the body against infection.

• Regular blood tests identify dangerous changes early.

• Treatment can then be stopped or altered where necessary.

Question 4

Award up to four marks:

• Biological explanations link schizophrenia with abnormal neurotransmitter activity.

• Atypical antipsychotics act on dopamine and serotonin receptor systems.

• Blocking dopamine receptors reduces dopamine stimulation in relevant pathways.

• This may reduce positive symptoms such as hallucinations and delusions.

• Their effectiveness supports neurotransmitter involvement but does not prove the original cause.

Question 5

Award up to five marks:

• Clozapine is an atypical antipsychotic.

• It may be used where other antipsychotics have failed to produce sufficient improvement.

• It acts across dopamine and serotonin receptor systems.

• Its broader action may reduce the persistent hallucinations.

• It carries a rare risk of a serious reduction in white blood cells.

• Regular blood monitoring is therefore necessary.

• The monitoring burden or physical risk may reduce its appropriateness.

Question 6

Award up to four marks:

• Risperidone continues to control Imogen’s positive symptom, showing effectiveness.

• The reduction in tremors suggests a more tolerable side-effect profile for Imogen.

• Improved tolerability may increase adherence.

• Continued treatment may reduce her risk of relapse.

• The result is individual and does not show risperidone is superior for every patient.

Question 7

Award up to six marks.

Possible content:

• Typical drugs are older first-generation medications, whereas atypical drugs are newer second-generation medications.

• Typical drugs are mainly associated with strong D2 blockade, whereas atypical drugs generally affect dopamine and serotonin systems.

• Typical drugs have a greater general risk of severe movement effects, whereas atypical drugs often have different risks such as weight gain.

• Clozapine may be used in treatment-resistant cases, unlike ordinary first-line use of typical drugs.

• Both are biological treatments.

• Both affect dopamine activity.

• Both can reduce positive symptoms.

• Both can cause side effects and raise adherence issues.

Higher marks require explicit comparison.

Question 8a

6042​×100=70%

Award:

• One mark for suitable working.

• One mark for 70%.

Question 8b

6033​×100=55%

Award:

• One mark for suitable working.

• One mark for 55%.

Question 8c

Award up to four marks.

Possible conclusion:

• A greater percentage improved with the atypical antipsychotic.

• The difference was 15 percentage points.

• This is consistent with the atypical drug being more effective for this sample.

Possible limitation:

• No inferential-test result is given, so statistical significance cannot be claimed.

• The results do not show side effects or treatment withdrawals.

• The drugs, dosages or initial symptom severity may differ.

• Substantial improvement may have been defined subjectively.

• The findings concern group averages rather than every patient.

Question 9

Award up to three marks for a developed strength and three marks for a developed limitation.

Possible strength:

Atypical antipsychotics may benefit patients who have not responded to typical drugs. Clozapine therefore provides a valuable option for treatment-resistant schizophrenia and can reduce otherwise persistent positive symptoms.

Possible limitation:

Atypical drugs can produce serious side effects. Clozapine may reduce white blood cells and requires regular monitoring, while other atypicals may produce substantial weight gain. These effects can reduce appropriateness and adherence.

Alternative creditworthy points include:

• Reduced movement-side-effect risk.

• Evidence involving risperidone.

• Broader receptor action.

• Relapse following discontinuation.

• Masking symptoms.

• Ethical issues.

• Individual differences.

Question 10

A strong answer should include:

• Evidence that antipsychotics reduce symptoms.

• Bagnall’s evidence concerning risperidone.

• Chlorpromazine comparisons and broader supporting research.

• Greater effectiveness of typical drugs for positive symptoms.

• Possible broader benefits of atypical drugs.

• Individual differences in response.

• Side effects of both drug classes.

• Movement-related effects.

• Weight gain and physical-health effects.

• Clozapine and blood monitoring.

• Side effects reducing adherence.

• Relapse following discontinuation.

• Short-term versus long-term effectiveness.

• Historical reduction in institutionalisation.

• Medication masking symptoms rather than addressing causes.

• Economic benefits and monitoring costs.

• Ethical issues involving consent and control.

• Comparison with CBT and family therapy.

• Benefits of combined treatment.

• Problems in drug trials, including attrition or publication bias.

Because AQA’s 2022 question allocated all eight marks to AO3, the answer should remain evaluative rather than becoming a lengthy description of receptor action.

Question 11

A strong response should include:

Knowledge and understanding

• Atypical antipsychotics as second-generation drugs.

• Clozapine.

• Dopamine and serotonin receptor action.

• Reduction of excessive dopamine effects.

• Use in treatment-resistant schizophrenia.

• Oral medication and maintenance treatment.

• Requirement for blood monitoring.

• Comparison with typical D2-blocking drugs.

• Effects on positive symptoms.

• Possible broader symptom effects.

Application

• Marcus’s voices are auditory hallucinations and positive symptoms.

• The typical drug has not reduced them sufficiently.

• Clozapine is selected because it may benefit treatment-resistant patients.

• The reduction in voices demonstrates effectiveness.

• Regular blood tests are linked with the risk of reduced white blood cells.

• Marcus finds monitoring inconvenient, reducing appropriateness.

• Weight gain is an unwanted physical effect.

• These costs contribute to missed doses.

• Missing doses reduces continuing receptor action.

• Symptoms may return, increasing relapse risk.

• CBT may help Marcus respond to voices and develop alternative interpretations.

Evaluation

• Evidence suggests some atypical drugs may outperform typical drugs.

• Group evidence does not guarantee individual improvement.

• Clozapine provides an important treatment-resistant option.

• Serious side effects require cost-benefit analysis.

• Blood monitoring improves safety but creates inconvenience and expense.

• Weight gain may affect physical health and adherence.

• Better tolerability can improve long-term effectiveness.

• Atypicals still produce side effects.

• Medication may manage symptoms without treating psychological or social causes.

• Treatment effectiveness supports neurotransmitter involvement but not original causation.

• Discontinuation and relapse limit long-term effectiveness.

• Consent and patient choice affect ethical appropriateness.

• CBT can address interpretations and coping that medication does not.

• Combined therapy reflects an interactionist approach.

• Treatment should be judged using quality of life as well as symptom reduction.

Higher-level responses will compare atypical and typical drugs accurately, apply each element of the scenario and balance biological effectiveness against monitoring, side effects, adherence, autonomy and psychological treatment.