First-generation antipsychotics are more likely than second-generation to cause which side effect?

• A. False
• B. True
• C. Some extrapyramidal symptoms
• D. Only at high doses

Answer: (B)

Extrapyramidal symptoms come from blocking dopamine D2 receptors in the nigrostriatal motor pathway. First-generation (typical) antipsychotics are potent D2 antagonists with limited serotonin modulation, so they more strongly suppress dopamine in motor circuits. This leads to a higher risk of EPS such as dystonia, parkinsonism, akathisia, and tardive dyskinesia. Second-generation (atypical) antipsychotics also block D2 but include 5-HT2A antagonism, which helps modulate dopamine release and reduces EPS risk. Thus, the statement that first-generation antipsychotics are more likely to cause extrapyramidal symptoms is true. EPS can still occur with some atypicals at higher doses or with certain agents, but the overall risk is higher with typical antipsychotics.