Antipsychotic-induced Akathisia Research Articles

Mianserin was successful in the treatment of antipsychotic-induced akathisia

Mianserin was successful in the treatment of antipsychotic-induced akathisia

Antipsychotic-induced akathisia occurs frequently

Antipsychotic-induced akathisia occurs frequently

Serotonin-dopamine interaction and its relevance to schizophrenia.

The therapeutic success of clozapine and risperidone has focused attention on the interaction between serotonin and dopamine systems as an avenue for superior therapeutics in schizophrenia. The authors review the neurobiological basis for this interaction and its clinical relevance. The authors synthesized information from more than 100 published articles obtained through electronic and bibliography-directed searches. The serotonin system inhibits dopaminergic function at the level of the origin of the dopamine system in the midbrain as well as at the terminal dopaminergic fields in the forebrain. Serotonergic antagonists release the dopamine system from this inhibition. This disinhibition of the dopamine system in the striatum may alleviate neuroleptic-induced extrapyramidal symptoms, and a similar disinhibition in the prefrontal cortex may ameliorate negative symptoms. However, the benefits of combined serotonergic-dopaminergic blockade may be observed in only a narrow dose range and may be lost with doses that produce suprathreshold dopaminergic blockade. Serotonergic modulation of dopaminergic function provides a viable mechanism for enhancing therapeutics in schizophrenia, but much remains unclear. Future research will have to establish the existence of this interaction in humans in vivo, specify the conditions under which it leads to optimal therapeutic benefits, and explore the possibility of using specific serotonergic treatments as flexible adjuncts to typical neuroleptics, rather than the present trend toward using single drugs with combined actions.

The Role of ??-Adrenoceptor Blockers in the Treatment of Psychiatric Disorders

Although β-adrenoceptor blockers (in particular, propranolol) have been used in the treatment of psychiatric disorders for many years, their indications, extent of efficacy and place in therapy remain unclear. This overview assess the published reports on the use of these drugs in psychiatric disorders. It can be concluded that β-adrenoceptor blockers may be helpful in the management of some forms of anxiety disorders, including performance anxiety and other types of situational anxiety, especially when somatic symptoms are prominent. In the same way, alcohol (ethanol) withdrawal syndrome of moderate severity, antipsychotic-induced akathisia and lithium-induced tremor seem to be responsive to this drug class. Because of the fact that they are well tolerated, the use of β-adrenoceptor blockers in these disorders should be considered whenever drug treatment is being contemplated. In contrast, the efficacy of high doses of β-adrenoceptor blockers in schizophrenia remains unestablished. However, they may be of benefit in some patients presenting with aggressive behaviour due to organic brain disease. Studies have shown a high rate of improvement in this condition, especially in patients who have previously failed to respond to other treatments. Finally, preliminary results suggest that β-adrenoceptor blockers may be useful as adjunctive medication in the treatment of depression and chronic anxiety, but further investigations are needed in these areas of patient management.