Akathisia

Definition

Akathisia is an extrapyramidal symptom (EPS) characterized by subjective inner restlessness and the inability to remain still. Patients pace, shift weight, rock, or repeatedly cross and uncross their legs. It is one of the most distressing drug-induced side effects and can lead to treatment non-adherence or suicidal ideation.

Common Causes

First-generation ('typical') antipsychotics (haloperidol, fluphenazine) and, less commonly, second-generation agents (risperidone, aripiprazole). Also seen with metoclopramide and SSRIs.

Differential Recognition

• Akathisia: Inner restlessness with purposeless movement.
• Dystonia: Sustained muscle contractions (torticollis, oculogyric crisis).
• Parkinsonism: Tremor, rigidity, bradykinesia.
• Tardive Dyskinesia: Late-onset involuntary orofacial movements.

Nursing Interventions

Report symptoms promptly, such as treatment options include dose reduction, switching antipsychotics, or adding a beta-blocker (propranolol), benzodiazepine, or anticholinergic (benztropine). Provide supportive care and safety monitoring for suicidal risk.

NCLEX Relevance

High-yield for psychiatric medication management and EPS differentiation. Recognize akathisia as inner restlessness (not anxiety).