The Identification and Management of Drug-Induced Akathisia

Abstract

Summary Akathisia is a common and clinically important adverse effect of antipsychotic and some other psychotropic drugs, which has until recently been neglected by researchers and clinicians. It manifests as a subjective feeling of restlessness (particularly referable to the lower limbs) and a compulsion to move, and is objectively characterised by limb and body movements and behavioural features. The association of akathisia with antipsychotic drugs is complex. Subtypes of akathisia (acute, chronic, tardive and withdrawal akathisia) are now recognised, which resemble each other phenomenologically, but may have different pharmacological profiles in terms of treatment and, possibly, aetiology. The clinical diagnosis of akathisia may be difficult, as it has to be distinguished from psychotic agitation, anxiety and other syndromes. However, there are some distinctive features that assist in the identification of akathisia, especially if there is a high index of suspicion. The treatment of akathisia is not always satisfactory, and strategies to prevent or minimise its occurrence should prevail. The 2 classes of drugs most commonly used in the treatment of acute akathisia are anticholinergics and f3-adrenoceptor blockers, but other drugs may playa minor role. The treatment of tardi ve akathisia is insufficiently researched and complicated by its overlap with tardive dyskinesia. However, catecholamine depleters, anticholinergic drugs, anti-adrenergic drugs and clozapine may have a role in the treatment of this subtype.