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Ivan Donaldson

, C. David Marsden

, Susanne A. Schneider

, and Kailash P. Bhatia

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date: 05 July 2022

There is no definitely accepted definition of akathisia or agreement on the diagnostic features. In its typical form there are two components, which are subjective and objective. The subjective aspect consists of feelings of inner tension and restlessness, with a desire to move. The objective component is manifest by clinical evidence of restlessness, including moving the limbs, shifting the feet, altering the body position when sitting, moving the body weight from one foot to the other when standing, walking on the spot, and pacing about.

There is no consensus, however, about whether both these elements are necessary for diagnosis and to what extent they have to be present. Some authors accept feelings of restlessness and tension without actual movement and indeed a few have restricted the term to these subjective sensations (Crane et al. 1971). Others, however, have found no difference in the sensations of inner restlessness between acute akathisic and non-akathisic psychiatric patients and have regarded these symptoms as being common and non-specific (Braude et al. 1983). At the other extreme, some workers have included patients with motor signs of restlessness without any accompanying subjective desire to move (Barnes and Braude 1985).

Overall we have adopted a fairly liberal approach to what constitutes akathisia, as there is evidence that these different features are manifestations of the same condition or similar conditions. In fact, it seems likely that there are a number of akathisic disorders and these may arise from different mechanisms. Thus, with regard to neuroleptic-induced akathisia, acute, persisting, ‘pseudo-akathisic’, and tardive forms can be distinguished. There is clinical and pharmacological data suggesting that these have basic underlying differences. With this exception, however, there is no other sub classification of neuroleptic-induced akathisia, which is the commonest form. Naturally, cases due to other causes can be categorized according to aetiology.

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