Akathisia masked by hypokinesia

Here, we will discuss the concept of subjective akathisia and present a pat ient case. Our patient was suffering from neuroleptic-induced hypokinesia a nd akathisia at the same time. The typical motor manifestations of akathisi a were masked by hypokinesia, which made the diagnosis difficult. However, the subjective symptoms of akathisia were evident and distressing. Although not observable to bare eye, the pathognomonic pattern of motor activity de tected in akathisia was demonstrated by actometric recording. Changing the conventional neuroleptic to an atypical one brought relief to the subjectiv e symptoms of akathisia and hypokinesia, while the motor activity was clear ly diminished in actometric recording. Actometric recording may be useful i n diagnosing akathisia masked by hypokinesia, but the typical subjective sy mptoms of akathisia should not be ignored, even when actometry is not avail able to demonstrate the missing motor component of akathisia. Not only akat hisia defined by DSM-IV but also subjective akathisia should be adequately treated to relieve the subjective distress, and to diminish the unfavorable effects on psychotic symptoms, behavior, and drug compliance.