A patient develops involuntary, continuous, restless movements after taking antipsychotics. This condition is known as:

Appeared in: NORCET 9 Mains - 2025

Explanation

Akathisia is a medication-induced movement disorder characterized by a subjective feeling of inner restlessness and an objective inability to stay still.
The symptoms described in the question—involuntary, continuous, and restless movements—are the classic presentation of akathisia.
It is a common extrapyramidal side effect of antipsychotic medications, especially first-generation agents.
The key feature that distinguishes akathisia from other EPS is the compelling urge to move and the inability to find a comfortable position.

Option B: Parkinsonism is incorrect because it is characterized by a triad of tremor, rigidity, and bradykinesia (slowness of movement), not restlessness.
Option C: Acute dystonia is incorrect as it involves sudden, painful, and sustained muscle spasms (e.g., torticollis, oculogyric crisis), not continuous restless movements.
Option D: Tardive dyskinesia is incorrect because it is a late-onset disorder (developing after months or years) characterized by repetitive, involuntary movements, especially of the mouth and tongue (e.g., lip-smacking, tongue protrusion). The question implies a more acute onset of restlessness.

Visual 1: Table: A comparative table showing the onset, hallmark signs, and management of the four main types of extrapyramidal symptoms (Acute Dystonia, Akathisia, Parkinsonism, Tardive Dyskinesia).
Visual 2: Flowchart: A decision-making flowchart for nurses to differentiate between anxiety/agitation and akathisia in a patient taking antipsychotics.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Identification of extrapyramidal side effects (EPS) of antipsychotic medications in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Nurses must be able to differentiate between the various extrapyramidal side effects to ensure prompt and appropriate intervention.
Akathisia is highly distressing and can be mistaken for worsening psychosis or anxiety. Accurate assessment is critical for patient comfort and treatment adherence.
Patient safety is a concern, as the constant need to move can increase the risk of falls, especially in elderly or frail patients.

How to Approach the Question

First, identify the key terms in the question stem: 'involuntary,' 'continuous,' and especially 'restless movements' following 'antipsychotics.'
Recognize that these symptoms are related to extrapyramidal side effects (EPS).
Systematically review the definitions of each option:
Recall that 'restlessness' is the hallmark of Akathisia.
Recall that 'spasms' are the hallmark of Acute Dystonia.
Recall that 'tremor and rigidity' are hallmarks of Parkinsonism.

Concept Tested & Keywords

Concept Tested: Identification of extrapyramidal side effects (EPS) of antipsychotic medications.
Stem keywords: involuntary, continuous, restless movements, antipsychotics
Lead-in keywords: known as
Clinical cues: The key descriptor 'restless movements' points directly to Akathisia.

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Practise the full NORCET 9 Mains - 2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.