Akathisia

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For the album by Hovercraft, see Akathisia (album).

Akathisia
Other namesAcathisia
Common sign of akathisia
beta blockers[4][2]
FrequencyRelatively common[4]

Akathisia (IPA: /æ.kə.ˈθɪ.si.ə/) is a

suicidal thoughts.[2] Akathisia is also associated with threatening behaviour and physical aggression in mentally disordered patients.[8] However, the attempts to found potential links between akathisia and emerging suicidal or homicidal behaviour were not systematic and were mostly based on a limited number of case reports and small case series.[9] Apart from these few low-quality studies, there is another more recent and better quality study (a systematic review from 2021)[9] that concludes «akathisia cannot be reliably linked to the presence of suicidal behaviour in patients treated with antipsychotic medication».[9]


restless leg syndrome in that akathisia is not associated with sleeping. However, despite a lack of historical association between restless leg syndrome and akathisia, this does not guarantee that the two conditions do not share symptoms in individual cases.[2]

Treatment may include

beta blockers, particularly propranolol.[2][4][12]

The term was first used by Czech neuropsychiatrist Ladislav Haškovec, who described the phenomenon in 1901 long before the discovery of antipsychotics, with drug-induced akathisia first being described in 1960.[1] It is from Greek a-, meaning "not", and καθίζειν kathízein, meaning "to sit", or in other words an "inability to sit".[2]

Classification

Akathisia is usually grouped as a medication-induced

calcium channel blockers, antibiotics, anti-nausea and anti-vertigo drugs.[5]

Signs and symptoms

Symptoms of akathisia are often described in vague terms such as feeling nervous, uneasy, tense, twitchy, restless, and an inability to relax.[1] Reported symptoms also include insomnia, a sense of discomfort, motor restlessness, marked anxiety, and panic.[13] Symptoms have also been said to resemble symptoms of neuropathic pain that are similar to fibromyalgia and restless legs syndrome.[14] When due to psychiatric drugs, the symptoms are side effects that usually disappear quickly and remarkably when the medication is reduced or stopped. However, tardive akathisia which has a late onset, may go on long after the medication is discontinued, for months and sometimes years.[15]

When misdiagnosis occurs in antipsychotic-induced akathisia, more antipsychotic may be prescribed, potentially worsening the symptoms.[7][16] If symptoms are not recognised and identified akathisia can increase in severity and lead to suicidal thoughts, aggression and violence.[1][2]

Visible signs of akathisia include repetitive movements such as crossing and uncrossing the legs, and constant shifting from one foot to the other.

agitated depression, and attention deficit hyperactivity disorder may look like akathisia, but the movements feel voluntary and not due to restlessness.[17]

Jack Henry Abbott, who was diagnosed with akathisia, described the sensation in 1981 as: "You ache with restlessness, so you feel you have to walk, to pace. And then as soon as you start pacing, the opposite occurs to you; you must sit and rest. Back and forth, up and down you go … you cannot get relief …"[18]

Causes

Medication-induced

Medication related causes of akathisia
Category Examples
Antipsychotics[19] Haloperidol, amisulpride, risperidone, aripiprazole, lurasidone, ziprasidone
SSRIs[20]
 Fluoxetine,[20] paroxetine,[13] citalopram, sertraline[21]
Antidepressants Venlafaxine, tricyclics, trazodone, and mirtazapine[22]
Antiemetics Metoclopramide, prochlorperazine, and promethazine
Drug withdrawal Antipsychotic withdrawal[2]
Serotonin syndrome[23] Harmful combinations of
psychotropic drugs

Medication-induced akathisia is termed acute akathisia and is frequently associated with the use of

drug-dependent individuals. Since dopamine deficiency (or disruptions in dopamine signalling) appears to play an important role in the development of Restless Legs Syndrome (RLS), a form of akathisia focused in the legs,[medical citation needed] the sudden withdrawal or rapidly decreased dosage of drugs which increase dopamine signalling may create similar deficits of the chemical which mimic dopamine antagonism and thus can precipitate RLS. This is why sudden cessation of opioids, cocaine, serotonergics, and other euphoria-inducing substances commonly produce RLS as a side-effect.[24]

Akathisia involves increased levels of the neurotransmitter norepinephrine, which is associated with mechanisms that regulate aggression, alertness, and arousal.[25] It has been correlated with Parkinson's disease and related syndromes, and descriptions of akathisia predate the existence of pharmacologic agents.[5]

Akathisia can be miscoded in side effect reports from antidepressant clinical trials as "agitation, emotional lability, and hyperkinesis (overactivity)"; misdiagnosis of akathisia as simple motor restlessness occurred, but was more properly classed as dyskinesia.[medical citation needed][13]

Diagnosis

The presence and severity of akathisia can be measured using the Barnes Akathisia Scale,[26][27] which assesses both objective and subjective criteria.[26] Precise assessment of akathisia is problematic, as there are various types making it difficult to differentiate from disorders with similar symptoms.[5]

The primary distinguishing features of akathisia in comparison with other syndromes are primarily subjective characteristics, such as the feeling of inner restlessness and tension.[28][29] Akathisia can commonly be mistaken for agitation secondary to psychotic symptoms or mood disorder, antipsychotic dysphoria, restless legs syndrome, anxiety, insomnia, drug withdrawal states, tardive dyskinesia, or other neurological and medical conditions.[24]

The controversial diagnosis of "pseudoakathisia" is sometimes given.[1]

Treatment

Acute akathisia induced by medication,

Vitamin B, and iron supplementation if deficient, may be of help.[2][4]
Although they are sometimes used to treat akathisia, benzodiazepines and antidepressants can actually cause akathisia.[citation needed]

Epidemiology

Approximately one out of four individuals treated with first-generation antipsychotics have akathisia.[5] Prevalence rates may be lower for modern treatment as second-generation antipsychotics carry a lower risk of akathisia.[30] In 2015, a French study found an overall prevalence rate of 18.5% in a sample of outpatients with schizophrenia.[32]

History

The term was first used by Czech neuropsychiatrist Ladislav Haškovec, who described the phenomenon in a non-medication induced presentation in 1901.[33][1]

Reports of medication-induced akathisia from chlorpromazine appeared in 1954.[a] Later in 1960 there were reports of akathisia in response to phenothiazines (a related drug).[1] Akathisia is classified as an extrapyramidal side effect along with other movement disorders that can be caused by antipsychotics.[1]

In the former

Parkinson's-type symptoms in prisoners.[35]

In 2020 clinical psychologist and professor of psychology Jordan Peterson was diagnosed with akathisia after being treated for insomnia and depression with benzodiazepines that was associated with an autoimmune disorder and was subsequently treated in Russia.[36][37]

See also

Notes

  1. ^ "In 1954, two separate researchers, Professor Hans Steck of Lausanne, and German psychiatrist Hans Joachim Haase provided the first unambiguous descriptions of a syndrome of abnormally reduced and restricted movement that was associated with chlorpromazine. [...] They also described the drug-induced agitation known as akathisia (Hasse, 1954; Steck, 1954)."[34] : 40 

References

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  10. ^ "MISSD - The Medication-Induced Suicide Prevention and Education Foundation in Memory of Stewart Dolin - Akathisia Support". missd.co. Retrieved 26 August 2022.
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  17. ^ Forcen FE (January 2015). "Akathisia: Is restlessness a primary condition or an adverse drug effect?". Current Psychiatry. 14 (1): 14–18 – via mededge.
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  19. ^ Diaz, Jaime (1996). How Drugs Influence Behavior. Englewood Cliffs: Prentice Hall.[page needed]
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  22. ^ "Remeron (Mirtazapine) Drug Information". RxList. Retrieved 28 March 2016.
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  28. S2CID 23393707
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  29. ^ Practitioners, The Royal Australian College of General. "RACGP - Beyond anxiety and agitation: A clinical approach to akathisia". racgp.org.au. Retrieved 12 August 2020.
  30. ^
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  35. ISBN 978-1-4008-3087-9
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  36. ^ Why was Jordan Peterson placed in a medically induced coma? What we know about benzodiazepines and treatment Published 11 February 2020 by the National Post
  37. ^ Mikhaila Peterson's Response to The Times Article (and subsequent articles)

External links

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