Why are second-generation antipsychotics (SGAs) typically considered the first-line treatment for psychotic symptoms?

Second-generation antipsychotics (SGAs) are typically considered the first-line treatment for psychotic symptoms primarily due to their lower side effect profile compared to first-generation antipsychotics (FGAs).

SGAs tend to produce fewer extrapyramidal symptoms (EPS), which include involuntary movements and stiffness, as well as less severe tardive dyskinesia, which can occur with prolonged usage of FGAs. This improved tolerability enhances patient compliance with treatment, as the side effects are often a significant factor in patients' willingness to continue medication. The reduced side effects associated with SGAs make them a preferred choice, especially in populations that might be sensitive to these adverse effects, such as the elderly or those with existing movement disorders.

While effectiveness is important, both SGAs and FGAs can be effective in managing psychotic symptoms, and SGAs are not universally more effective than FGAs. Cost factors can vary widely based on healthcare plans and availability, and while SGAs may lead to fewer hospitalizations due to better management of symptoms and compliance, this is a secondary benefit rather than the primary reason they are considered first-line agents. Therefore, the primary driver for the recommendation of SGAs is indeed their more favorable side effect profile.