Which of the following has the highest risk for EPS among the SGA medications?

Risperidone is recognized for having a higher propensity to cause extrapyramidal symptoms (EPS) compared to other second-generation antipsychotic (SGA) medications listed. This is primarily due to its relatively higher affinity for D2 dopamine receptors, which is associated with the development of EPS. Although all SGAs have a lower risk for EPS than first-generation antipsychotics, risperidone can still significantly influence the dopaminergic pathways responsible for motor control, leading to symptoms such as tremors, rigidity, and bradykinesia.

In contrast, clozapine is known for a very low risk of EPS, making it often the preferred choice for treatment-resistant schizophrenia due to its unique mechanism that impacts D4 receptors more than D2. Olanzapine and quetiapine, while also associated with some risk for EPS, typically have lower rates of these symptoms compared to risperidone, due to their stronger antagonistic properties at serotonin receptors alongside dopamine receptors. This balance contributes to their overall lower likelihood of inducing EPS. Thus, the higher risk associated with risperidone stands out clearly among the options presented.