[Subjective experiences of patients with acute neuroleptic-induced akathisia]

Neuroleptic-induced akathisia is a clinically important neuropsychiatric syndrome with mainly subjectively experienced psychic symptoms on the one hand and well-observable motor signs on the other. There is no general consensus of opinion on the relative importance of these two aspects for diagnosing akathisia. Hence, differential diagnosis is difficult and in the absence of a biological marker it depends crucially on clinical judgement. Systematic investigation of 27 in-patients via a semistructural interview, a self-assessment scale (20 in-patients) and established akathisia rating scales (Hillside, Barnes, Prince Henry Hospital and Chouinard) revealed four characteristics of subjective experience in acute neuroleptic-induced akathisia: 1. perception of a foreign but nevertheless inner compulsion to move; 2. lack of control over motor behaviour; 3. feeling of inhibition of purposeful actions and 4. subjectively close or inseparable relationship between inner restlessness and restless movements. These features are strongly interrelated and correlate with severity of akathisia. They could be useful in differentiating akathisia from other states of restlessness. The results of this study are discussed in context of the literature on clinical phenomenology of akathisia. We propose a symptom-severity model of akathisia emphasizing psychodynamic aspects with considerable consequences for diagnosis and quantification of the disorder. The model points to the relevance of patient exploration for optimizing diagnostic reliability and should be taken into account when developing new and valid akathisia rating instruments.