The Relationship Between Antipsychotic-Induced Akathisia and Suicidal Behaviour: A Systematic Review

Abstract

Objective We aim to systematically review evidence for a relationship between antipsychotic-induced akathisia and suicidal behaviour, in order to guide further clinical decision making in this area. Methods Several electronic databases (Embase, Medline, Cochrane and PsychINFO) were systemically searched for articles published up to February 2021, using search terms related to akathisia, antipsychotics and suicidal behaviour. Two reviewers independently evaluated all the relevant studies using predetermined criteria and assessed the risk of bias for each included study. The systematic review was conducted in line with PRISMA methodology and reporting. Results Following de-duplication, screening and application of exclusion criteria, four eligible studies were identified. All of the available studies were in English and included adult patients. Nevertheless, there was significant variability regarding methodology and overall quality was deemed low due to small sample sizes. There was insufficient data to perform statistical analyses of the results. Of the four studies, two found a weak correlation between antipsychotic-related akathisia and suicidal behaviour, a finding that was not supported by the remaining two studies. Conclusion The search yielded very few studies for inclusion. On the basis of the existing evidence, akathisia cannot be reliably linked to the presence of suicidal behaviour in patients treated with antipsychotic medication. However, proactive screening for emerging suicidal behaviour in this vulnerable patient group is advisable. Our findings highlight the pressing need for further research in this area.

Family psychoeducation in schizophrenia and schizophrenia related disorder, treatment compliance, and suicidal risk reduction: questions about their relationship from a naturalistic observation

“…Prior to the family’s participation in the program, if treatment has little effect, it can have side effects. The increased risk of suicide sometimes associated with treatments aimed at reducing it, such as mood regulators ( 60 – 62 ), antidepressants ( 63 , 64 ), or antipsychotics ( 65 , 66 ), can be interpreted as follows: when they fail to relieve the patient’s symptoms, the presence of significant side-effects increases distress and hence the risk of suicide.…”

Effectiveness and safety of blonanserin in young and middle-aged female patients with schizophrenia: data from a post-marketing surveillance

“…A recent review showed that incidence rate of akathisia with the second-generation antipsychotic drugs ranged from 2.9 to 13.0%, with a composite incidence of 3.7% [ 32 ]. Akathisia may cause patients distress, poor adherence, and an increased risk of suicide [ 33 ]. While the post-marketing surveillance in China did not distinguish between patients with or without adjunctive antipsychotic treatment, which may also be a possible reason for the higher incidence of akathisia.…”