Review Question - QID 103748

This patient likely has akathisia, which is characterized by restlessness, agitation, and slow writhing movements and has an onset approximately four weeks after starting the medication.

Typical antipsychotic medications, such as haloperidol, have a group of common side effects known as extrapyramidal symptoms (EPS). EPS are various movement disorders caused by the blockade of dopamine receptors by antipsychotic medications. Haloperidol is the most common antipsychotic to elicit EPS, especially when used for schizophrenia. The EPS include, acute dystonic reactions (four hours), pseudoparkinsonism (four days), akathisia (four weeks), and tardive dyskinesia (four months).

Friedman et al. discuss akathisia as a complication of antipsychotic medication. Akathisia can be described by patients as an inner discomfort that necessitates relief via increased motor activity. These physical manifestations can often be misinterpreted as signs that more medication is required by the patient. Conversely, these manifestations are actually a byproduct of the medication, and careful investigation must be done in order to differentiate between the two.

Seemüller et al. report on the relationship between akathisia and suicidal ideation (SI) in patients being treated with first-episode schizophrenia (FES). It is well known that patients with FES are relatively sensitive to the development of EPS. There was a significant association between akathisia and suicidality in FES. Younger patients with schizophrenia were found not only to have a higher risk of suicidality, but also to be at a higher risk for the development of akathisia, independently.

Illustration A is a chart depicting various risk factors for drug-induced movement disorders.
Illustration B reports the percentages of various adverse effects of haloperidol versus olanzapine.
Illustration V demonstrates akathisia.

Incorrect Answers:
Answer 1: This statement describes pseudoparkinsonism. Consider this diagnosis when the patient has been taking the medication for about four days.
Answer 3: This statement describes tardive dyskinesia, a long-term side effect of typical antipsychotics. Consider this diagnosis when the patient has been taking the medication for four months or more.
Answer 4: This statement describes an acute dystonic reaction. Consider this diagnosis when the patient has taken the medication in the last four hours.
Answer 5: This statement describes neuroleptic malignant syndrome (NMS). Although this reaction can happen at any time, it is less likely if a person has been stable on the medication for a period of time, especially if the dose has not been changed and there are no issues of compliance.