Akathisia: Problem of History or Concern of Today

Abstract

Akathisia is a neurological side effect of antipsychotic medications, which are used to treat various psychiatric disorders. Akathisia is characterized by physical restlessness and a subjective urge to move. Although side effects such as akathisia, dystonia, and dyskinesia are common with the use of conventional antipsychotics, they occur in reduced frequency with the use of new-generation antipsychotics. Despite a lowered incidence profile, akathisia and similar conditions continue to affect patients. Neuroleptic-induced akathisia can present as fidgety movements while seated, rocking in place while standing, pacing, inability to sit or stand still for an extended period of time, and an overwhelming urge to move. These symptoms can cause severe distress and an increased risk of suicide for affected patients. First-line treatment of akathisia includes benzodiazepines or β-blockers for patients who do not have symptoms of Parkinson's disease and anticholinergic medications for patients with Parkinson's symptoms. Clinicians should ensure that an accurate diagnosis of akathisia is made and that target symptoms are decreasing due to treatment. At the same time, it must be ensured that the treatment used does not negatively affect the mental health of the patient. This expert roundtable supplement will address the diagnosis, pathophysiology, phenomenology, classification, and history of akathisia as well as discuss screening tools and treatment options for the condition.

An Open-Label Study of Aripiprazole for Methamphetamine Induced Psychosis

“…Akathisia is not uncommon with aripiprazole. While second-generation antipsychotic drugs have been reported to cause fewer incidences of extrapyramidal symptoms (EPSs) than typical antipsychotic drugs, AEs such as akathisia have been observed with atypical antipsychotic drugs [39,40].…”

Akathisia�rare cause of psychomotor agitation in patients with traumatic brain injury: Case report and review of literature

“…It is a complex problem that may hinder rehabilitation and cause distress and even physical harm to the patient and relatives. A widespread sequence of possible diagnoses may underlie psychomotor agitation after TBI, such as anxiety, nonakathisia antipsychotic dysphoria, agitation secondary to psychotic symptoms, mania, drug-withdrawal states, organic disorders (e.g., delirium, hypoglycemia, encephalitis lethargica, epilepsy, endocrine dysfunction, pain), agitation related to affective disorders, neurologic disorders (e.g., Parkinson disease, Huntington disease), tardive dyskinesia (commonly coexists with akathisia), myoclonus, acute dystonia, and tremor [7,[14][15][16]. It is not possible to identify one single underlying mechanism of posttraumatic agitation.…”

“…However, others state that it is unlikely that a single neurotransmitter hypothesis will explain all the complex features of the disorder. The interaction of several neurotransmitters may be involved, such as dopamine, acetylcholine, gamma-aminobutyric acid, norepinephrine, serotonin, and neuropeptides [1,[6][7]9,11,16].…”

Akathisia: Case Presentation and Review of Newer Treatment Agents

“…It has been associated with severe distress, suicidal thoughts, impulsive/violent behavior, 3,4 a risk of developing tardive dyskinesia, 4 drug use, 5 medication noncompliance, 5,6 and poor treatment response. 6 For patients with schizophrenia and bipolar I disorder, [6][7][8] who are the usual target population of antipsychotic medications, this could mean very real, negative healthcare consequences.…”

“…It is most often associated with conventional, first-generation antipsychotics. 2,5 Although newer, second-generation antipsychotics have a lower propensity of symptoms, the literature shows that they are not free from inducing akathisia. 2,8,[11][12][13] Low dopaminergic tone continues to be the primary attributable mechanism by which we understand this problem due to its association with medications that block dopaminergic transmission.…”