Patient is taking haloperidol and at home Patient is not able to sit quietly, during the clinic visit Patient has the urge to walk. What is suffering from?

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

The patient's symptoms of an inability to sit still and a constant urge to walk are the hallmark signs of akathisia.
Akathisia is a well-documented extrapyramidal side effect associated with dopamine-blocking agents, particularly first-generation antipsychotics like haloperidol.
The term akathisia is derived from Greek, meaning 'never to sit down,' which perfectly describes the patient's condition.
It involves both a subjective feeling of inner restlessness and objective motor signs like pacing and fidgeting.

Option B: Tardive dyskinesia involves involuntary, repetitive, and purposeless movements, typically of the face, mouth, and tongue (e.g., lip-smacking, tongue thrusting). The patient's symptoms are related to restlessness, not these types of movements.
Option C: While the patient is restless, 'restlessness' is a general symptom, not a specific diagnosis. Akathisia is the specific clinical syndrome that includes restlessness as a primary feature.
Option D: Irritability refers to a mood state or emotional response (e.g., being easily annoyed or angered). It does not describe a physical movement disorder.

Visual 1: Table: Comparison of Extrapyramidal Symptoms (EPS). A table outlining the onset, key features, and example movements for acute dystonia, akathisia, drug-induced parkinsonism, and tardive dyskinesia to help differentiate them.
Visual 2: Infographic: Dopamine Pathways and Antipsychotics. A diagram showing the nigrostriatal pathway and how D2 receptor blockade by drugs like haloperidol leads to EPS.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of extrapyramidal side effects (EPS) of antipsychotic medications to guide bedside assessment, documentation, and the next nursing action.
Nurses must be able to recognize akathisia promptly as it is extremely distressing to patients and can be a major reason for non-adherence to treatment.
Accurate assessment is crucial to differentiate akathisia from psychotic agitation. Mistaking akathisia for worsening psychosis and increasing the antipsychotic dose will worsen the akathisia.
Management involves reducing the antipsychotic dose, switching to an atypical antipsychotic with a lower risk of EPS, or adding medications like propranolol, benzodiazepines, or anticholinergics.

How to Approach the Question

First, identify the key information in the clinical scenario: the medication (haloperidol) and the primary symptoms (inability to sit quietly, urge to walk).
Recall the drug class of haloperidol (a typical or first-generation antipsychotic) and its common side effect profile.
Recognize that drug-induced movement disorders, known as extrapyramidal symptoms (EPS), are a major side effect.
Analyze the specific symptoms. The feeling of inner restlessness and the compulsion to move are the defining features of akathisia.
Compare these symptoms to the definitions of the other options to rule them out. Tardive dyskinesia involves different movements, 'restlessness' is too general, and 'irritable' is a mood, not a movement disorder.
Select the option that is the most precise diagnosis for the described clinical picture.

Concept Tested & Keywords

Concept Tested: Identification of extrapyramidal side effects (EPS) of antipsychotic medications.
Stem keywords: haloperidol, not able to sit quietly, urge to walk
Lead-in keywords: What is suffering from
Clinical cues: The use of haloperidol, a typical antipsychotic, is a major clue pointing towards drug-induced movement disorders.
Clinical cues: The specific symptoms of motor restlessness (inability to sit, urge to walk) are pathognomonic for akathisia.

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Practise the full NORCET 2 -2021 (Shift-2)

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