PSYX 340 Psychological Disorders · Unit 3: Psychosis, personality and childhood · on Exam 3
3.2 Treating schizophrenia and other severe disorders
Study notes for Treating schizophrenia and other severe disorders in PSYX 340 Psychological Disorders at Montana State University: the big ideas, a worked example, common mistakes and an exam tip. The same topic has endless practice questions and flashcards in Mathub.
Big ideas
- Before the 1950s, institutional care was the norm; milieu therapy (a therapeutic community) and the token economy (operant rewards for desired behaviors) improved hospital care.
- First-generation antipsychotics (chlorpromazine, haloperidol) block dopamine D2 receptors and reduce positive symptoms. Side effects include extrapyramidal effects (Parkinsonian symptoms, dystonia, akathisia), tardive dyskinesia (involuntary movements that can be permanent) and, rarely, neuroleptic malignant syndrome.
- Second-generation (atypical) antipsychotics (clozapine, risperidone, olanzapine, aripiprazole) cause fewer movement side effects and may help some negative symptoms, but can cause weight gain, diabetes and other metabolic problems. Clozapine works for many treatment-resistant patients but requires blood monitoring for agranulocytosis.
- Psychotherapy helps alongside medication: CBT for psychosis (testing beliefs about voices), family therapy and psychoeducation (lower expressed emotion, fewer relapses), social skills training and supported employment.
- Deinstitutionalization moved people out of hospitals; effective community mental health includes coordinated care, short-term hospitalization, halfway houses and assertive community treatment. Where community care was underfunded, many people became homeless or incarcerated. Coordinated specialty care for a first episode of psychosis improves outcomes.
Worked example
After years on haloperidol, a patient develops involuntary lip-smacking and tongue movements that continue after the dose is lowered. What is this and why did it happen?
Show the solution
Tardive dyskinesia, a late-appearing extrapyramidal side effect of long-term first-generation antipsychotics, linked to dopamine blockade in movement pathways. It can be permanent, which is one reason second-generation drugs are preferred when possible.
Common mistakes
- Saying atypical antipsychotics have no side effects. They trade movement effects for metabolic ones.
- Believing drugs alone are enough. Family and community support strongly affect relapse.
- Crediting the token economy with curing schizophrenia. It improved behavior in hospitals, but gains often did not carry over.
Exam tipMake a two-column drug table (first vs second generation: examples, target, side effects). Tardive dyskinesia and clozapine’s blood monitoring are favorite details.
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