Extrapyramidal Effects of First and Second Generation Antipsychotics: A Review

Abstract

Antipsychotics are essential for treating major psychiatric disorders like schizophrenia. Second-generation antipsychotics were developed to reduce the risk of extrapyramidal symptoms (EPS) caused by antipsychotic medications. While second-generation drugs have a lower risk of EPS than first-generation treatments, studies show that they can still cause EPS, with clozapine being the least risky and risperidone the most. A literature search of PubMed and Scopus databases until April 2023 found that high doses, a history of past EPS, comorbidities, and specific second-generation medications can increase the risk of EPS. The choice of a first-generation comparator also influences study findings. Although the prevalence and severity of EPS vary with antipsychotics, these medications have not met expectations in terms of tolerability. EPS is still a clinical issue, even in the era of second-generation antipsychotics. This review offers a concise overview of EPS induced by antipsychotics.