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• W2288800459 abstract "Akathisia--from the Greek for inability to sit--is a neuropsychiatric syndrome characterized by subjective and objective psychomotor restlessness. Patients typically experience feelings of unease, inner restlessness mainly involving the legs, and a compulsion to move. Most engage in repetitive movement. They might swing or cross and uncross their legs, shift from one foot to the other, continuously pace, or persistently fidget. In clinical settings, akathisia usually is a side effect of medication. Antipsychotics, serotonin reuptake inhibitors, and buspirone are common triggers, but akathisia also has been associated with some antiemetics, preoperative sedatives, calcium channel blockers, and antivertigo agents. It also can be caused by withdrawal from an antipsychotic or related to a substance use disorder, especially cocaine. Akathisia can be acute or chronic, occurring in a tardive form with symptoms that last >6 months. (1,3) Much isn't known about drug-induced akathisia Our understanding of the pathophysiology of akathisia is incomplete. Some have suggested that it results from an imbalance between the dopaminergic/cholinergic and dopaminergic/ serotonergic systems (4); others, that the cause is a mismatch between the core and the shell of the nucleus accumbens, due in part to overstimulation of the locus ceruleus. (5) More recently, researchers established a positive association between higher scores on the Liverpool University Neuroleptic Side Effects Rating Scale and D2/D3 receptor occupancy in the ventral striatum (nucleus accumbens and olfactory tubercle). (6) The D2/D3 receptor occupancy model might explain withdrawal symptoms associated with cocaine/ as well as relative worsening of symptoms after tapering or discontinuing stimulants in attention-deficit/hyperactivity disorder (ADHD). Elements of a clinical evaluation When akathisia is suspected, evaluation by a clinician familiar with its phenomenology is crucial. A validated tool, such as the Barnes Akathisia Rating Scale (at out cometracker.org/library/BAS.pdf) can aid in the detection and assessment of severity. (8) In evaluating patients, keep in mind that the inner restlessness that characterizes akathisia can affect the trunk, hands, and arms, as well as the legs, and can cause dysphoria and anxiety. Akathisia has been linked to an increased likelihood of developing suicidal ideation and behavior. (9) Less common subjective symptoms include rage, fear, nausea, and worsening of psychotic symptoms. Because of its association with aggression and agitation, drug-induced akathisia has been cited--with little success--as the basis for an insanity defense by people who have committed a violent act. (10) Or is akathisia another psychiatric disorder? Akathisia might go undetected for several reasons. One key factor: Its symptoms resemble and often overlap with those of other psychiatric disorders, such as mania, psychosis, agitated depression, and ADHD. In addition, akathisia often occurs concurrently with, and is masked by, akinesia, a common extrapyramidal side effect of many antipsychotics. Such patients might have the inner feeling of restlessness and urge to move but do not exhibit characteristic limb movements. In some cases, cognitive or intellectual limitations prevent patients from communicating the inner turmoil they feel. (11) Medication nonadherence further complicates the picture, sometimes prompting a clinician to increase the dosage of the drug that is causing akathisia (Box 1 (12)). Box 1 Think twice before increasing the dosage Patients who develop symptoms of akathisia sometimes stop taking their medication; this often results in psychiatric relapse. (12) In addition, symptoms of akathisia often mimic psychiatric symptoms and can be mistaken for worsening anxiety or psychosis; in such cases, a practitioner might increase the dosage of the agent that is causing akathisia, potentially leading to further deterioration of the clinical picture. …" @default.
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• W2288800459 date "2015-01-01" @default.
• W2288800459 modified "2023-10-17" @default.
• W2288800459 title "Akathisia: Is Restlessness a Primary Condition or an Adverse Drug Effect? Keep a Discerning Eye out for This Adverse Effect of Antipsychotics and Other Drugs" @default.
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