Although akathisia is a true neuropsychiatric disorder and an ideal model for collaboration between neurology and psychiatry, to date there has been very limited joint research in its regard. The disconnection between the two in the clinical setting is perhaps even more troubling.  When patients with sudden-onset akathisia present to neurology, they may be distraught, pleading for help, and adamant their condition is neurological. Due to their anxious appearance and distractible/suppressible movements, however, they are most often diagnosed as psychogenic and referred to psychiatry. If they are unwilling to accept the diagnosis, this scenario can recur repeatedly and ultimately lead to hopelessness, loss of family support and significantly worsened suicidality. It is, however, a practice that can be challenged scientifically, as noted by Ellenstein, Kranick, and Hallett in “An Update on Psychogenic Movement Disorders” (2011)¹:

Psychogenic movement disorders (PMD) and other conversion disorders (CD) with apparent neurologic signs (neurologic CD) plague patients and perplex physicians. Due to a lack of objective evidence of underlying brain lesions, CD were largely abandoned by neurologists and remained poorly understood psychiatric diagnoses throughout most of the 20th century. Modern neuroscience now supports increasingly comprehensive biological models for these complex disorders, definitively establishing their place in both neurology and psychiatry.  Although it is often clinically useful to distinguish a movement disorder as either “organic” or “psychogenic,” this dichotomy is difficult to defend scientifically.

This was also addressed by Wilshire and Ward in “Psychogenic Explanations of Physical Illness, Time to Examine the Evidence” (2016)²:

Clearly, psychological causation cannot be demonstrated by the mere absence of a confirmed disease diagnosis (argument from ignorance). Medical practitioners simply cannot assume that the current knowledge of disease and its markers is 100% perfect or that all complaints not otherwise accounted for must have a psychological origin. It is commonly assumed that any physical complaint without a medical explanation must reflect somatization. Given our current incomplete understanding of disease, this assumption is difficult to justify….We conclude that there is currently little evidential support for psychogenic theories of illness in the neurological domain. In the future, researchers need to take a wider view concerning the etiology of these illnesses.