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The BARS calculator is in the Library.
Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.
Use it for
- Rating akathisia in a person on an antipsychotic or other dopamine blocker who has become restless.
- Following akathisia after a dose change, a switch or the addition of a treatment.
- Separating true akathisia from pseudoakathisia, where movements are seen but no inner restlessness is reported.
Do not use it for
- Diagnosing tardive dyskinesia or parkinsonism. See the AIMS for dyskinesia.
- Rating agitation from psychosis, mania or anxiety, though it can help tell them apart.
- Use without the observation period. The objective item depends on watching the person for at least two minutes each, seated and standing.
Observe the person seated, then standing, in neutral conversation, for at least two minutes in each position. Movements seen at other times, such as on the ward, can also be rated.
Then ask directly about inner restlessness and distress.
BARS
Answer the questions to see the result.
This calculator adds up the score in your browser. Nothing you enter is stored or sent.
More about the BARS
About the BARSWhat it is and what it is for
The BARS rates drug-induced akathisia, the inner restlessness and urge to move that dopamine-blocking drugs can cause. It has four parts. Objective restlessness, awareness of restlessness and distress are each scored 0 to 3. A global clinical rating runs from 0 (absent) to 5 (severe).
The first three items add to a total of 0 to 9. The global rating is kept separate. Barnes wrote it to be completed after a short observation seated and standing, followed by direct questions about what the person feels.
How to use itGiving it and scoring it
Watch the person seated and then standing for at least two minutes each, in neutral conversation. Rate the objective item from what you see.
Then ask about inner restlessness and distress, and rate the two subjective items. Finish with the global rating. Record the total of items 1 to 3 and the global rating separately.
Interpreting the scoreScore ranges and what they suggest
| Global rating | What it suggests | Usual response |
|---|---|---|
| 0 | AbsentNo inner restlessness. Movements without it would be pseudoakathisia. | No treatment for akathisia. |
| 1 | QuestionableNon-specific tension or fidgetiness. | Watch. Review the drug and the dose, and re-rate soon. |
| 2 | Mild akathisiaAware of restlessness, little distress. | Review the dose and the drug. Treat if it bothers the person. |
| 3 | Moderate akathisiaRestless movements with distress. | Treat. Reduce or switch the drug and add a treatment for akathisia. |
| 4 | Marked akathisiaA compulsion to pace, obvious distress. | Treat now, and ask about mood and suicidal thoughts. |
| 5 | Severe akathisiaCannot stay still, intense distress and insomnia. | Treat urgently, and assess for suicidal thoughts and for the risk of non-adherence. |
Anchors are Barnes (1989). The global rating is the main severity measure. The total of the first three items is used for tracking.
Pearls and pitfallsTips and common mistakes
- Ask the person to stand still for a minute and watch their feet. Restlessness that gets worse when asked to stand still is characteristic.
- Ask what the restlessness feels like. A person with akathisia will often say they cannot stay still or that the feeling is in the legs.
- Akathisia is easy to confuse with agitation from the illness. If a dose increase made the person more restless, think akathisia first.
- SSRIs and other serotonergic drugs can also cause akathisia-like restlessness.
- Re-rate under the same conditions each time: same time of day, same observation, same rater if you can.
EvidenceAccuracy and reliability
- Barnes (1989) developed the scale and reported interrater agreement of 0.74 to 0.96 (kappa) across the items in raters who used the standard observation.
- The BARS is the most widely used akathisia scale in trials, and the usual primary outcome is the global rating or the total of items 1 to 3.
- Evidence for treatment is limited and mostly from small trials. The APA 2020 guideline suggests lowering the dose, switching, adding a benzodiazepine, or adding a beta-blocker.
Source, license and referencesWhere it comes from
The BARS was published by Thomas R. E. Barnes in the British Journal of Psychiatry (1989). The published scoring form states that the scale can be reproduced freely. Wording here follows the form.
- Barnes TRE. A rating scale for drug-induced akathisia. Br J Psychiatry. 1989;154:672-676.
- Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 2020;177(9):868-872.
- Pringsheim T, Gardner D, Addington D, et al. The assessment and treatment of antipsychotic-induced akathisia. Can J Psychiatry. 2018;63(11):719-729.