Which of the following has the highest risk for EPS?

A. Lacks empathy. Individuals with narcissistic personality disorder (NPD) show a profound lack of empathy, often disregarding the feelings and needs of others. They may appear emotionally detached and struggle to recognize or validate other people’s experiences, leading to superficial and exploitative relationships.

B. Takes advantage of others. A key characteristic of NPD is a pattern of exploiting others for personal gain, whether in professional, social, or personal relationships. Individuals with NPD often manipulate people to maintain their sense of superiority and entitlement, showing little remorse for their actions.

C. Needs constant admiration. People with NPD have an excessive need for admiration and validation to support their inflated self-image. They may seek praise, attention, and recognition, becoming defensive or hostile when they feel unappreciated or criticized.

D. Mood swings. While mood instability can occur in response to narcissistic injury (perceived criticism or rejection), frequent and extreme mood swings are more characteristic of borderline personality disorder (BPD) or mood disorders like bipolar disorder. NPD primarily involves grandiosity, entitlement, and emotional detachment, rather than rapid emotional shifts.

A. Haloperidol (Haldol) is a first-generation (typical) antipsychotic, which has a higher risk of extrapyramidal symptoms (EPS) but a lower risk of metabolic syndrome compared to second-generation antipsychotics.

B. Aripiprazole (Abilify) is a second-generation (atypical) antipsychotic with a lower risk of metabolic side effects. It has a partial dopamine agonist mechanism, which makes it less likely to cause weight gain, dyslipidemia, or glucose intolerance.

C. Clozapine (Clozaril) has the highest risk of metabolic syndrome among antipsychotics. It is associated with significant weight gain, hyperglycemia, dyslipidemia, and an increased risk of diabetes. Regular metabolic monitoring (weight, blood glucose, lipids) is essential for patients taking clozapine.

D. Lurasidone (Latuda) is a second-generation antipsychotic with a lower metabolic risk compared to other atypical antipsychotics. It is generally considered weight-neutral and has minimal effects on glucose and lipid metabolism.