Antipsychotic-induced akathisia — MRCPsych Paper A MCQ

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ModeratePsychopharmacologyAntipsychotic-induced akathisiaMRCPsych Paper A

A 28-year-old man with schizophrenia starts aripiprazole. Five days later, his psychotic symptoms are settling, but he reports mounting discomfort whenever he tries to remain seated, which is relieved briefly by walking. During the interview, he repeatedly shifts his weight, stands and paces. What is the most likely adverse effect?

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Correct answer: C — Akathisia

The answer is akathisia. The rapid onset after starting aripiprazole, discomfort when remaining still, temporary relief from walking, and observable pacing and weight-shifting are characteristic. The aripiprazole SmPC lists akathisia as a common adverse reaction. An oculogyric crisis causes sustained involuntary eye deviation and is a focal form of acute dystonia. Acute dystonia otherwise produces sustained muscle contractions or abnormal postures, such as torticollis or jaw and tongue spasm. Catatonia requires a broader psychomotor syndrome, with features such as stupor, mutism, posturing or negativism. Tardive dyskinesia usually follows longer antipsychotic exposure and causes involuntary, often orobuccolingual, movements rather than a medication-linked urge to walk. Akathisia can be mistaken for psychotic agitation, potentially prompting inappropriate antipsychotic dose escalation.

Reference: Otsuka Pharmaceuticals (UK) Ltd. ABILIFY 10 mg orodispersible tablets, Summary of Product Characteristics, section 4.8 Undesirable effects. Updated 27 April 2026. https://www.medicines.org.uk/emc/product/7149/smpc