What class of antipsychotics is typically associated with a higher occurrence of extrapyramidal side effects?

The class of antipsychotics most commonly associated with a higher occurrence of extrapyramidal side effects is phenothiazines. These medications, which include well-known agents like chlorpromazine and fluphenazine, work by blocking dopamine receptors in the brain, particularly D2 receptors. This mechanism can lead to various movement disorders, such as rigidity, tremors, and akathisia, characteristic of extrapyramidal symptoms.

Phenothiazines are first-generation antipsychotics, often referred to as typical antipsychotics, and they are known for their strong dopamine antagonist properties. Since dopamine plays a critical role in movement control, the blockade of its receptors manifests as extrapyramidal side effects, making this class of drugs particularly problematic in this regard.

In contrast, atypical antipsychotics generally have a lower risk of causing these side effects due to their more complex mechanism of action, which often involves serotonin receptor antagonism alongside dopamine receptor blockade. Thienobenzodiazepines and butyrophenones, while also having potential side effects, do not have the same profile of extrapyramidal symptoms as phenothiazines. Thus, the association between phenothiazines and a higher occurrence of extrapyramidal side effects