Tardive nocturnal akathisia due to clozapine treatment

In the following case report we present a 43-year-old male patient diagnosed with schizophrenia, paranoid type, who exhibited nocturnal tardive akathisia or pseydoakathisia approximately one year after being treated with clozapine 300 mg per day. Because of the low occurrence of akathisia due to clozapine, the episodes of restlessness were at first considered as a sign of worsening of the patient's psychopathology. Since the patient was resistant to other antipsychotic agents, clozapine was reinitiated. A week later, the patient once again exhibited episodes of restlessness. This time, the episodes were diagnosed as akathisia and the patient was treated with biperidene and lorazepam, while he had already been on propanolol for cardiovascular reasons. The episodes continued without any change in frequency or severity. Therefore, treatment with clozapine was discontinued and the patient was started on a new regimen with ziprasidone. Three days later, the episodes that caused distress to the patient resolved. Thus, it is possible that apart from episodes of acute akathisia, episodes of tardive akathisia or pseydoakathisia can also occur in patients treated with atypical antipsychotics.