Severe motor restlessness with inability to sit and an urge to move is seen in?

Appeared in: NIMHANS Nursing Officer - 2021

Explanation

Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness and a compelling need to be in constant motion.
The term comes from the Greek for "never to sit down," which perfectly describes the patient's inability to remain still.
It is a common and distressing side effect of antipsychotic medications, and also some antidepressants.
Objectively, it manifests as rocking, pacing, and fidgeting, which matches the question's description of "severe motor restlessness with inability to sit and an urge to move.".

Why Other Options Were Wrong

Option A: Ataxia is a problem with coordination and balance, not a feeling of restlessness. It presents as an unsteady, clumsy gait.
Option C: Guillain-Barré Syndrome (GBS) is characterized by ascending muscle weakness and paralysis, not restlessness. Patients experience a loss of movement, not an urge to move.
Option D: Dystonia involves sustained, involuntary muscle contractions leading to abnormal postures or twisting movements in specific body parts (like the neck or eyes). It is a focal spasm, not a generalized restlessness.

Related Visual

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of Extrapyramidal Symptoms (EPS), specifically Akathisia as background academic context rather than a clinical decision trigger.
Nurses must be able to recognize akathisia promptly, as it is extremely distressing for patients and can be mistaken for psychotic agitation, leading to an inappropriate increase in the causative medication.
Assessment involves both observing the patient's objective movements (pacing, fidgeting) and asking about their subjective experience of inner restlessness.
Patient safety is a priority, as the severe discomfort and agitation from akathisia can increase the risk of non-adherence, aggression, or self-harm.

How to Approach the Question

First, analyze the keywords in the question stem: "severe motor restlessness," "inability to sit," and "urge to move."
This cluster of symptoms points directly to a specific type of movement disorder.
Next, evaluate each option against this clinical picture.
Ataxia is about incoordination, not restlessness. Eliminate it.
GBS is about weakness/paralysis, the opposite of restlessness. Eliminate it.
Dystonia is about sustained muscle spasms/posturing, not a generalized urge to move. Eliminate it.

Concept Tested & Keywords

Concept Tested: Identification of Extrapyramidal Symptoms (EPS), specifically Akathisia.
Stem keywords: motor restlessness, inability to sit, urge to move
Lead-in keywords: BEST, MOST RELEVANT CLUE
Negative lead-in flag: false

Question ID

QyawHCrjsHfYf5TZW84JaO

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 3902-3904, 12286-12288, 10051-10053

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