A man started an antipsychotic ten days ago and now cannot sit still during the consultation, repeatedly shifting his weight from foot to foot and pacing when he is asked to wait. He describes an intense inner restlessness and unease that is, if anything, more distressing to him than the visible movement itself. What is this?

This is akathisia: visible restlessness, such as pacing or shifting weight, together with a significant subjective component of inner restlessness and unease, developing in clear temporal association with starting or increasing antipsychotic medication. It is not tardive dyskinesia, which has a later, more gradual onset and involves repetitive, purposeless oral and facial movements rather than a core feature of restlessness and inner tension. It is not anxiety of psychiatric origin, since the clear temporal link to the new medication and the specific quality of restless inner unease point toward a medication effect rather than a primary anxiety state. And it is not acute dystonia, which presents as sustained muscle spasm rather than restlessness.