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Handbook of Clinical Neurology 2019Although highly prevalent, motor syndromes in psychiatry and motor side effects of psychopharmacologic agents remain understudied. Catatonia is a syndrome with specific... (Review)
Review
Although highly prevalent, motor syndromes in psychiatry and motor side effects of psychopharmacologic agents remain understudied. Catatonia is a syndrome with specific motor abnormalities that can be seen in the context of a variety of psychiatric and somatic conditions. The neuroleptic malignant syndrome is a lethal variant, induced by antipsychotic drugs. Therefore, antipsychotics should be used with caution in the presence of catatonic signs. Antipsychotics and other dopamine-antagonist drugs can also cause motor side effects such as akathisia, (tardive) dyskinesia, and dystonia. These syndromes share a debilitating impact on the functioning and well-being of patients. To reduce the risk of inducing these side effects, a balanced and well-advised prescription of antipsychotics is of utmost importance. Clinicians should be able to recognize motor side effects and be knowledgeable of the different treatment modalities.
Topics: Antipsychotic Agents; Benzodiazepines; Catatonia; Dystonia; Humans; Neuroleptic Malignant Syndrome; Psychomotor Agitation; Psychopharmacology; Tardive Dyskinesia
PubMed: 31727227
DOI: 10.1016/B978-0-444-64012-3.00025-3 -
Sleep Medicine Clinics Jun 2021Akathisia is an urgent need to move that is associated with treatment with dopamine receptor blocking agents (DRBAs) and with restless legs syndrome (RLS). The... (Review)
Review
Akathisia is an urgent need to move that is associated with treatment with dopamine receptor blocking agents (DRBAs) and with restless legs syndrome (RLS). The pathogenetic mechanism of akathisia has not been resolved. This article proposes that it involves an increased presynaptic dopaminergic transmission in the ventral striatum and concomitant strong activation of postsynaptic dopamine D receptors, which form complexes (heteromers) with dopamine D and adenosine A receptors. It also proposes that in DRBA-induced akathisia, increased dopamine release depends on inactivation of autoreceptors, whereas in RLS it depends on a brain iron deficiency-induced down-regulation of striatal presynaptic A receptors.
Topics: Dopamine; Humans; Psychomotor Agitation; Restless Legs Syndrome
PubMed: 33985651
DOI: 10.1016/j.jsmc.2021.02.012 -
Nederlands Tijdschrift Voor Geneeskunde Jan 2002Akathisia (restlessness and characteristic movements of the legs) is one of the most disagreeable extrapyramidal side effects and often causes non-compliance. Dopamine... (Review)
Review
Akathisia (restlessness and characteristic movements of the legs) is one of the most disagreeable extrapyramidal side effects and often causes non-compliance. Dopamine blocking agents such as antipsychotics and antiemetics, may induce akathisia. Particular care must be taken to distinguish akathisia from psychotic agitation and restless legs. The prevalence of akathisia in patients using classical antipsychotics is 20-30% and for users of clozapine, olanzapine and quetiapine (atypical antipsychotics) it is lower. Risk factors are a high dosage of antipsychotics, akathisia in a previous treatment, and diabetes mellitus. The treatment of akathisia starts, if possible, with the antipsychotic being withdrawn or the dose administered being lowered. Another treatment possibility is switching to clozapine, olanzapine or quetiapine, or adding a beta-blocking agent, an anticholinergic or mianserin.
Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Benzodiazepines; Clozapine; Diabetes Complications; Diagnosis, Differential; Dibenzothiazepines; Dose-Response Relationship, Drug; Humans; Olanzapine; Pirenzepine; Prevalence; Psychomotor Agitation; Quetiapine Fumarate; Recurrence; Restless Legs Syndrome; Risk Factors
PubMed: 11826669
DOI: No ID Found -
Seminars in Neurology Feb 2023Tics, stereotypies, akathisia, and restless legs fall at different places on the spectrum of discrete, unwanted and potentially disabling motor routines. Unlike tremor,... (Review)
Review
Tics, stereotypies, akathisia, and restless legs fall at different places on the spectrum of discrete, unwanted and potentially disabling motor routines. Unlike tremor, chorea, myoclonus, or dystonia, this subgroup of abnormal movements is characterized by the subject's variable ability to inhibit or release undesired motor patterns on demand. Though it may be sometimes clinically challenging, it is crucial to distinguish these "unvoluntary" motor behaviors because secondary causes and management approaches differ substantially. To this end, physicians must consider the degree of repetitiveness of the movements, the existence of volitional control, and the association with sensory symptoms, or cognitive-ideational antecedent. This review aims to summarize the current existing knowledge on phenomenology, diagnosis, and treatment of tics, stereotypies, akathisia, and restless leg syndrome.
Topics: Humans; Restless Legs Syndrome; Tics; Psychomotor Agitation; Movement Disorders; Tremor
PubMed: 36854394
DOI: 10.1055/s-0043-1764164 -
Journal of Clinical Oncology : Official... Sep 2023
Topics: Humans; Psychomotor Agitation; Drug-Related Side Effects and Adverse Reactions
PubMed: 37352484
DOI: 10.1200/JCO.23.00853 -
Current Opinion in Psychiatry May 2009Akathisa is one of the most common and distressing neuroleptic-induced extrapyramidal side effects. Although it is well recognized in the context of conventional... (Review)
Review
PURPOSE OF REVIEW
Akathisa is one of the most common and distressing neuroleptic-induced extrapyramidal side effects. Although it is well recognized in the context of conventional antipsychotic medications, there have been recent concerns raised by clinicians and researchers that this syndrome is overlooked in relation to second-generation or atypical antipsychotics. This review examines the recent literature relevant to second-generation antipsychotic (SGA)-induced akathisia.
RECENT FINDINGS
Recent studies using large databases clearly indicate that extrapyramidal side effects, in particular akathisia, do occur with the SGAs, although the frequency is not as high as with the conventional antipsychotics. Risk factors include use of high doses, high potency SGAs, or combinations of SGAs with other psychotropic drugs, bipolar depression, palliative care settings, and comorbid substance abuse in psychosis. The dopamine hypothesis remains plausible for understanding the pathophysiology of akathisia. There is emerging evidence that mirtazapine may be useful in the treatment of acute akathisia.
SUMMARY
Even though akathisia is less prevalent with SGAs than with the first-generation drugs, it remains clinically important and all clinicians should be conversant with its recognition and management.
Topics: Amisulpride; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Dibenzothiazepines; Humans; Isoxazoles; Olanzapine; Piperazines; Piperidines; Prevalence; Psychomotor Agitation; Psychotic Disorders; Quetiapine Fumarate; Quinolones; Risk Factors; Risperidone; Sulpiride; Thiazoles
PubMed: 19378382
DOI: 10.1097/yco.0b013e32832a16da -
CNS Spectrums Dec 2015Akathisia is one of the most vexing problems in neuropsychiatry. Although it is one of the most common side effects of antipsychotic medications, it is often difficult... (Review)
Review
Akathisia is one of the most vexing problems in neuropsychiatry. Although it is one of the most common side effects of antipsychotic medications, it is often difficult to describe by patients, and is difficult to diagnose and treat by practitioners. Akathisia is usually grouped with extrapyramidal movement disorders (ie, movement disorders that originate outside the pyramidal or corticospinal tracts and generally involve the basal ganglia). Yet, it can present as a purely subjective clinical complaint, without overt movement abnormalities. It has been subtyped into acute, subacute, chronic, tardive, withdrawal-related, and "pseudo" forms, although the distinction between many of these is unclear. It is therefore not surprising that akathisia is generally either underdiagnosed or misdiagnosed, which is a serious problem because it can lead to such adverse outcomes as poor adherence to medications, exacerbation of psychiatric symptoms, and, in some cases, aggression, violence, and suicide. In this article, we will attempt to address some of the confusion surrounding the condition, its relationship to other disorders, and differential diagnosis, as well as treatment alternatives.
Topics: Humans; Psychomotor Agitation
PubMed: 26683525
DOI: 10.1017/S1092852915000838 -
Psychiatria Polska 2009Akathisia is an atypical disorder (or the symptom) of the motor system standing on the border of neurology and psychiatry. In neurology, akathisia is a disorder... (Review)
Review
Akathisia is an atypical disorder (or the symptom) of the motor system standing on the border of neurology and psychiatry. In neurology, akathisia is a disorder resulting mainly from disturbed dopaminergic transmission; in the field of psychiatry it is recognized as one of the extrapiramidal side effects during the treatment with neuroleptics. The paper describes the historical context of disorder defined as akathisia, its clinical course, pathophysiology, as well as therapy.
Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Diagnosis, Differential; Dopamine Antagonists; Humans; Neurologic Examination; Psychiatric Status Rating Scales; Psychomotor Agitation; Psychotic Disorders; Psychotropic Drugs; Severity of Illness Index
PubMed: 20128247
DOI: No ID Found -
Clinical NeuropharmacologyThe prevalence of akathisia is variably reported in the literature and its psychiatric impact is little studied. The aim of this study was to establish the prevalence,...
OBJECTIVES
The prevalence of akathisia is variably reported in the literature and its psychiatric impact is little studied. The aim of this study was to establish the prevalence, the associated factors, and the psychiatric impact of akathisia among patients undergoing antipsychotic treatment.
METHODS
A cross-sectional descriptive study was carried out at the Department of Psychiatry A, at Razi Hospital, in Tunis. It included patients with psychosis, undergoing antipsychotic treatment, from June 2016 to February 2017. Akathisia was diagnosed according to the Barnes Akathisia Scale.
RESULTS
The prevalence of akathisia was 19.5% (n = 24, schizophrenia/schizoaffective disorder, n = 20; bipolar disorder, n = 4). The delay between the diagnosis of the disease and the onset of akathisia was 7.1 ± 8.8 years. Among the sample of patients with akathisia, 20/24 were on monotherapy of which 14 on conventional antipsychotics and six on atypical antipsychotics. Patients with akathisia were on atypical (8/24), low-potency conventional (4/24), or high-potency conventional (17/24) antipsychotics. The average dose of antipsychotics in chlorpromazine equivalent was 2294.5 ± 3037.7 mg. After adjusting for confounders, the only factor significantly positively associated with the diagnosis of akathisia was the dose of antipsychotics prescribed ( P = 0.01). The following psychiatric manifestations were reported by patients with akathisia: dysphoria/irritability (16/23), anxiety (18/24), sadness (15/24), suicidal thoughts (11/24), heteroaggressivity (8/23), sleep disturbances (16/24), and suicidal attempts (9/24).
CONCLUSIONS
Despite the high psychiatric and social burden of akathisia, it remains largely underdiagnosed and undertreated, because in part of its subjective component.
Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Cross-Sectional Studies; Humans; Prevalence; Psychomotor Agitation; Schizophrenia
PubMed: 35696611
DOI: 10.1097/WNF.0000000000000506 -
Journal of Clinical Sleep Medicine :... Sep 2019SieminskiM, Zemojtel L. Akathisia is more than restlessness in the legs. J Clin Sleep Med. 2019;15(9):1383.
SieminskiM, Zemojtel L. Akathisia is more than restlessness in the legs. J Clin Sleep Med. 2019;15(9):1383.
Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Emergency Service, Hospital; Humans; Psychomotor Agitation; Restless Legs Syndrome
PubMed: 31538614
DOI: 10.5664/jcsm.7944