Akathisia

Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and/or an inability to sit still. Usually, the legs are most prominently affected. Those affected may fidget, rock back and forth, or pace, while some may just have an uneasy feeling in their bodies. The most severe cases may result in poor adherence to medications, exacerbation of psychiatric symptoms, and, because of this, aggression, violence, and/or suicidal thoughts. Akathisia is also associated with threatening behaviour and physical aggression in mentally disordered patients. However, the attempts to find 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. Apart from these few low-quality studies, there is another more recent and better quality study that concludes akathisia cannot be reliably linked to the presence of suicidal behavior in patients treated with antipsychotic medication.

Classification

Akathisia is usually classified as a medication-induced movement disorder. It can also be considered a neuropsychiatric concern, however, as it can be experienced purely subjectively without apparent movement abnormalities. Akathisia is generally associated with antipsychotics, but was previously described in Parkinson's disease and other neuropsychiatric disorders. It can also present with the use of non-psychiatric medications, including calcium channel blockers, antibiotics, anti-nausea and anti-vertigo drugs. == Signs and symptoms ==

Signs and symptoms

Symptoms of akathisia are often described in vague terms, such as feeling nervous, uneasy, tense, twitchy, restless, and unable to relax. When caused by psychiatric drugs, akathisia usually disappears quickly once the medication is reduced or stopped. However, late-onset akathisia, or tardive akathisia, may persist for months or years after the medication is discontinued. When misdiagnosis occurs in antipsychotic-induced akathisia, more antipsychotics may be prescribed, potentially worsening the symptoms. If not identified, akathisia symptoms can increase in severity and lead to suicidal thoughts, aggression and violence. 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 …" == Causes ==

Causes

Medication-induced Medication-induced akathisia is termed acute akathisia and is frequently associated with the use of antipsychotics. Akathisia involves increased levels of the neurotransmitter norepinephrine, which is associated with mechanisms that regulate aggression, alertness, and arousal. It has been correlated with Parkinson's disease and related syndromes, with descriptions of akathisia predating the existence of pharmacologic agents. == Diagnosis ==

Diagnosis

The presence and severity of akathisia can be measured using the Barnes Akathisia Scale, which assesses both objective and subjective criteria. 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. The controversial diagnosis of "pseudoakathisia" is sometimes given. == Treatment ==

Treatment

Acute akathisia induced by medication, Low doses of the antidepressant mirtazapine may be of help. Biperiden, an anticholinergic, commonly used to improve acute extrapyramidal side effects related to antipsychotic drug therapy, is also used to treat akathisia. Benzodiazepines, such as lorazepam; beta blockers such as propranolol; anticholinergics such as benztropine; and serotonin antagonists such as cyproheptadine may also be of help in treating acute akathisia but are much less effective for treating chronic akathisia. Vitamin B, and iron supplementation if deficient, may be of help. Although they are sometimes used to treat akathisia, benzodiazepines and antidepressants can actually cause akathisia. == Epidemiology ==

Epidemiology

Approximately one out of four individuals treated with first-generation antipsychotics develop akathisia. == History ==

History

The term was first used by Czech neuropsychiatrist Ladislav Haškovec, who described the phenomenon in a non-medication induced presentation in 1901. 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. == See also ==

Source: Wikipedia ↗

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