A 26-year-old man with schizophrenia, recently started on risperidone, complains of an unbearable inner restlessness and an urge to pace constantly. His family interprets this as worsening psychosis, and the resident considers increasing the antipsychotic dose. Which statement about his condition is correct?
- A It is an early sign of neuroleptic malignant syndrome and requires stopping all antipsychotics immediately
- B It is a conversion disorder and responds best to psychotherapy
- C It is akathisia, and raising the antipsychotic dose typically worsens it ✓
- D It is a negative symptom of schizophrenia and predicts a poor outcome
Correct answer: C. It is akathisia, and raising the antipsychotic dose typically worsens it
Explanation
Akathisia is subjective inner restlessness with an objective need to move, appearing days to weeks after starting or increasing an antipsychotic. It is frequently misread as agitation or relapse, and increasing the dose aggravates it. Management includes dose reduction, propranolol, or switching agents. It lacks the fever, rigidity, and autonomic instability of neuroleptic malignant syndrome, it is a medication side effect rather than a psychogenic or primary psychotic phenomenon, and it is unrelated to negative symptoms.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.