Akathisia is characterized by which symptom?

• A. Inability to sit still and a sense of restlessness
• B. Acute muscle spasm causing fixed posture
• C. Jaw clenching
• D. Visual hallucinations

Answer: (A)

Akathisia is defined by a subjective inner restlessness that makes it hard to sit still, usually with observable motor activity such as pacing, fidgeting, or repeatedly shifting in the chair. The key is the combination of a felt urge to move and accompanying outward movement, which is a classic extrapyramidal side effect from dopamine-blocking antipsychotics. This contrasts with dystonia, where the problem is a sustained, involuntary muscle contraction causing a fixed abnormal posture (for example, jaw clenching as part of an oromandibular dystonia). Visual hallucinations are unrelated to motor restlessness and reflect a psychotic symptom, not akathisia. Recognizing the inner restlessness with accompanying movement helps distinguish akathisia from agitation or anxiety and guides targeted management, such as adjusting the antipsychotic or using agents like propranolol or benzodiazepines.