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Akathisia (or "acathisia") is an often extremely unpleasant subjective sensation of "inner" restlessness that manifests itself with an inability to sit still or remain motionless, hence the origin of its name: Greek a (without) + kathesis (sitting).
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 with overwhelming anxiety and severe dysphoria (manifesting as an almost undescribable sense of terror and doom). In the most severe cases, dysphoria can be so severe that the patient is literally compelled to take action, leading, possibly, to suicide attempts. It is not unknown to have patients literally run out of a hospital or emergency room.
Partially due to the fact that the condition (and its attendant feeling) is difficult for the patient to describe, it is often misdiagnosed and can lead the patient to commit suicide in or outside the hospital. Furthermore, many clinical definitions of akathisia, as studied by psychiatrists and psychologists, may downplay the true psychological gravity of this symptom and simply refer to its psychological effects as "a subjective inner restlessness".
The presence and severity of akathisia can be measured using the Barnes Akathisia Scale.
Causes
It is a common side effect of certain drugs, notably:
- typical or atypical antipsychotics (also called major tranquilizers), such as haloperidol (Haldol®) and droperidol, olanzapine (Zyprexa®), aripiprazole (Abilify);
- SSRIs, such as paroxetine (Paxil®);
- tricyclic antidepressants, certain antihistamines, such as promethazine and diphenhydramine (Benadryl®);
- and certain anti-emetic drugs, particularly the dopamine blockers (e.g. metoclopramide (Reglan®) and prochlorperazine (Compazine®)).
Treatment
Treatment includes the discontinuation or reduction of dose of the causative agent and the use of typical or atypical antipsychotics (also called major tranquilizers) to reduce the agitation and anxiety. Unfortunately, these neuroleptics are often the cause of the condition and are known to cause irreversible akathisia in some cases. While the administration of these drugs may temporarily ameliorate the symptoms, there is a serious risk of worsening the condition over the longterm.
Therefore, some consider the drug of choice for the treatment of akathisia to be propranolol, along with other beta blockers such as metoprolol. The antihistamine cyproheptadine is also effective, though with shorter effect than beta blockers. Second-line treatments include benztropine and benadryl, though excess use of Benadryl may worsen symptoms. Most of the clinical cases of akathisia can be prevented by not administering the drugs that cause the condition.
Recent studies have shown that Vitamin B6 is effective for the treatment of neuroleptic induced akathisia. *
References
- T. R. E. Barnes, "A Rating Scale for Drug-Induced Akathisia", British Journal of Psychiatry, vol 154, pp. 672-676, 1989 Abstract
External links
"Akathisia"