Managing antipsychotic-induced
acute and chronic akathisia

by
Miller CH, Fleischhacker WW
Department of Biological Psychiatry,
Innsbruck University Clinics Innsbruck,
Austria
Drug Saf 2000 Jan; 22(1):73-81


ABSTRACT

Akathisia is a frequent and common adverse effect of treatment with antipsychotic (neuroleptic) drugs. This syndrome consists of subjective (feeling of inner restlessness and the urge to move) as well as objective components (rocking while standing or sitting, lifting feet as if marching on the spot and crossing and uncrossing the legs while sitting). Antipsychotic-induced akathisia can be classified according to the time of onset in the course of antipsychotic treatment (acute, tardive, withdrawal and chronic akathisia). Reported prevalence rates vary widely between 5 and 36.8%. Numerous risk factors for acute akathisia have been described and the exact pathophysiology of akathisia is still unknown. Since akathisia is a drug-induced adverse effect, optimal management involves its prevention rather than treatment. Standardised titration and the use of novel antipsychotics are successful measures of prevention. This paper reviews different forms of therapeutic approaches for the treatment of akathisia. Based on the available literature, propranolol or other lipophilic beta-blockers seem to be the most consistently effective treatment for acute akathisia. There is nothing in the literature to guide a clinician when treatment with beta-blockers fails. Addition of benzodiazepines would appear to be a sensible next choice, especially if subjective distress persists. If all of these drugs are unsuccessful, amantadine or clonidine can be tried. Other agents that have been investigated include ritanserin, piracetam, valproic acid (sodium valproate) and tricyclic antidepressants. Evidence on the treatment of tardive akathisia is unsatisfactory.
Apathy
Anxiety
Akathisia
Dopamine
Valproate
Fluoxetine
Olanzapine
Haloperidol
Trimipramine
Chlorpromazine
Benzodiazepines
SSRI suicide link?
The deficit syndrome
Atypical antipsychotics
Schizoaffective disorder
Bipolars and schizophrenics
Akathisia and suicidal behaviour
Akathisia (inner restlessness) caused by SSRIs
SSRI-induced extrapyramidal side-effects and akathisia


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