A 24-year-old man started on haloperidol 10 mg per day reports intense inner restlessness and an urge to keep moving his legs. He paces continuously and cannot sit through meals. The team interprets this as psychotic agitation and doubles the antipsychotic dose. Two days later he is worse. What is the correct next step?
- A Reduce the antipsychotic dose and consider propranolol for akathisia ✓
- B Continue the higher dose since symptoms reflect relapsing psychosis
- C Add another antipsychotic from a different class
- D Start lithium augmentation immediately
Correct answer: A. Reduce the antipsychotic dose and consider propranolol for akathisia
Explanation
The picture is classic akathisia, a subjective restlessness with motor signs appearing early in antipsychotic treatment. Escalating the dose worsens it and increases suicide risk. Management is dose reduction where feasible, switch to a lower-risk agent, and symptomatic treatment with propranolol or a benzodiazepine. Adding antipsychotics or lithium treats neither the cause nor the symptom.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.