In unspecified psychosis, the first-line pharmacologic treatment is which class?

• A. First-generation antipsychotics
• B. Second-generation antipsychotics
• C. Antidepressants
• D. Benzodiazepines

Answer: (B)

Second-generation (atypical) antipsychotics are used first for unspecified psychosis because they treat psychotic symptoms effectively while generally causing fewer movement-related side effects than older, first-generation drugs. They block dopamine pathways to reduce delusions and hallucinations, and their additional action on serotonin receptors helps lessen these motor side effects and may help with mood and some negative symptoms. This favorable tolerability improves adherence and allows treatment to focus on controlling symptoms rather than managing EPS. However, they can cause metabolic changes like weight gain and blood sugar or lipid problems, so monitoring is important. Agents like clozapine are reserved for when others fail, and antidepressants or benzodiazepines aren’t primary treatments for the psychosis itself, though they may be used for coexisting symptoms or agitation.