Objective: To highlight the clinical impact of drug-induced akathisia on affective, psychotic, and cognitive symptoms and the importance of recognizing it in psychiatric practice.

Background: Akathisia is a highly distressing adverse effect characterized by inner restlessness and motor agitation. Beyond reducing treatment adherence, it may worsen depressive symptoms, increase suicidality, and negatively affect cognitive functioning, making correct recognition clinically critical.

Method: We report the case of a 62-year-old woman followed by psychiatrists since 2023 for anxiety-depressive symptoms triggered by a traumatic life event. Over the following year, psychotic features emerged, including impoverishment ideas, suspiciousness, and food-related paranoid thoughts. She had received treatment with a selective serotonin reuptake inhibitor and a second-generation antipsychotic, without clear benefit. After repeated treatment in a day hospital, she performed superficial wrist self-harm and was admitted to an inpatient psychiatric unit. On admission, she was anxious, markedly motor restless, unable to sit still, stepping from foot to foot, distractible, cognitively slowed, and minimally productive in conversation. Mood was depressed with anxiety and anguish. Although she denied current suicidal ideation, she reported wanting to kill herself because she could no longer tolerate the constant inner and motor restlessness. Barnes Akathisia Rating Scale score was 5.

Results: All previous psychotropic treatment was discontinued. Propranolol and trazodone were initiated. Following treatment adjustment, akathisia resolved, depressive-delusional symptoms regressed, and cognitive functions fully recovered.

Conclusion: This case illustrates that iatrogenic akathisia may substantially shape the clinical picture and mimic or amplify affective, psychotic, and cognitive symptoms. Interpretation of psychiatric deterioration should therefore include careful assessment of medication-induced factors, as timely recognition of akathisia may change both management and outcome.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/iatrogenic-akathisia-aggravating-depressive-and-psychotic-symptoms-a-case-report/