Akathisia and Tardive Dyskinesia

It is now 30 years since the introduction of neuroleptics into clinical practice, and we are still learning more about the effects of these drugs in our patients. On the positive side, research on second-generation antipsychotics such as BW234U,¹piquindone (R022-1319),²the substituted benzamides,³and others has given rise to the hope that control of psychotic symptoms may someday be accomplished with much less risk of akathisia, parkinsonism, and tardive dyskinesia than exists for currently marketed neuroleptics. Until that day, however, we will more and more be forced to deal with the increasingly troublesome short- and long-term side effects of the first-generation compounds. The article by Barnes and Braude⁴in this issue of theArchivesdeals with one of the relatively neglected side effects of the first-generation neuroleptics, namely akathisia. These authors boldly attempt to make an operational definition of neuroleptic-induced akathisia, to subtype it, to