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Assessment Tool: BARS

The Barnes Akathisia Rating Scale (BARS) assesses drug-induced akathisia — an extrapyramidal side effect characterized by inner restlessness and an urge to move. Observe the patient for at least 2 minutes at rest, then ask about subjective awareness and distress. A global score of 2 or above requires clinical intervention. Akathisia is frequently misidentified as worsening psychosis.

BARS — Barnes Akathisia Rating Scale

A validated 4-item instrument for assessing drug-induced akathisia — an extrapyramidal side effect characterized by inner restlessness and compulsion to move. Developed by Thomas Barnes (1989). Global score ≥ 2 indicates clinically significant akathisia requiring intervention.

Global score thresholds

0–1

Absent / questionable

2–3

Mild–moderate akathisia

4–5

Marked–severe akathisia

Clinical note: Akathisia is frequently misidentified as worsening psychosis, which can lead to antipsychotic dose escalation and worsening of the adverse effect. The BARS provides objective documentation to distinguish akathisia from psychotic agitation.
1. Objective Akathisia (observed restlessness)

Observe patient at rest (seated and standing) for at least 2 minutes.

2. Subjective Awareness of Restlessness

Ask: "Do you feel restless or an urge to move about?"

3. Subjective Distress Related to Restlessness
4. Global Clinical Assessment of Akathisia

Integrates objective and subjective findings into a single clinical rating.