Which symptom is an urgent extrapyramidal symptom that warrants immediate assessment for a patient on haloperidol?

• A. Restlessness and constant pacing
• B. Visual hallucinations
• C. Dry mouth
• D. Mild constipation

Answer: (A)

Restlessness with constant pacing points to akathisia, an urgent extrapyramidal side effect from haloperidol. Akathisia arises from dopamine blockade in the nigrostriatal pathways and tends to emerge within days to weeks of starting or increasing the dose. It’s especially troubling because it causes severe inner restlessness and a compelling need to move, which can lead to agitation, injury, or nonadherence if not addressed promptly. That urgency is why this symptom warrants immediate assessment and action, such as evaluating severity, considering dose adjustment or a switch to a lower-EPS antipsychotic, and initiating targeted treatment (for example, beta-blockers like propranolol or short-term benzodiazepines, with choices tailored to the patient).

The other symptoms listed do not reflect an urgent EPS: visual hallucinations may indicate ongoing or worsened psychosis or another cause; dry mouth and mild constipation are common non-urgent anticholinergic or autonomic side effects.