2Tardive dyskinesia, which is permanent and requires immediate medication discontinuation.
3Akathisia, a movement-related side effect that should be reported and may respond to dose reduction or a beta-blocker.✓ Correct answer
4A sign of relapse requiring an increased aripiprazole dose.
Explanation
Correct (2): Akathisia — subjective inner restlessness with observable motor restlessness — is a common acute EPS of aripiprazole because of its partial D2 agonism. Treatment options: dose reduction, switching agents, or adding propranolol or a short-course benzodiazepine. (1) Relapse presents with positive psychotic symptoms (hallucinations, delusions), not motor restlessness. (3) Tardive dyskinesia develops after months to years and presents with repetitive involuntary movements (lip smacking, tongue thrusting). (4) NMS requires fever, rigidity, and autonomic instability — all absent here.
In-depth explanation
Memory Tip Aripiprazole = partial D2 agonist; akathisia is its signature EPS despite overall lower EPS than haloperidol. DifferentiateAkathisia (early, motor restlessness) ≠ Tardive dyskinesia (late, repetitive involuntary) ≠ NMS (fever + rigidity + autonomic).
Clinical scenario
Scenario A 32-year-old male on aripiprazole 15 mg PO daily for 2 weeks for schizophrenia reports being unable to sit still, constantly pacing, and feeling "jittery from the inside." Vital signs are stable. There is no fever, rigidity, or repetitive involuntary movement.
Key concepts
Akathisia — Subjective inner restlessness with observable motor restlessness; a common acute EPS of antipsychotics, especially aripiprazole and high-potency typicals.
Partial D2 agonist — Pharmacologic action of aripiprazole, brexpiprazole, and cariprazine — stabilizes dopamine signaling rather than fully blocking it; reduces EPS and metabolic risk.
Tardive dyskinesia — Late-onset involuntary repetitive movements (face, tongue, limbs) after months to years of antipsychotic therapy; treatable with valbenazine or deutetrabenazine.