Which statement about extrapyramidal symptoms risk is correct?

• A. Both have equal risk
• B. Atypical antipsychotics have higher EPS risk
• C. Typical antipsychotics have higher EPS risk
• D. Neither has EPS risk

Answer: (C)

Extrapyramidal symptoms arise mainly from blocking dopamine D2 receptors in the brain’s motor pathways. Typical (first-generation) antipsychotics are strong D2 antagonists in the nigrostriatal pathway, which directly drives a higher chance of EPS such as acute dystonia, drug-induced parkinsonism, and akathisia. Atypical (second-generation) antipsychotics also block D2 but add serotonin-2A antagonism, which helps balance dopamine release and reduces the likelihood of these motor side effects. Because of this difference in action, the general pattern is that typical antipsychotics carry a higher risk of EPS than atypical ones. Some atypicals can still cause EPS at higher doses, but the overall risk is lower.