Neuroleptic-induced akathisia (NIA) is a relatively common side effect of neuroleptics, in which patients complain of a subjective sense of restlessness usually referable to the legs and have characteristic motor movements. This paper will review: 1) history of spontaneously occurring syndromes of pathologic restlessness and NIA, 2) the clinical significance of NIA, 3) issues concerning the diagnosis and quantification of NIA, 4) treatments of NIA and 5) possible future directions for research in this area. Special attention will be paid to newer treatments for this syndrome, specifically beta-blockers.
"Nevertheless, these signs may have been overemphasized in diagnosing not only severe akathisia in patients who cannot communicate verbally but mild akathisia in patients who can communicate their inner restlessness but do not have apparent motor restless- ness. Authors stressing objective restlessness have reported a lower incidence of akathisia than have those stressing subjective restlessness (Gibb and Lees 1986; Adler et al. 1989; Miller and Fleischhacker 2000). This suggests that objective restlessness is less sensitive than subjective restlessness in detecting a broader range of akathisia. "
[Show abstract][Hide abstract] ABSTRACT: This article reviews what causes clinicians to overlook or underdiagnose akathisia. The causes are considered to be related to both the patient's symptoms and the clinician's attitude toward akathisia. The patient factors include mild severity of akathisia, lack of apparent motor restlessness, no voluntary expression of inner restlessness, no clear communication of inner restlessness, restlessness in body parts other than the legs, atypical expressions of inner restlessness, other prominent psychic symptoms, and absence of other extrapyramidal signs. The clinician factors include emphasis on objective restlessness, failure to consider akathisia during antipsychotic therapy, failure to fully implement antiakathisia treatments in ambiguous cases, and strict adherence to research diagnostic criteria. Akathisia is likely to be overlooked or underdiagnosed when both patient and clinician factors are present. Currently, there may be two major problems with underdiagnosis: (1) symptoms that fulfill the diagnostic criteria for akathisia are overlooked, and (2) conditions that do not fulfill the diagnostic criteria but can still benefit from antiakathisia measures are underdiagnosed.
"The best treatment for akathisia is reduction of antipsychotic dosage or use of beta-adrenergic blocking agents (Adler et al. 1989; Casey 1991, 1995; Sachdev 19956). Clozapine, despite causing some acute akathisia, may be an effective treatment for cases of tardive akathisia (Sachdev 1995a, 19956). "
[Show abstract][Hide abstract] ABSTRACT: This article reviews antipsychotic medication side effects, especially those that require the physician to discontinue or the patient to be noncompliant with otherwise useful medication. They include such common problems as extrapyramidal syndromes (dystonia, akathisia, drug-induced Parkinsonism, tardive dyskinesia), sedation, weight gain, and sexual dysfunction, as well as less frequent concerns, such as seizures, neuroleptic malignant syndrome, agranulocytosis, torsade de pointes, hepatitis, and dermatological and ophthalmological syndrome. The adverse events associated with some of the new antipsychotic drugs are included. Available information about individual susceptibility to side effects is addressed by syndrome.
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