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The clinical challenges of akathisia

  • James B. Lohr (a1) (a2), Carolyn A. Eidt (a1) (a2), Areej Abdulrazzaq Alfaraj (a1) and Mounir A. Soliman (a1)


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.


Corresponding author

*Address for correspondence: James B. Lohr, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA. (Email:


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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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