What is the first-line pharmacologic treatment for schizophrenia?

• A. Haloperidol
• B. Risperidone
• C. Fluoxetine
• D. Lorazepam

Answer: (B)

Schizophrenia is best managed long-term with an antipsychotic medication, and second-generation (atypical) antipsychotics are preferred because they control psychosis with fewer movement-related side effects than older drugs. Risperidone is an atypical antipsychotic that blocks both dopamine D2 and serotonin 5-HT2A receptors, helping reduce positive symptoms like hallucinations and delusions and offering a better tolerability profile regarding extrapyramidal symptoms. That makes it a common first-line choice.

Haloperidol, a typical antipsychotic, can be effective but carries a higher risk of extrapyramidal symptoms and tardive dyskinesia, so it’s less favored as a first-line option. Fluoxetine is an antidepressant and does not address the core psychosis of schizophrenia. Lorazepam is a benzodiazepine used for acute agitation or anxiety and is not a primary treatment for schizophrenia.