It's often described as a desperate need to move around.
Pt's often pace, move their arms as if smoothing hair or clothing, but the movements can be seen as having no real purpose. When asked, they can usually say that their hair or clothes are not, in fact, bothering them. When seated, they will usu move their legs a lot, or not be able to sit for more than seconds-minutes. When they get up, they kind of pop up without warning, with an intensity that's a bit scary to the interviewer. They often say the difficulty is NOT in their limbs, but that they feel the need to do something, go somewhere, but can't figure out what/where.
The best description of the experience I've heard is this:
Imagine for a moment that someone put their hand over your nose & mouth. You'd be fine for 10-15 seconds. But then you'd notice that a sense of needing to do something starts to form in your chest. Not really in your lungs, but down deep inside you, "in your soul." That need to "do something" becomes stronger and stronger. IF you make a conscious decision not to knock the hand away from your face, you will start fidgeting and then you will start to move your hands and feet about. If you can, you'll get up out of the chair and start moving about. If you're not going to breathe, you have to "do something."
That urgency and desperation to move is very similar to akathisia, but pt's w/ akathisia can't tell what it is their supposed to "do." It's very, very uncomfortable. It makes one very irritable and anxious.
This can make pt's seem manic, who are NOT. Be careful about diagnosing pt's with a manic episode (or amphetamine abuse) just based on excess movement. Lots of pt's with schizophrenia who get akathisia as a side effect to treatment end up getting diagnosed with Bipolar D/O or Schizoaffective-Bipolar Type and never get the akathisia treated. Then their irritability can get misdiagnosed as antisocial traits.
Manics can look like this, but usu describe the feeling differently. They will usu say they have a goal to their actions (even if it's not apparent) and they don't find their excess movement dysphoric. But, of course, sometimes it's hard to tell the difference. Adding a beta blocker or benzo (short-term) to the treatment for an acute manic can often be a good idea whether there's akathisia or not.
It's also a significant risk factor for SUICIDE and for violence.
TREAT the akathisia by lowering the dose and/or adding:
beta blocker
benzodiazepine
cogentin / artane / amantadine
Note that meds other than antipsychotics can cause akathisia, including SSRI's, lithium, benadryl. Some get it from certain opiates, e.g. Vicodin.
If pt's look like they have akathisia and describe their experience in any way close to this, assume it's akathisia until proven otherwise.
