The clinical challenges of akathisia

  title={The clinical challenges of akathisia},
  author={James B. Lohr and Carolyn A. Eidt and Areej Abdulrazzaq Alfaraj and Mounir A. Soliman},
  journal={CNS Spectrums},
  pages={1 - 16}
Akathisia is one of the most vexing problems in neuropsychiatry. Although it is one of the most common side effects of antipsychotic medications, it is often difficult to describe by patients, and is difficult to diagnose and treat by practitioners. Akathisia is usually grouped with extrapyramidal movement disorders (ie, movement disorders that originate outside the pyramidal or corticospinal tracts and generally involve the basal ganglia). Yet, it can present as a purely subjective clinical… 

Medication-Induced Akathisia with Newly Approved Antipsychotics in Patients with a Severe Mental Illness: A Systematic Review and Meta-Analysis

A systematic review and meta-analysis of akathisia incidence rates of the NAPs, as monotherapy or adjunctive treatment, in adult patients with a severe mental illness, using data from published and unpublished randomized controlled trials to assess the role of study characteristics.

Akathisia and atypical antipsychotics. Relation to suicidality, agitation and depression in a clinical trial.

Akathisia is still a prevalent side effect in a clinically relevant sample of patients treated with atypical antipsychotics, and the results suggest that akath is significantly associated with depression, suicidality, and agitation in different subgroups of patients receiving antipsychotic drugs.

Olanzapine-Induced Parkinsonism and Akathisia: A Case Report

The highlighted case stresses the need for proper monitoring of the drug dose and sequential periodic examination of the patient to nullify the risk of adverse effects and poor compliance.

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent.

Risperidone-Induced Tardive Akathisia: A Rare Antipsychotic Side Effect with Management Issues

A case of akathisia is reported that occurred after 10 months of starting atypical antipsychotic, risperidone, and challenges faced in management.

Tardive syndromes

Escitalopram-induced severe akathisia leading to suicide attempt

A case of severe akathisia leading to a suicide attempt in a 25-year-old male induced by 5 mg of escitalopram, that remitted completely after discontinuation of escITALopram and did not reappear later.

Роль антипсихотической терапии в развитии акатизии у больных шизофренией The Role of Antypsychotic Therapy in the Development of Akathisia in Patients with Schizophrenia

It was shown that the choice of antipsychotic therapy should be based not only on the actual mental state of the patient, but also considering the potential risk of akathisia, one of the most common adverse events in patients with schizophrenia.



Akathisia: a comprehensive review and treatment summary.

There are now valid and reliable methods to assess akathisia using standardized scales; doing so helps track the progress of treatment interventions and an overall treatment algorithm incorporating knowledge to date is presented.

Symptoms of agitated depression and/or akathisia.

It is necessary to have akathisia in mind when using certain medicaments, especially when combining several that use the same enzymatic system and consequently raise levels of at least one of them.

The causes of underdiagnosing akathisia.

  • S. Hirose
  • Medicine, Psychology
    Schizophrenia bulletin
  • 2003
What causes clinicians to overlook or underdiagnose akathisia is reviewed to be related to both the patient's symptoms and the clinician's attitude toward akath isia.

Akathisia and second-generation antipsychotic drugs

Even though akathisia is less prevalent with SGAs than with the first-generation drugs, it remains clinically important and all clinicians should be conversant with its recognition and management.

Neuroleptics. Violence as a manifestation of akathisia.

To my knowledge, however, the literature does not contain reports that the development of akathisia can precipitate violence, resulting in the behavior the drug was meant to alleviate.

The Mechanism of Drug-induced Akathisia

A possible mechanism for drug-induced akathisia based on the differential functions of the core and shell portions of the nucleus accumbens is described based on contemporary concepts regarding the mechanisms of compulsion, impulsivity, and depression.

Akathisia following traumatic brain injury: treatment with bromocriptine.

  • J. Stewart
  • Psychology, Medicine
    Journal of neurology, neurosurgery, and psychiatry
  • 1989
There is strong animal evidence that akathisia may be related to blockade of dopamine in the prefrontal cortex rather than the striatum, and a patient who developed severe motor restlessness following bilateral prefrontal brain injury responded dramatically to bromocriptine, lending further support to this hypothesis.

Akathisia and tardive dyskinesia. Changing concepts.

  • S. Stahl
  • Psychology
    Archives of general psychiatry
  • 1985
The article by Barnes and Braude 4 in this issue of theArchives deals with one of the relatively neglected side effects of the first-generation neuroleptics, namely akathisia.

The epidemiology of drug-induced akathisia: Part II. Chronic, tardive, and withdrawal akathisias.

  • P. Sachdev
  • Psychology, Medicine
    Schizophrenia bulletin
  • 1995
The studies suggest that a significant proportion of patients chronically treated with neuroleptics suffer from akathisia, and the prevalence may be as high as 40 percent, although a conservative estimate would be closer to 30 percent.