A woman recently started on an antipsychotic reports feeling 'more anxious' and is noted to be pacing in the waiting room. Her team considers whether this represents a worsening of her underlying anxiety or something else. Before revealing the answer: what should specifically be asked to clarify this?

Ask directly about the quality of the restlessness and its timing in relation to the medication change, since akathisia can be mistaken for, or coexist with, anxiety or a worsening of the underlying condition if it is not specifically recognised as a medication effect. A clear temporal association with starting or increasing the antipsychotic, together with a specific quality of inner restlessness and physical unease rather than the more typical worry and apprehension of anxiety, points toward akathisia. Without asking these specific questions, there is a real risk of the antipsychotic dose being increased in response to what looks like worsening anxiety, when the correct response would in fact be to reduce or change the medication causing the akathisia.