Akathisia remains a concern with the use of SGAs. More accurate and standardized evaluations are required for a better understanding of the nature and incidence of akathisia.

The purpose of this paper was to make a critical review of akathisia, based on the principles of evidence-based medicine, and to explore a possible link between akathisia and suicidal behaviour (suicidal thinking, parasuicide and completed suicide). An extensive systematic search was carried out on three major databases, Embase, ClinPsych and Medline. Fifty-seven relevant references were found, and a further 26 references were reviewed after careful selection from the references of the original references. The Cochrane Library did not contain any systematic reviews on the subject. Akathisia can be caused by several different groups of drugs, but most frequently by antipsychotics and to a lesser extent antidepressants. Research into akathisia is made considerably more difficult by the lack of a universally agreed definition of the condition. The underlying pathophysiology is still far from clear, but the literature offers guidelines on less hazardous management regimes for patients. On the basis of the existing literature, akathisia cannot at this stage unequivocally be linked to suicidal behaviour. It is certain, however, that the condition of akathisia does cause considerable distress in an already vulnerable group of patients. Because it is largely avoidable, new, more rigorous strategies must be put in place to prevent it. Copyright 2001 John Wiley & Sons, Ltd.

Patients with schizophrenia are at high risk of suicide. Cognitive behavior therapy (CBT) has been shown to reduce symptoms in schizophrenia. This study examines whether CBT also changes the level of suicidal ideation in patients with schizophrenia compared to a control group. Ninety ambulatory patients with symptoms of schizophrenia resistant to conventional antipsychotic medication were randomized to CBT or befriending. They were assessed using the Comprehensive Psychopathological Rating Scale, including a rating of suicidal ideation at baseline, post intervention, and after 9 months. Post-hoc analysis revealed that CBT provided significant reductions in suicidal ideation at the end of therapy, and sustained at the follow-up. Further research is required to substantiate these findings and determine the process and mechanisms through which this reduction is achieved.

Suicide of the over-65s has improved in seven countries, especially in England and Wales, who had the greatest proportional reduction, which reflects well upon the psycho-geriatric and community services. However, in all countries, male 65-74 rates did not match the female out so extra efforts are needed to improve male rates.