Akathisia is a feeling of inner restlessness, often associated with restless movements of a continuous and often purposeless nature, such as rocking to and fro, repeatedly crossing and uncrossing the legs, standing up and sitting down, pacing up and down. Moaning, humming, and groaning may also be features. Voluntary suppression of the movements may exacerbate inner tension or anxiety.
Recognized associations of akathisia include Parkinson’s disease and neuroleptic medication (acute or tardive side effect), suggesting that dopamine depletion may contribute to the pathophysiology; dopamine depleting agents (e.g., tetrabenazine, reserpine) may cause akathisia.
Treatment by reduction or cessation of neuroleptic therapy may help, but can exacerbate coexistent psychosis. Centrally acting β-blockers, such as propranolol, may also help, as may anticholinergic agents, amantadine, clonazepam, and clonidine.
Sachdev P. Akathisia and restless legs. Cambridge: CUP, 1995