Clozapine-induced acute akathisia: A case report

Existing data suggest that clozapine has lesser propensity of developing akathisia as compared to first general antipsychotics. Clozapine is mostly used in patients with treatment-resistant schizophrenia, which is a second-generation antipsychotic. Akathisia is one of the rare side effects of clozapine. A 34-year-old woman with a 7-year history of schizophrenia exhibited positive and negative symptoms, initially treated with haloperidol and clonazepam. Despite relief in positive symptoms, she experienced recurring cycles of symptom exacerbation upon discontinuing medication. Because of poor compliance, she was admitted and started on clozapine, reaching 150 mg/day. Although showing symptom improvement, she developed clozapine-induced akathisia, characterized by restlessness and limb movements. Propranolol and a gradual reduction in clozapine alleviated akathisia, supplemented by lorazepam. The Barnes Akathisia Rating Scale dropped to 0 after three weeks. This case highlights the challenges of managing schizophrenia and the importance of tailored medication strategies. The use of clozapine should be customized based on each patient's needs to prevent clozapine-induced akathisia.