Which side effect profile is most associated with typical antipsychotics compared to atypical antipsychotics?

• A. Typical have higher EPS and hyperprolactinemia; Atypicals have lower EPS but higher metabolic risks.
• B. Atypicals have higher EPS and hyperprolactinemia; Typical have lower EPS but higher metabolic risks.
• C. Typical have no metabolic effects; Atypicals cause lipid changes.
• D. Typical improve cognition; Atypicals worsen cognition.

Answer: (A)

Blockade of D2 receptors in different brain pathways underlies the differences here. Typical antipsychotics are strong D2 antagonists, especially in the nigrostriatal pathway, which leads to extrapyramidal symptoms (EPS) and in the tuberoinfundibular pathway, to elevated prolactin levels. Atypical antipsychotics also block D2, but their receptor profile—particularly 5-HT2A antagonism—reduces EPS and prolactin elevation, even though they often bring metabolic side effects like weight gain, dyslipidemia, and glucose intolerance. That combination makes the described pattern the best fit: typicals with higher EPS and hyperprolactinemia, atypicals with lower EPS but greater metabolic risk. Note that some atypicals can still raise prolactin (and some typicals can have metabolic effects), but the overall trend aligns with this option.