Second-Generation Antipsychotics: Identifying the Incorrect Characteristic
The statement "Has effects limited to positive symptoms, with no effect on negative symptoms" is NOT a general characteristic of second-generation antipsychotics—this is the incorrect option.
Understanding Second-Generation Antipsychotic Properties
The question asks you to identify which characteristic does NOT apply to second-generation antipsychotics. Let me break down each option:
Effects on Positive vs. Negative Symptoms
- Second-generation antipsychotics DO have effects on negative symptoms, contrary to the first option 1, 2
- A 2009 meta-analysis of 150 studies with 21,533 participants found that several second-generation antipsychotics (amisulpride, clozapine, olanzapine, risperidone) showed efficacy for overall symptoms, though the effect on negative symptoms specifically was not consistently superior across all agents 1
- Second-generation antipsychotics provide "at least modest promise of reduction of negative symptoms and enhancement of some aspects of cognition," unlike first-generation agents which "had little or no effect on the most disabling, core symptoms associated with withdrawal of interests and interpersonal relationships" 2
- This makes the first statement FALSE and therefore the correct answer to identify
Lower Incidence of Extrapyramidal Symptoms (EPS)
- Second-generation antipsychotics ARE associated with lower EPS compared to high-potency first-generation agents 1, 3, 4
- The 2009 meta-analysis confirmed that second-generation drugs "induced fewer extrapyramidal side-effects than did haloperidol (even at low doses)" 1
- A 2017 review stated that "the incidence of treatment-emergent extrapyramidal side effects is lower" with second-generation agents 3
- This statement is TRUE about second-generation antipsychotics
Better Tolerability
- Second-generation antipsychotics ARE generally more easily tolerated than first-generation agents 3, 2
- Evidence indicates that second-generation drugs "show an improved safety and tolerability profile compared with FGAs" with "less impairment of cognitive function and treatment-related negative symptoms" 3
- They have "strikingly less morbidity, contributing little or no EPS" 2
- This statement is TRUE about second-generation antipsychotics
Cognitive Improvement
- Second-generation antipsychotics HAVE been found to improve cognition 3, 2
- They provide "enhancement of some aspects of cognition" 2
- There is "less impairment of cognitive function" compared to first-generation agents 3
- This statement is TRUE about second-generation antipsychotics
Critical Clinical Context
Important caveat: The traditional classification system distinguishing first- from second-generation antipsychotics is "clinically misleading and should not guide treatment selection" according to current guidelines 5, 6. Treatment decisions should be based on individual drug pharmacodynamic profiles, side-effect profiles, and patient-specific factors rather than generational labels 5, 6.