Restlessness in suboccipital muscles as a manifestation of akathisia

Antipsychotic-induced akathisia is primarily manifested as restlessness, particularly expressed in the legs. Consequently, rating scales and the research criteria of DSM-IV regard restlessness in the legs as the major sign of akathisia, although it has been suggested that such restlessness may occur in other areas of the body. A case of antipsychotic-induced akathisia is reported where the region of inner restlessness (the subjective component) was identified in posterior cervical muscles. The patient was initially suspected to be experiencing somatic delusions and the dose of antipsychotic medication was increased. This did not improve the symptoms, and upon careful questioning about his head discomfort, the patient acknowledged that he felt an inner restlessness in the suboccipital muscles. The restlessness ceased with intramuscular biperiden and subsequent discontinuation of antipsychotic medication. This case suggests that subjective restlessness may occur in muscle groups that are not usually associated with akathisia. Thus, this report may assist clinicians in the diagnosis of akathisia that could be overlooked or misdiagnosed as somatic delusions or the worsening of the patient's psychosis.