Akathisia and atypical antipsychotics: relation to suicidality, agitation and depression in a clinical trial

Abstract

Objective: Akathisia is among the most unpleasant side effects related to antipsychotic drug use, and possible associations between akathisia and agitation, depression and suicidal behaviour, respectively, have been described in previous literature. New generation antipsychotics are however regarded less prone to induce this particular adverse effect compared to older drugs, but evidence is incomplete and in need of confirmation from clinically relevant samples and settings. We therefore aim to investigate akathisia at hospital discharge for patients consecutively admitted with acute phase psychosis and treated with second generation antipsychotics according to guideline concordant clinical practice. Methods: This exploratory study is part of a naturalistic randomised controlled study in patients admitted with acute phase psychosis (N = 109). We report cross-sectional data at discharge/first follow-up after acute psychiatric hospital admission for patients with schizophrenia and related psychotic disorders. Results: There were statistically significant positive associations between akathisia and the following; suicidality in men (Beta 0.306, p=0.048), but not in women; agitation in those previously unexposed to antipsychotics (Beta 0.288, p=0.047); and depression in those exposed to antipsychotics before hospital admittance (Beta 0.375, p=0.031). Conclusion: Main findings were that akathisia is still a prevalent side effect in a clinically relevant sample of patients treated with atypical antipsychotics. Our results suggest that akathisia is significantly associated with depression, suicidality, and agitation in different subgroups of patients receiving antipsychotic drugs. Akathisia can be detrimental and the relations between akathisia and depression, suicidality and agitation should be investigated further in prospective, hypothesis-testing studies with larger samples.

Efficacy and Safety of Iloperidone in Bipolar Mania

“…29,52 The underlying reasons for observed differences in the two patient populations remains incompletely characterized, but clinical observations support that increased agitation and akathisia associated with depressive episodes complicates clinical evaluations of patients with bipolar disorder. [53][54][55] Iloperidone has a unique receptor binding profile that includes strong affinity for the α 1 -adrenergic receptor. 23 α 1 Receptor antagonism is associated with a variety of physiological effects including decreased peripheral vascular resistance, which results in acute and sustained decreases in blood pressure.…”

Overview of Movement Disorders Secondary to Drugs

“…Akathisia is a neurological disease characterized by a sense of inner restlessness and difficulty sitting or standing still, with a prevalence of up to thirty percent with antipsychotic use [ 18 ]. The symptoms of akathisia can range from mild to severe.…”

Comparative efficacy and acceptability of treatment strategies for antipsychotic-induced akathisia: a systematic review and network meta-analysis

“…1,2 Akathisia is very irritating, sometimes urges patients to commit harmful behaviors including suicide. 1,3 Clinical practice guidelines recommend dose reduction, switching antipsychotic, and adjuvant medications. 4,5 Some adjuvant medications have been examined in a few randomized trials and conventional pairwise meta-analyses.…”