The Epidemiology of Drug-induced Akathisia: Part II. Chronic, Tardive, and Withdrawal Akathisias

Abstract

This article examines the epidemiological data on chronic akathisia, tardive akathisia, and withdrawal akathisia. The limitations of the data are discussed--in particular, the lack of consistent definitions of the syndromes. The studies suggest that a significant proportion of patients chronically treated with neuroleptics suffer from akathisia. The prevalence may be as high as 40 percent, although a conservative estimate would be closer to 30 percent. Risk factors for the development of chronic akathisia and tardive akathisia are poorly understood, but old age, female sex, iron deficiency, negative symptoms, cognitive dysfunction, and affective disorder diagnosis need to be studied further for their potential role. While there is convincing evidence that akathisia may develop after neuroleptic cessation or reduction in dose, the prevalence and risk factors for withdrawal akathisia are not known. Reports of akathisia in children and the elderly have been few, and more systematic research is necessary. Akathisia appears to be common in individuals with mental retardation treated chronically with neuroleptics.

A critical review of akathisia, and its possible association with suicidal behaviour

“…Eleven of the 20 complained of dysphoria. The numbers of patients in these studies are small and the samples of healthy young students not appropriate, but the results correspond surprisingly well with the most common estimates of antipsychotic-induced akathisia in psychiatric patient populations, which range from 25% to 75% (Sachdev, 1995). The large difference in these estimates is due mainly to varying diagnostic approaches; all the authors reporting lower ®gures stress the objective part of the condition, while it seems that the reports that emphasize the subjective component ®nd higher rates (King et al, 1995).…”

“…Sachdev suggests a simple classi®cation of all akathisia symptoms lasting longer than 3 months as chronic (Sachdev, 1995;Sachdev and Chee, 1990). Mode of onset should be used for more speci®c classi®cation, i.e.…”

Manifestations of Pregabalin Withdrawal

“…Drug-withdrawal akathisia has been reported as far back as 1960 with phenothiazine, an early psychotropic medication [7]. However, while literature review suggests that it can be reasonably caused by neuroleptics, prevalence and risk factors are not known [7].…”

Acatisia inducida por fármacos no psicotrópicos: a propósito de un caso asociado a metoclopramida.

“…acatisia aguda por antipsicóticos clásicos era del 10 al 20% y para acatisia crónica y tardía era alrededor del 40%, los factores de riesgo eran poco conocidos pero había especial énfasis en la deficiencia de hierro sérico (en el caso reportado no se hizo dicho dosaje) (10,11). El estudio CATIE no encontró diferencias significativas entre los antipsicóticos de primera generación y los de segunda generación (risperidona, olanzapina, quetiapina y ziprasidona), sin embargo el porcentaje de aparición de acatisia aguda siguió siendo mayor para los antipsicóticos de primera generación (8,12,13).…”