Akathisia

Inner restlessness, pacing, shifting, inability to sit still after antipsychotic/antiemetic/antidepressant

EmergentReview due

At a glance

High risk: Yes
Onset: Days
Course: Dose-linked
Treatable: Yes

Safety snapshot

Watch forSuicidality from unbearable restlessnessrecent dose escalationmislabelled behavioural disturbanceSuicidalityaggressiontreatment refusal

Presentation hinge

Subjective inner restlessness is the key feature, often with observable motor restlessness.

Separates the Psychomotor Agitation group. It is not specific to Akathisia.

Do now

1Ask directly about inner restlessness, because the subjective complaint is the diagnosis and observable movement may be absent
2Chart the timeline against every dose increase, switch and depot, including antiemetics
3Ask about suicidal thinking: akathisia is a recognised and under-recorded contributor to acute risk
4Discuss dose reduction or a switch with the treating team rather than adding a further antipsychotic

Locally authored, reviewed by PsychSift on 27 September 2026

Clinical review

Rows marked “Whole group”: Applies to the Psychomotor Agitation group — not specific to Akathisia

Why it fits

Inner restlessness, pacing, shifting, inability to sit still after antipsychotic/antiemetic/antidepressant

Key features2 features

Subjective bodily torment and urge to move dominate. Mood or psychosis may be absent.
Inner restlessness, pacing, rocking, inability to sit still after antipsychotic or antidepressant exposure

Must-not-miss

Suicidality from unbearable restlessness, recent dose escalation, mislabelled behavioural disturbance.

High-risk causes7 causes

Suicidality from unbearable restlessness
recent dose escalation
mislabelled behavioural disturbance
Suicidality
aggression
treatment refusal
severe distress

Bedside question

Applies to the Psychomotor Agitation group.

Subjective inner restlessness is the key feature, often with observable motor restlessness.

Helpful clues1 clue

Subjective bodily torment and urge to move dominate. Mood or psychosis may be absent.

Immediate action

Applies to the Psychomotor Agitation group.

One of the most commonly missed and most distressing psychiatric side effects Bilateral onset after medication strongly suggests drug-induced parkinsonism Dramatic but very treatable once recognised Not every restless movement is akathisia; tardive phenomenology is different Tremor type and context usually solve the differential

Priority steps5 steps

1One of the most commonly missed and most distressing psychiatric side effects
2Bilateral onset after medication strongly suggests drug-induced parkinsonism
3Dramatic but very treatable once recognised
4Not every restless movement is akathisia; tardive phenomenology is different
5Tremor type and context usually solve the differential

Investigations

Applies to the Psychomotor Agitation group.

Thyroid function tests

Core tests

Mimics / overlap

Applies to the Psychomotor Agitation group.

None listed

Consider

Do now

1Ask directly about inner restlessness, because the subjective complaint is the diagnosis and observable movement may be absent
2Chart the timeline against every dose increase, switch and depot, including antiemetics
3Ask about suicidal thinking: akathisia is a recognised and under-recorded contributor to acute risk
4Discuss dose reduction or a switch with the treating team rather than adding a further antipsychotic

Locally authored, reviewed by PsychSift on 27 September 2026

First-line tests

Applies to the Psychomotor Agitation group — not specific to Akathisia

Thyroid function tests

Watch for

Suicidality from unbearable restlessness
recent dose escalation
mislabelled behavioural disturbance
Suicidality
aggression
treatment refusal

Also consider

Source and review

Review due· Unverified

v10 · exported 2026-07-11

Clinical reference — not validated decision support. Review before use.