The psychiatric client getting the antipsychotic drugs, and the client getting the symptoms of agitation,

feeling of restlessness, dysphoria, and difficulty in sleeping, the group of this adverse effect is called

as?

1. A

   Akathisia

2. B

   Tardive dyskinesia

3. C

   Shakiness

4. D

   Dyskinesia

Appeared in: NORCET 1 - 2020

Explanation

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• Akathisia is the correct diagnosis as it perfectly matches the described cluster of symptoms: subjective restlessness, agitation, dysphoria, and sleep disturbance.
• It is a common acute extrapyramidal side effect (EPS) of antipsychotic medications, stemming from dopamine blockade.
• The term 'akathisia' is from Greek, meaning 'inability to sit still,' which captures the essence of this distressing symptom.
• Unlike other movement disorders, akathisia has both a subjective component (inner restlessness, anxiety) and an objective one (pacing, rocking).

Why Other Options Were Wrong

• Option B: Tardive dyskinesia involves involuntary, repetitive, choreoathetoid (jerky and writhing) movements, such as lip-smacking and tongue protrusion. The symptoms in the question do not match this description.
• Option C: Shakiness (tremor) is a single symptom, not a syndrome. While it is an extrapyramidal symptom, it is characteristic of drug-induced parkinsonism, which also includes rigidity and bradykinesia.
• Option D: Dyskinesia is a very general term for abnormal, involuntary movements. While akathisia is a type of dyskinesia, 'Akathisia' is the more specific and accurate term for the particular syndrome of restlessness and agitation described.

Related Visual

• Visual 1: Table: Comparison of Extrapyramidal Symptoms (EPS). A table comparing Akathisia, Acute Dystonia, Parkinsonism, and Tardive Dyskinesia based on key features, presentation, and onset time.
• Visual 2: Flowchart: Nursing Assessment for EPS. A flowchart guiding the nurse on how to assess a patient on antipsychotics, differentiate between agitation from psychosis and akathisia, and the appropriate next steps.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Adverse effects of antipsychotic medications, specifically Extrapyramidal Symptoms (EPS) as background academic context rather than a clinical decision trigger.
• A nurse's primary role is patient safety and accurate assessment. Misinterpreting akathisia as worsening psychosis is a serious error that can lead to increasing the antipsychotic dose, thereby intensifying the patient's distress and non-adherence.
• The Abnormal Involuntary Movement Scale (AIMS) is a standardized tool used by nurses and clinicians to screen for and monitor tardive dyskinesia, but being aware of the signs of acute EPS like akathisia is equally critical for early intervention.
• What if? If the patient's symptoms were primarily muscle spasms in the neck and a locked jaw, the correct answer would be Acute Dystonia, which is a medical emergency requiring immediate intervention with anticholinergic medication like benztropine or diphenhydramine.

How to Approach the Question

• First, identify the core topic of the question: adverse effects of a specific drug class (antipsychotics).
• Next, carefully analyze the cluster of symptoms presented in the clinical scenario: agitation, restlessness, dysphoria, and sleep difficulty.
• Recall the different types of extrapyramidal symptoms (EPS) associated with antipsychotics.
• Systematically compare the patient's symptoms with the definitions of each option: Akathisia, Tardive Dyskinesia, Shakiness, and Dyskinesia.
• Select the option that most precisely and completely describes the symptom cluster. Note that 'Akathisia' is a specific syndrome that perfectly matches the description, making it a better choice than the general term 'Dyskinesia' or the single symptom 'Shakiness'.

Concept Tested & Keywords

• Concept Tested: Adverse effects of antipsychotic medications, specifically Extrapyramidal Symptoms (EPS).
• Stem keywords: antipsychotic drugs, agitation, restlessness, dysphoria, difficulty in sleeping
• Lead-in keywords: adverse effect
• Negative lead-in flag: false

Question ID

QTkc0Gv0Gnxr8m6mHJ9z6y

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