Which of the following antipsychotic has Akathisia as its side effect?
**Core Concept**
Akathisia is a movement disorder characterized by subjective feelings of restlessness and objective signs of agitation, typically associated with the use of antipsychotic medications. It is a form of extrapyramidal side effect (EPS) caused by dopamine receptor blockade, particularly D2 receptor antagonism.
**Why the Correct Answer is Right**
Haloperidol, a typical antipsychotic, acts primarily as a dopamine D2 receptor antagonist. By blocking these receptors, haloperidol disrupts the normal dopaminergic transmission, leading to an imbalance in the nigrostriatal pathway. This imbalance results in the development of EPS, including akathisia. The risk of akathisia is higher with high-potency antipsychotics like haloperidol, which have a higher affinity for D2 receptors.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because risperidone, an atypical antipsychotic, has a lower risk of akathisia due to its partial agonist activity at D2 receptors, which reduces the risk of EPS.
**Option B:** This option is incorrect because olanzapine, another atypical antipsychotic, has a lower risk of akathisia due to its weak affinity for D2 receptors and strong affinity for serotonin 5-HT2A receptors, which reduces the risk of EPS.
**Option C:** This option is incorrect because quetiapine, an atypical antipsychotic, has a lower risk of akathisia due to its weak affinity for D2 receptors and strong affinity for serotonin 5-HT2A receptors, which reduces the risk of EPS.
**Clinical Pearl / High-Yield Fact**
To remember the risk of EPS, including akathisia, use the mnemonic "FIRST": "F" for first-generation antipsychotics (typical antipsychotics like haloperidol) have a higher risk of EPS, "I" for high-potency antipsychotics have a higher risk of EPS, "R" for risperidone and other atypical antipsychotics have a lower risk of EPS, "S" for serotonin antagonism reduces the risk of EPS, and "T" for typical antipsychotics have a higher risk of EPS.
**Correct Answer:** C. Haloperidol.