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Akathisia, or acathisia, is a syndrome characterized by unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain motionless, hence its origin Ancient Greek α (a), without, not + κάθισις (káthisis), sitting]. Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), piperazines (such as ziprasidone), and rarely, antidepressants. Akathisia can also, to a lesser extent, be caused by Parkinson disease-related syndromes.
Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still, accompanied by overwhelming anxiety, malaise, and severe dysphoria (manifesting as an almost indescribable sense of terror and doom). Partly because the condition is difficult for the patient to describe, it is often misdiagnosed. When misdiagnosis occurs in antipsychotic neuroleptic-induced akathisia, more antipsychotic neuroleptics may be prescribed, potentially worsening the symptoms. High functioning patients have described the feeling as a sense of inner tension and torment or chemical torture from the inside out.
Akathisia makes some patients act out in violent fits of rage throwing and breaking things or harming others. Ironically antipsychotic drugs are many times prescribed as “mood stabilizers” but then have the opposite intended effect, which often leads to increased doses further escalating the symptoms when the intent was to ameliorate the symptoms.
Healy, et al (2006), described the following regarding akathisia: tension, insomnia, a sense of discomfort, motor restlessness, and marked anxiety and panic. Increased labile affect can result, such as weepiness. Interestingly, in some people the opposite response to SSRIs occurs, in the form of emotional blunting; but sufficient clinical research has not yet been made in this area.
Jack Henry Abbot (1981) described the effects of akathisia produced by antipsychotic drugs:
In severe cases, akathisia can be so tormenting that the patient is compelled to take action, such as suicide attempts.
Treatment non-compliance is a common consequence of neuroleptic-induced akathisia. At the extreme end of non-compliance, patients who have been treated with neuroleptic antipsychotics for psychotic episodes or prochlorperazine for nausea may rarely run away from hospitals or emergency rooms due to this disconcerting sensation.
Akathisia is most often seen as a side effect of certain drugs. However it is by far most commonly seen in the use of antipsychotic medications.
The 2006 UK study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as "agitation, emotional lability, and hyperkinesis (overactivity)". The study further points out that misdiagnosis of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia. Healy, et al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can "exacerbate psychopathology." The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebos showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%).
Treatment includes the discontinuation or reduction of dose of the causative agent.
The most common treatment for antipsychotic akathisia is the anticholinergic medication benztropine (Cogentin). But since benztropine is for extrapyramidal side effects such as muscle spasms, muscle stiffness and tremors it is not effective in treating akathisia which is not a true extrapyramidal side effect. Other anticholinergic medications such as diphenhydramine may also be used in the treatment of akathisia.
Akathisia can be reduced by administering other drugs, though effectiveness can vary with more severe cases resistant to most drug treatment. Benzodiazepines like clonazepam (Klonopin) are effective. Some consider the drug of choice for the treatment of akathisia to be beta-blockers such as propranolol (Inderal) or metoprolol. The antihistamine cyproheptadine is also effective, though with shorter effect than beta blockers.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Akathisia". A list of authors is available in Wikipedia.|