Akathisia

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**Akathisia**
*Classification & external resources*
ICD-9	781.0, 333.99

Akathisia (or "acathisia") is an often extremely unpleasant subjective sensation of "inner" restlessness that manifests itself with an inability to sit still or remain motionless, hence the origin of its name: Greek a (without) + kathesis (sitting). Its most common cause is as a side effect of medications, mainly neuroleptics, and rarely, antidepressants.

Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still with overwhelming anxiety and severe dysphoria (manifesting as an almost indescribable sense of terror and doom). In the most severe cases, dysphoria can be so severe that the patient is literally compelled to take action, leading, possibly, to suicide attempts.

It is not unknown to have patients (who have been treated most often with neuroleptics for psychotic episodes or prochlorperazine for nausea) to bolt out of hospitals or emergency rooms due to this odd and disconcerting emotion.

Partially because the condition (and its attendant feeling) is difficult for the patient to describe, it is often misdiagnosed.

The presence and severity of akathisia can be measured using the Barnes Akathisia Scale.

1 Causes
2 Treatment
3 References
4 External links

[edit] Causes

Akathisia is most often the side effect of certain drugs - commonly seen in the antipsychotics, and less so in the others listed below:

typical or atypical antipsychotics, such as haloperidol (Haldol®) and droperidol, olanzapine (Zyprexa®), aripiprazole (Abilify®); Pimozide is especially infamous for causing akathisia;
SSRIs, such as paroxetine (Paxil®)
Other antidepressants, such as the tricyclics and trazodone
certain antihistamines, such as promethazine and diphenhydramine (Benadryl®);
certain anti-emetic drugs, particularly the dopamine blockers (e.g. metoclopramide (Reglan®) and prochlorperazine (Compazine®)).
certain drugs of abuse, such as GHB, methamphetamine and MDMA when administered in excessive doses.

[edit] Treatment

Treatment includes the discontinuation or reduction of dose of the causative agent and the use of typical or atypical antipsychotics (also called major tranquilizers) to reduce the agitation and anxiety. Unfortunately, these neuroleptics are often the cause of the condition and are known to cause irreversible akathisia in some cases.^{[citation needed]} While the administration of these drugs may temporarily ameliorate the symptoms, there is a serious risk of worsening the condition over the longterm.

Therefore, some consider the drug of choice for the treatment of akathisia to be propranolol, along with other beta blockers such as metoprolol. The antihistamine cyproheptadine is also effective, though with shorter effect than beta blockers. Second-line treatments include benztropine and benadryl, though excess use of Benadryl may worsen symptoms. Most of the clinical cases of akathisia can be prevented by not administering the drugs that cause the condition.

Recent studies have shown that Vitamin B₆ is effective for the treatment of neuroleptic induced akathisia. [1]