Three weeks after starting risperidone, a 24-year-old woman reports an inner restlessness and an irresistible urge to keep moving her legs; she paces continuously and feels she will jump out of her skin. There are no involuntary movements at rest. The best next step in management is:

• A Add levodopa-carbidopa
• B Switch immediately to clozapine
• C Add benztropine
• D Add propranolol and consider reducing the risperidone dose ✓

Explanation

Akathisia is a subjective sense of inner restlessness with an urge to move, typically appearing within weeks of starting or increasing an antipsychotic. Beta blockers such as propranolol are the standard adjunctive treatment, along with dose reduction or switching to a lower-EPS agent. Benztropine treats parkinsonism rather than akathisia, levodopa is not indicated and may worsen psychosis, and clozapine is reserved for treatment-resistant illness, not drug-induced akathisia.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.