ABSTRACT
This chapter presents a case of a 25-year-old man with moderate learning disability who comes to the accident and emergency department. This involves him finding it very difficult to sit still and feeling anxious much of the time. Prior to this he had been doing well in a supported working environment where he works in a small team, making cardboard boxes. He has not been aggressive or described any intent to harm himself or others. It occurs with antipsychotic medication and to a lesser extent antidepressant medication and also in parkinsonism. The risk of akathisia is higher in higher dosage and so reduction in medication dose is a possibility, although in this situation it is worth returning to an atypical antipsychotic such as aripiprazole or quetiapine, where the risk of akathisia is lower. It can look like Parkinson disease, which is caused by nigro-striatal degeneration. It is usually a side effect of long-term neuroleptic treatment and can be irreversible.
