Three ideas carry this whole section. Antipsychotics block dopamine D2 receptors — and dopamine runs down four pathways, so blocking the one you want costs you the other three. Atypicals add 5‑HT2A blockade to buy the movement pathway back, and pay for it at the waistline. Benzodiazepines never touch dopamine at all: they lean on the GABA‑A chloride channel. Drag the occupancy slider, step the EPS clock, and open the channel.
Class boxed warning — every antipsychotic, typical and atypical, carries an increased risk of death in older adults with dementia‑related psychosis. They are not approved for that use. Antipsychotics are also not a treatment for agitation in dementia by default.
The clock — tap a point or use Prev / Next
ADAPT — the order they arrive: Acute Dystonia (hours) → Akathisia (days) → Parkinsonism (weeks) → Tardive dyskinesia (months to years). NMS can hit at any time, but usually within two weeks of a start or a dose increase.
What is sitting on the receptor
The drugs
Every benzodiazepine, every time — fall precautions (bed low, call light in reach; the Beers Criteria say avoid in older adults). No alcohol, no opioids. Never stop abruptly after regular use — withdrawal causes seizures and delirium and can kill; taper. Dependence develops within about 2–4 weeks of scheduled dosing, so short‑term and lowest effective dose. Watch for paradoxical agitation in older adults and children.