Akathisia: Assessment and Management

Assessment combines the person’s report of inner restlessness with observation, medication review and consideration of other causes. A structured scale may help document severity and change. Clinicians consider dose, recent adjustments, interactions and the importance of continuing treatment for the underlying condition.

Akathisia is a movement-related adverse effect characterised by distressing inner restlessness and often a need to move. Antipsychotics and some other medicines can cause it. It is not simply ordinary anxiety or voluntary fidgeting, and the subjective discomfort can be severe even when visible movement appears relatively mild to an observer.

Management may include a supervised dose change, switching medicine or selected additional treatment, depending on the circumstances. Each option has potential harms and should be chosen through clinical review rather than self-medication. The person’s level of distress and ability to function matter as much as visible movement. Clear follow-up is needed to determine whether the plan helps. Recognising akathisia early can improve tolerability and prevent it from being mistaken for psychiatric deterioration. Treatment should aim for relief while preserving an effective and acceptable overall care plan.

Management should include a clear review point and the outcomes to assess, such as sleep, ability to sit comfortably and subjective distress. Additional medicines may have contraindications or unwanted effects of their own. This makes a tailored plan important. Relief of akathisia and maintenance of psychiatric stability need to be evaluated together rather than assuming that success in one guarantees the other.

Further reading: DailyMed prescribing information (1); DailyMed prescribing information (2); Research record 2877708.