A 38-year-old woman with schizophrenia on haloperidol reports restlessness and trouble sleeping: "I can't stay still at night." What side effect is she likely experiencing?

1. A

   Opisthotonos

2. B

   Dystonia

3. C

   Akinesia

4. D

   Akathisia

Appeared in: NORCET 9 Mains - 2025

Explanation

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• Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness and a compelling urge to be in constant motion.
• The patient's statement, "I can't stay still at night," is a classic and direct description of the subjective distress caused by akathisia.
• Haloperidol, a high-potency typical antipsychotic, is well-known for causing extrapyramidal symptoms (EPS), with akathisia being one of the most common.
• The symptoms of akathisia can be mistaken for anxiety or worsening psychosis, but it is a direct neurological side effect of the medication.

Why Other Options Were Wrong

• Option A: Opisthotonos is a specific, severe muscle spasm where the head, neck, and spine are arched backward. It is a dramatic posture, not a feeling of general restlessness.
• Option B: Dystonia involves sustained, involuntary muscle contractions (spasms) of specific muscle groups, such as torticollis (neck twisting) or oculogyric crisis (eyes rolling upward). It does not involve the subjective feeling of restlessness.
• Option C: Akinesia means a loss or impairment of voluntary movement, often described as 'poverty of movement.' It is a parkinsonian symptom and is the opposite of the restlessness and constant motion seen in akathisia.

Related Visual

• Visual 1: Infographic: A comparative chart showing the key symptoms, onset, and management of the four main types of Extrapyramidal Symptoms (EPS): Acute Dystonia, Akathisia, Pseudoparkinsonism, and Tardive Dyskinesia.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Extrapyramidal Side Effects of Antipsychotics as background academic context rather than a clinical decision trigger.
• Prompt recognition of akathisia is crucial as it is extremely distressing for patients and can be mistaken for worsening psychosis, leading to inappropriate dose increases that worsen the side effect.
• Untreated akathisia is a significant risk factor for medication non-adherence, agitation, and even suicidal ideation due to the intense discomfort it causes.
• What if? If the patient instead presented with a shuffling gait, pill-rolling tremor, and a flat facial expression, the most likely side effect would be Pseudoparkinsonism, another common EPS that requires different management (e.g., anticholinergic agents).

How to Approach the Question

• First, identify the key information in the scenario: the drug (haloperidol), the patient's diagnosis (schizophrenia), and the presenting symptoms (restlessness, 'can't stay still').
• Recall that haloperidol is a typical antipsychotic with a high risk of extrapyramidal side effects (EPS).
• Systematically evaluate the options. The patient's subjective feeling of restlessness is the core symptom.
• Match the patient's symptoms to the definition of each option. 'Akathisia' is derived from Greek for 'inability to sit still'.
• Eliminate the other options based on their distinct definitions: Dystonia (spasms), Opisthotonos (a type of severe spasm), and Akinesia (lack of movement).

Concept Tested & Keywords

• Concept Tested: Extrapyramidal Side Effects of Antipsychotics
• Stem keywords: schizophrenia, haloperidol, restlessness, trouble sleeping, can't stay still
• Lead-in keywords: What side effect
• Negative lead-in flag: false

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