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Olanzapine is considered first-line therapy for schizophrenia due to its efficacy in both controlling positive symptoms, such as hallucinations and delusions, and addressing negative symptoms, including emotional flattening and lack of motivation. As an atypical antipsychotic, olanzapine has a favorable side effect profile compared to older, typical antipsychotic medications. It works by antagonizing dopamine D2 receptors and has a broader action on serotonin receptors, which may contribute to its effectiveness and reduced likelihood of extrapyramidal side effects, a common concern with typical antipsychotics.

In addition to its efficacy, olanzapine is also well-studied and frequently prescribed in clinical practice, making it a standard treatment choice for managing schizophrenia symptoms. Other medications, while effective, may not provide the same balance of therapeutic benefits and safety concerns that characterize olanzapine's use in the treatment of this condition.