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Akathisia
Other namesAcathisia
Common sign of akathisia
SpecialtyNeurology, psychiatry
SymptomsFeelings of restlessness, inability to stay still, uneasy
ComplicationsViolence or suicidal thoughts
DurationShort- or long-term
CausesAntipsychotics, selective serotonin reuptake inhibitors, metoclopramide, reserpine, Parkinson’s disease, untreated schizophrenia
Diagnostic methodBased on symptoms
Differential diagnosisAnxiety, tic disorders, tardive dyskinesia, dystonia, medication-induced parkinsonism, restless leg syndrome
TreatmentReduce or switch antipsychotics, correct iron deficiency
MedicationDiphenhydramine, trazodone, benzodiazepines, benztropine, mirtazapine, beta blockers
FrequencyRelatively common

Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still. Usually, the legs are most prominently affected. Those affected may fidget, rock back and forth, or pace, while some may just have an uneasy feeling in their body. The most severe cases may result in aggression, violence or suicidal thoughts.

Antipsychotic medication, particularly the first generation antipsychotics, are a leading cause. Other causes may include selective serotonin reuptake inhibitors, metoclopramide, reserpine, Parkinson’s disease, and untreated schizophrenia. It may also occur upon stopping antipsychotics. The underlying mechanism is believed to involve dopamine. Diagnosis is based on the symptoms. It differs from restless leg syndrome in that akathisia is not associated with sleeping.

Treatment may include switching to an antipsychotic with a lower risk of the condition. The antidepressant mirtazapine has demonstrated benefit, and there is tentative evidence of benefit for diphenhydramine, trazodone, benzatropine and beta blockers.

The term was first used by Czech neuropsychiatrist Ladislav Haškovec, who described the phenomenon in 1901. It is from Greek a-, meaning "not", and καθίζειν kathízein, meaning "to sit", or in other words an "inability to sit".

Classification