Akathisia (IPA: /æ.kə.ˈθɪ.si.ə/) is a movement disorder[5] characterized by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still.[6][4] Usually, the legs are most prominently affected.[2] Those affected may fidget, rock back and forth, or pace,[7] while some may just have an uneasy feeling in their body.[2] The most severe cases may result in poor adherence to medications, exacerbation of psychiatric symptoms, and, because of this, aggression, violence, and/or suicidal thoughts.[2] Akathisia is also associated with threatening behaviour and physical aggression in mentally disordered patients.[8] However, the attempts to find potential links between akathisia and emerging suicidal or homicidal behaviour were not systematic and were mostly based on a limited number of case reports and small case series.[9] Apart from these few low-quality studies, there is another more recent and better quality study (a systematic review from 2021)[9] that concludes akathisia cannot be reliably linked to the presence of suicidal behaviour in patients treated with antipsychotic medication.[9]
Antipsychotic medication, particularly the first generation antipsychotics, are a leading cause.[4][7] Other agents commonly responsible for this side-effect may also include selective serotonin reuptake inhibitors, metoclopramide, and reserpine, though any medication listing agitation as a side effect may trigger it.[2][10] It may also occur upon stopping antipsychotics.[2] The underlying mechanism is believed to involve dopamine.[2] When antidepressants are the cause, there is no agreement regarding the distinction between activation syndrome from akathisia.[11] Akathisia is often included as a component of activation syndrome.[11] However, the two phenomena are not the same since the former, namely antipsychotic-induced akathisia, suggests a known neuroreceptor mechanism (e.g., dopamine-receptor blockade).[11] Diagnosis is based on the symptoms.[2] It differs from restless leg syndrome in that akathisia is not associated with sleeping. However, despite a lack of historical association between restless leg syndrome and akathisia, this does not guarantee that the two conditions do not share symptoms in individual cases.[2]
Treatment may include switching to an antipsychotic with a lower risk of the condition, if the akathisia was caused by an antipsychotic.[2] The antidepressant mirtazapine has demonstrated benefit, but is also known to have caused akathisia in certain individuals.[5] as well as diphenhydramine, trazodone, benzatropine, cyproheptadine, and beta blockers, particularly propranolol.[2][4][12]
The term was first used by Czech neuropsychiatrist Ladislav Haškovec, who described the phenomenon in 1901 long before the discovery of antipsychotics, with drug-induced akathisia first being described in 1960.[1] It is from Greek a-, meaning "not", and καθίζεινkathízein, meaning "to sit", or in other words an "inability to sit".[2]
^ abCite error: The named reference Salem2017 was invoked but never defined (see the help page).
^Kaufman, David Myland; Milstein, Mark J. (2012). Kaufman's Clinical Neurology for Psychiatrists E-Book. Elsevier Health Sciences. p. 429. ISBN 978-1455740048.
^ abcdeLaoutidis, ZG; Luckhaus, C (May 2014). "5-HT2A receptor antagonists for the treatment of neuroleptic-induced akathisia: a systematic review and meta-analysis". The International Journal of Neuropsychopharmacology (Review). 17 (5): 823–32. doi:10.1017/S1461145713001417. PMID 24286228.
^ abCite error: The named reference Poyurovsky2020 was invoked but never defined (see the help page).
^Forcen, FE; Matsoukas, K; Alici, Y (February 2016). "Antipsychotic-induced akathisia in delirium: A systematic review". Palliative & Supportive Care (Review). 14 (1): 77–84. doi:10.1017/S1478951515000784. PMC 5516628. PMID 26087817.
^ abThomas, JE; Caballero, J; Harrington, CA (2015). "The Incidence of Akathisia in the Treatment of Schizophrenia with Aripiprazole, Asenapine and Lurasidone: A Meta-Analysis". Current Neuropharmacology (Review). 13 (5): 681–91. doi:10.2174/1570159x13666150115220221. PMC 4761637. PMID 26467415.
^Stubbs, J. H.; Hutchins, D. A.; Mountjoy, C. Q. (2000). "Relationship of akathisia to aggressive and self-injurious behaviour: A prevalence study in a UK tertiary referral centre". International Journal of Psychiatry in Clinical Practice. 4 (4): 319–325. doi:10.1080/13651500050517894. ISSN 1365-1501. PMID 24926584. S2CID 26486432.
^ abcKalniunas, Arturas; Chakrabarti, Ipsita; Mandalia, Rakhee; Munjiza, Jasna; Pappa, Sofia (3 December 2021). "The Relationship Between Antipsychotic-Induced Akathisia and Suicidal Behaviour: A Systematic Review". Neuropsychiatric Disease and Treatment. 17: 3489–3497. doi:10.2147/NDT.S337785. ISSN 1176-6328. PMC 8651045. PMID 34887662.
^"MISSD - The Medication-Induced Suicide Prevention and Education Foundation in Memory of Stewart Dolin - Akathisia Support". missd.co. Retrieved 26 August 2022.
^ abcAmitai, Maya; Chen, Alon; Weizman, Abraham; Apter, Alan (1 March 2015). "SSRI-Induced Activation Syndrome in Children and Adolescents—What Is Next?". Current Treatment Options in Psychiatry. 2 (1): 28–37. doi:10.1007/s40501-015-0034-9. ISSN 2196-3061.
^Fischel, T.; Hermesh, H.; Aizenberg, D.; Zemishlany, Z.; Munitz, H.; Benjamini, Y.; Weizman, A. (December 2001). "Cyproheptadine versus propranolol for the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study". Journal of Clinical Psychopharmacology. 21 (6): 612–615. doi:10.1097/00004714-200112000-00013. ISSN 0271-0749. PMID 11763011. S2CID 22663143.
Akathisia (IPA: /æ.kə.ˈθɪ.si.ə/) is a movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and...
dysfunction such as dystonia (continuous spasms and muscle contractions), akathisia (may manifest as motor restlessness), parkinsonism characteristic symptoms...
assess the severity of drug-induced akathisia. The Barnes Akathisia Scale is the most widely used rating scale for akathisia. This scale includes objective...
migraine headaches. Common side effects include: feeling tired, diarrhea, akathisia, and tardive dyskinesia. More serious side effects include neuroleptic...
in palliative care. Serious side effects include tardive dyskinesia, akathisia, abnormalities in the electrical cycle of the heart, low blood pressure...
cariprazine. The most prevalent side effects for cariprazine include akathisia, and insomnia. Cariprazine does not appear to impact prolactin levels...
parkinsonism, akathisia and acute dystonia, Parkinson's disease, and idiopathic or secondary dystonia. It is used in patients with parkinsonism and akathisia, and...
psychomotor agitation can be caused by antipsychotic medications. For instance, akathisia, a movement disorder sometimes induced by antipsychotics and other psychotropics...
as well as extrapyramidal side effects of antipsychotics, including akathisia. It is not useful for tardive dyskinesia. It is taken by mouth or by injection...
It is an atypical antipsychotic. The most common side effects include akathisia (a constant urge to move) and weight gain. The most common side effects...
adverse effects such as tardive dyskinesia, tardive dystonia, and tardive akathisia. First-generation antipsychotics (e.g., chlorpromazine), known as typical...
long-term adherence to treatment. Extrapyramidal symptoms, including akathisia, are associated with all commercially available antipsychotic to varying...
effects) Chest discomfort/pressure (In children less than 2 years old) Akathisia Less frequent: Cardiovascular side effects to include arrhythmias and...
antidepressants include dry mouth, weight gain, dizziness, headaches, akathisia, sexual dysfunction, and emotional blunting. There is an increased risk...
also cause restless legs syndrome and other movement disorders such as akathisia and parkinsonism usually associated with antipsychotics opioid withdrawal...
member of Hovercraft, Krusen toured with the band and recorded the album Akathisia (1997). In 1994 Krusen co-founded Diamond Star Halo with former Candlebox...
already used for this purpose". Essential tremor. Evidence for use for akathisia however is insufficient Migraine and cluster headache prevention and in...
central nervous system. Risperidone may induce extrapyramidal side effects, akathisia and tremors, associated with diminished dopaminergic activity in the striatum...
'multidimensional approach'. It has also been prescribed for essential tremor and akathisia. Contraindications include according to the Therapeutic Goods Administration...
seizures, bipolar mania, agitation associated with psychosis, OCD and akathisia. It is a long-acting tranquilizer of the benzodiazepine class. It possesses...
and include restlessness, dystonic reactions, pseudoparkinsonism, and akathisia; the extrapyramidal symptoms can affect 2% of people at low doses, whereas...
also produce a variety of additional side effects including drowsiness, akathisia, restlessness, insomnia, lassitude, fatigue, extrapyramidal symptoms,...
trials, buspirone was given at dosages even as high as 2,400 mg/day, with akathisia, tremor, and muscle rigidity observed. Deliberate overdoses with 250 mg...
America, they were represented by "Mute Records America". They released Akathisia in 1997 and Experiment Below in 1998. Hovercraft toured the United States...
effects with greater than 10% incidence include weight gain, headache, akathisia, insomnia, and gastrointestinal effects like nausea and constipation,...