Why do traditional antipsychotics have a high risk of extrapyramidal symptoms?

• A. They block dopamine receptors in the nigrostriatal pathway
• B. They only affect serotonin receptors
• C. They increase dopamine in mesolimbic pathways
• D. They primarily target GABA receptors

Answer: (A)

Traditional antipsychotics raise EPS risk because they block dopamine D2 receptors throughout the brain, including the nigrostriatal pathway, which governs movement. When D2 signaling in this motor pathway is inhibited, motor control becomes impaired, leading to extrapyramidal symptoms such as acute dystonia, parkinsonism, akathisia, and tardive dyskinesia. While blocking D2 in the mesolimbic pathway helps reduce positive psychotic symptoms, the same receptor blockade in the nigrostriatal tract drives EPS. Other options don’t fit because serotoning receptor effects alone don’t cause EPS, increasing dopamine in the mesolimbic pathway wouldn’t produce the same motor symptoms, and GABA receptors aren’t the primary target for these antipsychotics.