Akathisia

Abstract Akathisia is a frequently overlooked syndrome characterized by the subjective complaint of restlessness often with objective increase in movements, including pacing, rocking, and inability to sit or stand still. It is usually noticed within days or weeks of either starting or stopping antipsychotic treatment or changing dosage. Its clinical presentation may resemble other conditions such as anxiety and psychomotor agitation. The management of akathisia involves three steps: prevention, antipsychotic drug adjustment, and symptomatic strategies. Risks and benefits of antipsychotics should always be weighed-in to avoid akathisia. Even though second-generation antipsychotics were considered to have reduced risk for akathisia, recent data suggest that using second generation antipsychotics with high risk of akathisia would be as harmful as using any first-generation antipsychotics. Combinations, rapid upward or downward titrations, and sudden discontinuation of antipsychotics should be avoided. Beta blockers, anticholinergics, serotonergic medications, and benzodiazepines can help control the symptoms of akathisia.