Akathisia refers to subjective inner restlessness and a feeling of the need to move. Its occurrence in association with Parkinson disease suggests a common underlying pathophysiological mechanism. We investigated the relationship of neuroleptic-induced akathisia to drug induced parkinsonism in a group of 123 neuroleptic-treated elderly chronic schizophrenic inpatients (mean age: 63.9 +/- 8.9 years). In addition, since neuroleptic-induced akathisia has been noted to be more common in females, we studied the severity of akathisia separately by gender. Akathisia was present in 40 patients (32.5%). We found no significant differences in the severity of akathisia between patients with and these without parkinsonism. Although a significantly larger proportion of females than males had akathisia, there were no significant differences in respect of parkinsonism. Our findings do not support a major role for the dopaminergic system in the pathophysiology of akathisia might be related to dysfunction of nondopaminergic systems.