Akathisie

Abstract

The syndrome of akathisia typically consists of a subjective component, e.g. inner restlessness and an urge to move, and observable symptoms such as restless legs and inability to sit still. In most cases akathisia is caused by neuroleptics. There are several subtypes of akathisia according to the time of onset in the course of neuroleptic treatment. In clinical routine extrapyramidal motor disturbances are often underestimated or misinterpreted. As far as akathisia is concerned, differential diagnosis of restlessness or of repetitive movement patterns may be problematic. Non-compliance and impulsive behaviour are regarded as possible complications of akathisia, but systematic investigations are lacking. The pathophysiology of akathisia is not clear, but it probably differs from other pharmacologically induced motor disturbances. If warrantable, the first step in akathisia treatment is dose-reduction of the causing agent. Anticholinergic drugs, benzodiazepines, and beta-receptor blockers may be effective. Clinical assessment and survey of the patient's behaviour, e.g. during occupational therapy and group therapy is important for an early diagnosis of akathisia so that complications may be minimised.

Transient Restless Legs-like Syndrome as a Complication of Opiate Withrawal

“…Differentiation between the two disorders is rather difficult [2,4,6], and RLS is sometimes defined as an akathisia-related disorder [4]. There are only two differentiating criteria: RLS ist most pronounced in the evening hours, when the patient is lying down [4], whereas there is no such typical situation provoking akathisia. In addition, akathisia occurs most often in the context of neuroleptic treatment, especially with highly potent neuroleptics like haloperidol.…”

Akathisia: Case Presentation and Review of Newer Treatment Agents

“…2,10 Although some clinicians may forego scales in favor of clinical observation, akathisia can be confused in the clinical setting with other disorders, such as agitation related to mood or psychotic disorders, restless legs syndrome, anxiety states, drug-withdrawal states, antipsychotic dysphoria, organic medical/neurological disorders, or tardive dyskinesia. [2][3][4]6 As such, a rating scale may be useful in diagnosis and early treatment.…”

“…Studies point to interactions of the mesolimbic, mesocortical, and spinal dopamine/norepinephrine systems, particularly with respect to the dopaminergic neurons of the ventral tegmental area and substantia nigra. [1][2][3]14 However, treatment strategies that include benzodiazepines, beta-adrenergic blockers, and serotonin antagonists suggest that a more complicated relationship exists between multiple neurotransmitter systems, including dopamine, acetylcholine, gamma-aminobutyric acid (GABA), norepinephrine, serotonin, and neuropeptides. 2,5 Involvement of multiple neurotransmitter systems is further supported by the fact that drugs such as clozapine and quetiapine, which tend to weakly bind with dopamine receptors (and more potently with serotonin receptors), may cause akathisia in the absence of other extrapyramidal effects.…”

“…[1][2][3]5,20 Alleviation of akathisia symptoms has been attributed to a GABA mechanism. Only short treatment courses of these drugs (lorazepam, clonazepam, diazepam) are indicated.…”

“…1 The use of anticholinergics (eg, benztropine and trihexyphenidyl) is frequently mentioned in the literature as a common treatment method. [1][2][3]5 However, data supporting their use in lone akathisia remain equivocal. In addition, their noted side effect profile (cognitive impairment, blurred vision, constipation, urinary retention) make them relatively unsuitable for longterm use.…”