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The clinical challenges of akathisia

Published online by Cambridge University Press:  18 December 2015

James B. Lohr
Department of Psychiatry, University of California–San Diego, La Jolla, California, USA Veterans Affairs Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
Carolyn A. Eidt
Department of Psychiatry, University of California–San Diego, La Jolla, California, USA Veterans Affairs Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
Areej Abdulrazzaq Alfaraj
Department of Psychiatry, University of California–San Diego, La Jolla, California, USA
Mounir A. Soliman
Department of Psychiatry, University of California–San Diego, La Jolla, California, USA
E-mail address:


Akathisia is one of the most vexing problems in neuropsychiatry. Although it is one of the most common side effects of antipsychotic medications, it is often difficult to describe by patients, and is difficult to diagnose and treat by practitioners. Akathisia is usually grouped with extrapyramidal movement disorders (ie, movement disorders that originate outside the pyramidal or corticospinal tracts and generally involve the basal ganglia). Yet, it can present as a purely subjective clinical complaint, without overt movement abnormalities. It has been subtyped into acute, subacute, chronic, tardive, withdrawal-related, and “pseudo” forms, although the distinction between many of these is unclear. It is therefore not surprising that akathisia is generally either underdiagnosed or misdiagnosed, which is a serious problem because it can lead to such adverse outcomes as poor adherence to medications, exacerbation of psychiatric symptoms, and, in some cases, aggression, violence, and suicide. In this article, we will attempt to address some of the confusion surrounding the condition, its relationship to other disorders, and differential diagnosis, as well as treatment alternatives.

CME Review Article
© Cambridge University Press 2015 

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We would like to thank Dr. Stephen Stahl and the staff of the Neuroscience Education Institute for their assistance in preparing this article. This activity is supported by an unrestricted educational grant from Vanda Pharmaceuticals Inc.


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