Which of the following is a side effect of first-generation antipsychotics?

• A. Weight gain.
• B. Parkinsonism, tardive dyskinesia, orthostatic hypotension.
• C. Hypotension with peripheral edema.
• D. Hyperglycemia in all patients.

Answer: (B)

First-generation antipsychotics block D2 receptors in the nigrostriatal pathway, which disrupts dopaminergic signals that control movement. This leads to extrapyramidal symptoms, including Parkinsonism (tremor, rigidity, slowed movement) and tardive dyskinesia with long-term use. They also block alpha-1 adrenergic receptors, causing orthostatic hypotension. These motor and autonomic effects are classic for typical antipsychotics. In contrast, metabolic issues like weight gain and hyperglycemia are more characteristic of second-generation antipsychotics, so the combination of Parkinsonism, tardive dyskinesia, and orthostatic hypotension best reflects the side effect profile of first-generation antipsychotics.