Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

Abstract

Background: Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies.Method:We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies.Conclusion:Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent.

Treating akathisia with pregabalin – A case report

“…Akathisia is a movement disorder characterized by a subjective experience of restlessness alongside an urge to move, generating repetitive movements 1,2 . Its clinical presentation can be confusing and vague, making the diagnosis often problematic and posing an important challenge in clinical practice 1 .…”

“…Akathisia is a movement disorder characterized by a subjective experience of restlessness alongside an urge to move, generating repetitive movements 1,2 . Its clinical presentation can be confusing and vague, making the diagnosis often problematic and posing an important challenge in clinical practice 1 . This challenge stems not only from its symptoms and difficult treatment, but also from the association with aggression and violence, emergence and/or worsening of suicidal ideation, insomnia and exacerbation of the psychotic illness 1,2 .…”

“…Akathisia is the most common movement disorder associated with psychotropic medication 1 , primarily antipsychotic drugs, but also occurs as a side effect of selective serotonin reuptake inhibitors 2 . Among antipsychotics, first generation agents have a higher risk of eliciting akathisia than second generation agents 1 .…”

“…An imbalance between serotonergic/ noradrenergic and dopaminergic neurotransmitter systems has been classically considered as the origin of akathisia. Nonetheless, other theories have been proposed, such as an overstimulation of the locus ceruleus and D2/D3 receptor occupancy variations in the ventral striatum 1 .…”

“…The second strategy lies with the addition of anti-akathisia pharmaceuticals. Many drugs have been proposed to this effect, including propranolol, mirtazapine, anticholinergics (Biperiden, Benztropine, Trihexyphenidyl), Mianserine, benzodiazepines, Cyproheptadine, Amantadine and Clonidine 1 . More recently, there has been a case report showing success of Pregabalin in the treatment of akathisia 3,4 .…”