Compared with typical antipsychotics, olanzapine and other atypical antipsychotics tend to cause which of the following side effects?

• A. Increases EPS
• B. Decreases EPS
• C. No effect on EPS
• D. Causes tardive dyskinesia

Answer: (B)

The key point is how atypical antipsychotics differ from typical ones in affecting motor symptoms. Typical antipsychotics block dopamine D2 receptors strongly, especially in the nigrostriatal pathway, which leads to extrapyramidal symptoms (EPS) like dystonia, parkinsonism, akathisia, and tardive dyskinesia. Atypical antipsychotics, including olanzapine, still block D2 receptors but also antagonize serotonin 5-HT2A receptors. This 5-HT2A blockade modulates dopamine release and helps preserve nigrostriatal dopamine activity, reducing the risk of EPS. So, relative to typical antipsychotics, olanzapine and other atypicals tend to decrease EPS. They may introduce other side effects (such as metabolic issues or weight gain) and tardive dyskinesia risk is lower but not entirely absent, which is why the best answer is that EPS risk is decreased with atypicals.