Akathisia — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisAkathisiaMRCPsych Paper B

A 45-year-old woman taking risperidone 4 mg daily reports an overwhelming urge to move, an inability to sit still and a distressing sense of inner restlessness. She is repeatedly pacing and rocking. Which extrapyramidal side effect is this?

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Correct answer: D — Akathisia

The correct answer is D, akathisia. Its defining features are a distressing subjective sense of inner restlessness and a compelling need to move, accompanied by observable motor activity such as pacing, rocking or an inability to remain seated. Risperidone can cause dose-related akathisia. Tardive dyskinesia usually causes repetitive involuntary movements, particularly of the mouth, tongue and face, rather than subjective restlessness. Parkinsonism presents with bradykinesia, rigidity and tremor. Acute dystonia causes sustained muscle contractions or abnormal postures, such as torticollis or an oculogyric crisis. Neuroleptic malignant syndrome is a medical emergency characterised by hyperthermia, severe rigidity, altered mental state and autonomic instability.

Reference: Electronic Medicines Compendium (eMC), Reagila hard capsules: Summary of Product Characteristics, section 4.4, “Akathisia, restlessness”, updated 10 April 2026. https://www.medicines.org.uk/emc/product/9487/smpc