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.