Least Extrapyrimidal S/E are seen in
**Core Concept**
Extrapyramidal side effects (EPS) are a group of movement disorders associated with the use of antipsychotic medications, particularly those with strong dopamine D2 receptor antagonism. These side effects include dystonia, akathisia, parkinsonism, and tardive dyskinesia.
**Why the Correct Answer is Right**
The least EPS are seen with **Atypical antipsychotics**, which have a lower affinity for dopamine D2 receptors and a higher affinity for serotonin 5-HT2A receptors. This unique pharmacological profile allows atypical antipsychotics to reduce the risk of EPS while still providing therapeutic effects. The lower risk of EPS is particularly notable with medications like Clozapine, Quetiapine, and Olanzapine.
**Why Each Wrong Option is Incorrect**
**Option A:** **Typical antipsychotics** have a high affinity for dopamine D2 receptors, which increases the risk of EPS. Medications like Haloperidol and Fluphenazine are more likely to cause EPS due to their strong D2 receptor antagonism.
**Option B:** **Metoclopramide** is a prokinetic agent that also has antipsychotic properties, but it is not an antipsychotic medication in the classical sense. Its use is associated with a high risk of EPS due to its strong dopamine D2 receptor antagonism.
**Option C:** **Reserpine** is an antipsychotic medication that depletes dopamine and norepinephrine stores, leading to a high risk of EPS. Its use is associated with a range of severe side effects, including EPS.
**Clinical Pearl / High-Yield Fact**
When choosing an antipsychotic medication, consider the patient's risk of EPS and choose an atypical antipsychotic if possible. Always monitor patients for signs of EPS, especially during the initial treatment phase.
**Correct Answer: C. Reserpine**