Akathisia is a common and unpleasant side effect of many psychotropic medications. Junior doctors are often slow to recognise it with consequences for the patient which include reduced compliance, exacerbation of psychotic symptoms and an increased risk of suicide and violence. The word akathisia comes from the Greek meaning literally “not to sit’ and was initially used by Haskovec in 1902 to refer to restless patients with hysteria and neurasthenia. Akathisia is a relatively common side effect of antipsychotic medication, although other drugs including antidepressants, metoclopramide, some calcium channel blockers, dopamine agonists, amphetamine and buspirone have all been shown to cause it. The symptoms consist of objective and subjective components. Subjectively there are symptoms of dysphoria including tension, panic, irritability and impatience and objectively there are movements usually taking the form of shuffling of feet while sitting and pacing or rocking while standing. Fidgety leg movements may occur while lying down. The differential diagnosis includes agitation secondary to psychotic symptoms, the restless legs syndrome, anxiety, drug withdrawal states and a number of neurological disorders.