Motor Restlessness Research Articles

The psychometric properties of the Pearlin Mastery Scale in persons living with restless legs syndrome.

Restless Legs Syndrome (RLS) is a neurological disorder characterized by an urge to move arms and legs, commonly combined with distress, pain and motor restlessness. It can cause fragmented sleep, daytime symptoms, and decreased quality of life. Pharmacological treatment can suppress symptoms, but not cure. When challenged with illness, people may turn to their inner psychological resources such as self-esteem and mastery. The Pearlin Mastery scale was developed to study stress and coping, is commonly used in people with chronic illnesses, however, not yet validated in people with RLS. The aim was to test reliability and construct validity of the Pearlin Mastery Scale in persons with RLS. A cross-sectional postal survey including the Pearlin Mastery Scale, Restless Legs Syndrome-6 Scale, Pittsburgh Sleep Quality Index and Patient Health Questionnaire was sent out to members (n = 1500) of the national RLS association and 788 (52.5%) agreed to participate. Data were analyzed using classical test theory, Confirmatory factor analysis and Rasch measurement theory analysis. Hypothesis testing for construct validity was done by bivariate correlation analyses. Most respondents were women (65%), retired (71%) and had a mean-age of 70.8 years (SD 11.4). The 7-item version of the Pearlin Mastery Scale showed poor fit to the one factor model. After omitting the two positively worded items (i.e., item 4 and 6), the 5-item version was found to be unidimensional, with satisfactory internal consistency. However, all items showed considerable ceiling effects. No measurement variance was seen regarding age-groups or sex. Higher level of mastery was moderately correlated with less depressive symptoms but only weakly correlated to RLS-related sleep problems. The 5-item version of the Pearlin Mastery Scale is suggested to be used in persons with RLS due to its acceptable psychometric properties. The instrument could be applied as an outcome measure for behavioral change interventions aiming to support mastery in RLS.

The role of large muscle movements on excessive daytime sleepiness in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a heterogeneous disorder requiring personalized diagnostic approaches. Restless sleep and excessive daytime sleepiness (EDS) frequently accompany OSA, and are mainly linked to sleep fragmentation secondary to apneas and/or hypopneas. In this study, we aimed to analyze the characteristics of LMMs in OSA and to evaluate interrelationship between LMMs and EDS. Untreated-naïve adult OSA patients, with vs. without EDS were prospectively enrolled. Patients with comorbid neurological/psychiatric diagnosis, usage of drugs/substances known to affect sleep and positive airway pressure therapy were excluded. Routine evaluation of video-polysomnography was followed by LMM scoring. LMMs were compared between OSA with vs. without EDS, and correlations of LMMs with ESS scores and macrostructural sleep parameters were analyzed. Sixty patients were included (median age 43.5 [37.0] years, %78.3 men); 17 had EDS with Epworth Sleepiness Scale (ESS) ≥ 10 (28.3%). Total LMM index in total sleep time (TST) was 7.9 [20.6]. Total LMM index in TST (p = 0.048) and N1 (p = 0.020), and arousal-related LMM index in TST (p = 0.050) and N1 (p = 0.026) were higher in OSA with EDS than those without EDS. ESS scores were positively correlated with total (r = 0.332,p = 0.028) and arousal-related (r = 0.338,p = 0.025) LMM indexes in N1, and abnormal respiratory event-related LMM indexes in N1 (r = 0.440,p = 0.003) and N3 (r = 0.293,p = 0.050) after correction for age, sex, body-mass-index and apnea-hypopnea index. Our study demonstrated that LMMs were more frequent in OSA with EDS than those without EDS. This may have broad implications for the mechanisms of motor restlessness and residual sleepiness in OSA and warrants larger-scale, long-term follow-up studies. No clinical trial registration due to the observational design of the study.

Is iron depletion the only cause of motor restlessness in restless sleep presenting in autism spectrum disorder?

Is iron depletion the only cause of motor restlessness in restless sleep presenting in autism spectrum disorder?

Structural brain network degeneration associated with agitation in dementia

AbstractBackgroundAgitation is a behavioral syndrome involving increased motor activity, restlessness, aggressiveness and emotional distress. Its has a 30% prevalence across multiple types of dementia and is associated with negative outcomes, including reduced quality of life, caregiver distress, and mortality. Pharmacological treatment risks serious side effects, including mortality. Understanding brain network topology could provide insights into novel treatment methods.MethodParticipants comprised 600 subjects from 3 existing databases: the Alzheimer’s Disease Neuroimaging Initiative (ADNI), Frontotemporal Lobar Degeneration Neuroimaging Initiative (NIFD) and the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease at Northwestern University. Participants were clinically diagnosed with either behavioral variant frontotemporal dementia (bvFTD), mild cognitive impairment (MCI), dementia of the Alzeheimer type (DAT) or cognitively normal (CN). The Neuropsychiatric Inventory Questionnaire (NPI‐Q) caregiver rating was used to determine whether individuals were agitated or not. Morphometric similarity networks (MSNs) were generated from Freesurfer statistics calculated from T1‐weighted MRIs. 7 surface‐based cortical metrics (e.g. gray matter volume, surface area) were calculated for each of 360 parcels. Pairwise inter‐parcel Pearson correlations of feature vectors were calculated to produce a morphometric similarity matrix for each individual. We calculated sub‐matrices for salience (SN) cognitive control (CCN) and default mode networks (DMN). Brain Connectivity Toolbox calculated transitivity and global efficiency of each network. Metrics were calculated at different thresholds to ensure the results were not threshold‐dependent. We calculated 2 (Agitation present/absent) x 4 (Diagnosis) repeated measures ANCOVAS for transitivity and global efficiency for each network. Covariates were age, sex, race, database, education, ICV, CDR‐SB and days MRI‐NPI‐Q.ResultFor the SN, people with Agitation had significantly lower global efficiency than people without Agitation (Figure 1). There were no significant effects of diagnosis or interaction. For the CCN, people with agitation had significantly lower transitivity than people without Agitation (Figure 2). There were no significant effect of diagnosis or interaction.ConclusionAcross different forms of dementia, Agitation is associated with reduced integration (global efficiency) of the salience network, and reduced segregation (transitivity) of the cognitive control network. Interventions that alter these topological network features may be effective in reducing agitation in dementia, regardless of clinical diagnosis.

Structural brain network degeneration associated with agitation in dementia

AbstractBackgroundAgitation is a behavioral syndrome involving increased motor activity, restlessness, aggressiveness and emotional distress. Its has a 30% prevalence across multiple types of dementia and is associated with negative outcomes, including reduced quality of life, caregiver distress, and mortality. Pharmacological treatment risks serious side effects, including mortality. Understanding brain network topology could provide insights into novel treatment methods.MethodParticipants comprised 600 subjects from 3 existing databases: the Alzheimer’s Disease Neuroimaging Initiative (ADNI), Frontotemporal Lobar Degeneration Neuroimaging Initiative (NIFD) and the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease at Northwestern University.Participants were clinically diagnosed with either behavioral variant frontotemporal dementia (bvFTD), mild cognitive impairment (MCI), dementia of the Alzeheimer type (DAT) or cognitively normal (CN). The Neuropsychiatric Inventory Questionnaire (NPI‐Q) caregiver rating was used to determine whether individuals were agitated or not.Morphometric similarity networks (MSNs) were generated from Freesurfer statistics calculated from T1‐weighted MRIs. 7 surface‐based cortical metrics (e.g. gray matter volume, surface area) were calculated for each of 360 parcels. Pairwise inter‐parcel Pearson correlations of feature vectors were calculated to produce a morphometric similarity matrix for each individual. We calculated sub‐matrices for salience (SN) cognitive control (CCN) and default mode networks (DMN). Brain Connectivity Toolbox calculated transitivity and global efficiency of each network. Metrics were calculated at different thresholds to ensure the results were not threshold‐dependent.We calculated 2 (Agitation present/absent) x 4 (Diagnosis) repeated measures ANCOVAS for transitivity and global efficiency for each network. Covariates were age, sex, race, database, education, ICV, CDR‐SB and days MRI‐NPI‐Q.ResultFor the SN, people with Agitation had significantly lower global efficiency than people without Agitation (Figure 1). There were no significant effects of diagnosis or interaction.For the CCN, people with agitation had significantly lower transitivity than people without Agitation (Figure 2). There were no significant effect of diagnosis or interaction.ConclusionAcross different forms of dementia, Agitation is associated with reduced integration (global efficiency) of the salience network, and reduced segregation (transitivity) of the cognitive control network. Interventions that alter these topological network features may be effective in reducing agitation in dementia, regardless of clinical diagnosis.

Hyperkinetic disorder in children: principles of diagnosis and therapy

This pathology includes disorders of neuropsychological development, the leading clinical sign of which is constant persistent patterns (models) of behavior with impaired attention and/or increased motor activity and impulsivity, leading to maladjustment in several areas of the child’s social functioning. Attention disorders manifest themselves in the form of the following behavioral patterns: distractibility with disorganization of behavior and problems with stable focus on a task, which are not associated with a decrease in intelligence and lack of understanding of the proposed tasks. Hyperactivity is understood as excessive motor activity, fussiness, restlessness, or verbosity that is not adequate to accepted norms. Impulsive behavior involves quick, hasty, thoughtless, hurried actions that carry a high risk of serious harm and injury. Due to the great heterogeneity in the severity of clinical manifestations, this pathology tends to be diagnosed late, often with the start of schooling.

Validation of two brief instruments (the SURE and CollaboRATE) to measure shared decision-making in patients with restless legs syndrome.

Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk-benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.

A complex polymorphous psychosis or a cycloid psychosis with a different onset?

IntroductionAcute and transitory psychotic disorders comprise a polymorphous picture such as Leonhard’s cycloid psychoses, which alternate episodes of affective symptoms such as psychosis between two poles (anguish/happiness, incoherence/stupor, or akinesia/hyperkinesia).ObjectivesTo describe a case report of a 20-year-old man, in outpatient psychiatric follow-up, after debuting at age 18 with a severe depressive episode of endogenomorphic characteristics without psychotic symptoms, with subsequent complete remission. Two years after clinical stability, he required prolonged hospitalization due to polymorphous psychotic syndrome of abrupt onset in a context of previous continuous use of cannabis and cocaine. Suspicion towards parents, bizarre behaviors, rushing desires, unmotivated laughter, fixed gaze, bewilderment, anguish with a feeling of imminent death, alternates with euphoria and senseless purchases.MethodsWe present the case report of this patient with a mental examination of conscious, scattered attention with marked distractibility, confusion and experiences of strangeness, memory gaps, subjective sensation of well-being with tachypsychia, which fluctuates with thymic oscillations and alternates with episodes of marked indefinite anguish, intense anxiety with delusional fear of the death of him or his family. Little systematized ideas of reference and prejudice based on intuitions or delusional occurrences in their environment. Megalomaniac and religious-messianic ideation. No sensory perception disturbances. Disintegrated course of thought, with frequent illogical associations, ambivalence of thought, affectivity and psychomotricity. Motor restlessness and behavioral disorganization. Global insomnia. Judgment of reality and superior functions diminished. No auto/heteroaggressiveness.ResultsVarious psychoactive drugs were tested for two months, obtaining a response only with valproic acid 1500mg, pregabalin 450mg and olanzapine 15mg, presenting slow improvement in a situation of absence of consumption, with a predominance of symptomatic polymorphism, decreasing fluctuation between episodes of expansiveness and psychotic anguish, remitting disorganization and motility alterations, persisting poor awareness of the disease and cognitive complaints. He was referred for follow-up at the mental health center where his gradual recovery continued.A differential diagnosis of polymorphous psychosis is proposed, compatible with a cycloid psychosis of the anxiety-happiness type with marked affective symptoms, precipitated by substance use.ConclusionsCycloid anxiety-happiness psychosis stands out for intense and fluctuating anxiety, oscillating with feelings of happiness, ecstasy, and placidity, mystical-religious delusions, and preoccupation with death, which may comprise a different psychotic debut.Disclosure of InterestNone Declared

Opioids and restless legs syndrome: a double-edged sword.

Opioids and restless legs syndrome: a double-edged sword.

Prehospital drugs for sedation in psychomotor agitation, friends or foes? An observational retrospective study

Altered mental status (AMS) describes an undifferentiated presentation of disorders of mentation. It represents a common problem for prehospital and hospital providers and may be found in 5% to 10% of patients admitted to the Emergency Department (ED). Psychomotor Agitation (PMA), a state of motor restlessness and mental tension associated with a variety of psychiatric conditions, is one of the most frequent manifestations of AMS. In this observational retrospective study we included all the patients who presented PMA, treated by the out-of-hospital Emergency Medical System (EMS), and transported to the ED of the University Hospital of Udine, Italy. The objectives were to determine the incidence of patients with PMA treated by EMS in the area of investigation, the evaluation of pharmacologically treated patients considering the most commonly administered drugs, the intubation rate, the fraction of inspired oxygen (FiO2) needs, the length of hospital stay (LOHS), the adverse drug reactions (ADRs), and the excited delirium syndrome (ExDS). From January 2017 to December 2018, 319 patients were enrolled. The prevalence of PMA was 2.5% and 0.5% were the cases of PMA managed by the EMS. The predominant drugs used for sedation were midazolam (19.75%) and ketamine (9.09%), alone or in association; patients with consistent PMA required more than one sedative. Statistically significant differences were found in FiO2 supplementation for ketamine-sedated psychiatric patients and midazolam-sedated psychiatric patients with chronic home therapy, in the LOHS >24 hours (h), with a longer stay in case of midazolam and ketamine use, and in LOHS and FiO2 supplementation due to polypharmacy administration with more than one sedative drug. PMA is a frequent and widespread phenomenon and in the prehospital setting requires rapid assessment and management. Therapeutical strategies with benzodiazepines, ketamine, and rarely associations of drugs are safe, do not increase hypoxia and intubation rate.

Heterogeneity of associations between dissociation and attention deficit symptoms.

Childhood trauma and dissociative experiences are suggested to be predisposing transdiagnostic factors for attention deficit /hyperactivity disorder (ADHD) as well as many psychiatric disorders. Trauma-related symptoms such as motor restlessness, emotional instability, and concentration problems can mimic, trigger, or exacerbate ADHD symptoms. Moreover, given the relationship between ADHD and trauma-induced distress, it has been suggested that dissociative experiences and attention problems may reveal overlapping characteristics. The aim of this study was to investigate the associations between dissociative experiences and attention deficits by carrying out mixture analysis. A thousand and thirty-seven participants volunteered to the online investigation. Participants completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Wender Utah Rating Scale (WURS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ). Item responses on the DES and attention deficit symptoms as indexed by the ASRS were subjected to latent class analysis. The three-latent-class model outperformed alternative mixture models. Mixture analysis classified the sample into three homogenous subgroups as follows: (1) No/low dissociation or attention problems; (2) Moderate dissociation with attention problems; and (3) High dissociation with attention problems. High dissociators with attention problems were characterized by heightened scores on somatoform dissociation and emotional neglect. No/low dissociation or attention problems latent class reported significantly lower scores on hyperactivity/impulsivity, depression, attention deficit in childhood, and sexual abuse than both moderate and high dissociation latent classes. High dissociators and moderate dissociators significantly differed on conduct problems and physical abuse. We concluded that impulsive hyperactivity, depression, and childhood sexual abuse were common features in heightened dissociation latent classes, as well as attention deficit.

Further Studies on the Role of BTBD9 in the Cerebellum, Sleep-like Behaviors and the Restless Legs Syndrome

Genetic analyses have linked BTBD9 to restless legs syndrome (RLS) and sleep regulation. Btbd9 knockout mice show RLS-like motor restlessness. Previously, we found hyperactivity of cerebellar Purkinje cells (PCs) in Btbd9 knockout mice, which may contribute to the motor restlessness observed. However, underlying mechanisms for PC hyperactivity in Btbd9 knockout mice are unknown. Here, we used dissociated PC recording, brain slice recording and western blot to address this question. Our dissociated recording shows that knockout PCs had increased TEA-sensitive, Ca2+-dependent K+ currents. Applying antagonist to large conductance Ca2+-activated K+ (BK) channels further isolated the increased current as BK current. Consistently, we found increased amplitude of afterhyperpolarization and elevated BK protein levels in the knockout mice. Dissociated recording also shows a decrease in TEA-insensitive, Ca2+-dependent K+ currents. The result is consistent with reduced amplitude of tail currents, mainly composed of small conductance Ca2+-activated K+ (SK) currents, in slice recording. Our results suggest that BK and SK channels may be responsible for the hyperactivity of knockout PCs. Recently, BTBD9 protein was shown to associate with SYNGAP1 protein. We found a decreased cerebellar level of SYNGAP1 in Btbd9 knockout mice. However, Syngap1 heterozygous knockout mice showed nocturnal, instead of diurnal, motor restlessness. Our results suggest that SYNGAP1 deficiency may not contribute directly to the RLS-like motor restlessness observed in Btbd9 knockout mice. Finally, we found that PC-specific Btbd9 knockout mice exhibited deficits in motor coordination and balance similar to Btbd9 knockout mice, suggesting that the motor effect of BTBD9 in PCs is cell-autonomous.

A Review and Case Study of the Action of Chlorpromazine on Dopaminergic Pathways and its Associated Extrapyramidal Disturbances

Abstract: As a first-line antipsychotic, Chlorpromazine is an excellent blocking agent of the D2 receptor. Dopamine pathways are predominantly affected by the use of this medicine in schizophrenia therapy, leading to the development of drug-induced Parkinsonism (DIP). Extrapyramidal symptoms (EPS) include motor rigidity, tremors, restlessness, dystonia, stumbling, nervousness, improper posture, Tardive dyskinesia, Akathisia, and many other side effects. In seniors over 70 suffering from schizophrenia, DIP has become very common and is the second most common cause of Parkinsonism behind Parkinson's disease (PD). A concise review of the actual mechanism of blockade by chlorpromazine is presented in this article, with a particular focus on EPS and other adverse effects. Keywords: Drug-induced Parkinsonism, Extrapyramidal symptoms, Schizophrenia, Tardive dyskinesia, Chlorpromazine.

Surgical treatment of Littre hernia in a 6-month old child

Introduction. A surgical care in complicated hernias of the anterior abdominal wall remains an acute issue in pediatric surgery. Strangulated hernia is the most common and dangerous complication. It is worth mentioning that the risk of developing this complication in children during the first six months of their life reaches 24%. The clinical course of strangulated hernia in children is characterized by a large variety of symptoms depending on patient’s age, anatomical and pathomorphological features of his/her organs and systems. A correct assessment of clinical, laboratory and instrumental findings can help in identifying uncommon types of hernia infringement.Material and methods. A case of clinical observation and surgical treatment of a 6-month old child with Littre hernia is presented.Results. By the literature data, emotional and motor restlessness prevails in the structure of complaints in infants with strangulated hernia. Patients with uncommon types of hernia infringement may be regarded as a separate group. Patients with Littre hernia, which is one of the types of parietal infringement, belong to this group. Littre hernia incidence does not exceed 0.5% of the total number of hernia strangulations. Clinical symptoms of the atypical hernia infringement may be mild or non-classical. It is known that mild clinical manifestations of strangulated hernia as well as limited diagnostic potentials of laboratory, X-ray and ultrasound examinations in young children increase the risk of developing destructive changes in the intestinal wall. Therefore, an active surgical tactics of hernia treatment prevents the development of atypical forms of hernia infringement and complications associated with it.Conclusion. Thus, early detection of hernias of the anterior abdominal wall, since the neonatal period, an adequate observation tactics and timely performed surgical intervention is the basis for preventing peritonitis and intestinal obstruction in young children.

Clinical phenomenology and pathophysiology of daytime and nighttime imperative movements

Imperative movements have an intermediate position between voluntary and involuntary movements and are also referred to as semi-voluntary, or induced. Their common characteristic is the urge, forcing the patient to perform an action that can have a different duration and degree of complexity - from a short twitch (with tics) to prolonged episodes of general motor restlessness (for example, akathisia or stereotypes). The ability to slow down this movement for a short or longer period of time by volitional effort is associated with the urge to make a movement, which predetermines the patient's perception of the degree of its imperativeness and arbitrariness. All motor syndromes based on an imperative need to make movements (akathisia, tics, restless legs syndrome, some levodopa-induced dyskinesias, tardive dyskinesia, compulsive disorders, stereotypes), despite their differences, can be conditionally combined by the term «akathisia spectrum disorders». In some cases, violent imperative movements are paradoxically combined with hypokinetic disorders, primarily with parkinsonism, which makes the discomfort experienced by patients particularly severe.

Characterizing the Neuroimaging and Histopathological Correlates of Cerebral Small Vessel Disease in Spontaneously Hypertensive Stroke-Prone Rats.

Introduction: Spontaneously hypertensive stroke-prone rats (SHRSP) are used to model clinically relevant aspects of human cerebral small vessel disease (CSVD). To decipher and understand the underlying disease dynamics, assessment of the temporal progression of CSVD histopathological and neuroimaging correlates is essential.Materials and Methods: Eighty age-matched male SHRSP and control Wistar Kyoto rats (WKY) were randomly divided into four groups that were aged until 7, 16, 24 and 32 weeks. Sensorimotor testing was performed weekly. Brain MRI was acquired at each study time point followed by histological analyses of the brain.Results: Compared to WKY controls, the SHRSP showed significantly higher prevalence of small subcortical hyperintensities on T2w imaging that progressed in size and frequency with aging. Volumetric analysis revealed smaller intracranial and white matter volumes on brain MRI in SHRSP compared to age-matched WKY. Diffusion tensor imaging (DTI) showed significantly higher mean diffusivity in the corpus callosum and external capsule in WKY compared to SHRSP. The SHRSP displayed signs of motor restlessness compared to WKY represented by hyperactivity in sensorimotor testing at the beginning of the experiment which decreased with age. Distinct pathological hallmarks of CSVD, such as enlarged perivascular spaces, microbleeds/red blood cell extravasation, hemosiderin deposits, and lipohyalinosis/vascular wall thickening progressively accumulated with age in SHRSP.Conclusions: Four stages of CSVD severity in SHRSP are described at the study time points. In addition, we find that quantitative analyses of brain MRI enable identification of in vivo markers of CSVD that can serve as endpoints for interventional testing in therapeutic studies.

How to manage antipsychotic-induced akathisia

IntroductionAkathisia is a relatively common adverse effect of antipsychotics although some second-generation antipsychotics are known to have a lower liability for the condition. The core feature of akathisia is mental unease characterized by a sense of agitation, usually accompanied by motor restlessness, which can cause patients to pace up and down and be unable to stay seated for more than a short time. An association between this discomfiting subjective experience and suicidal ideation has been postulated but remains uncertain.ObjectivesOur aim is to perform a non-systematic review of the literature regarding the current understanding of antipsychotic-induced akathisia and its management.MethodsA semi-structured review was conducted on Pubmed concerning the relationship between akathisia and antipsychotics.ResultsAll antipsychotics drugs can cause akathisia. The management of antipsychotic-induced akathisia should include a dose reduction of the antipsychotic treatment or a switch to quetiapine or olanzapine. If ineffective, a trial with propranolol may be useful as well as the addition of a 5-HT2A antagonist like mirtazapine or mianserine. At last the inclusion of a benzodiazepine may be helpful albeit the risk of dependence and anticholinergics mainly when other extrapyramidal symptoms are present.ConclusionsHigh‐dose antipsychotic medication, antipsychotic polypharmacy and rapid increase in antipsychotic dosage should be avoided to prevent akathisia. There is limited evidence for any pharmacological treatment for akathisia such as switching to an antipsychotic medication with a lower liability for the condition, or adding a beta‐adrenergic blocker, a 5‐HT2A antagonist or an anticholinergic agent although some patients may benefit from such interventions.

Method of relieving alcohol dysphoria in the structure of hypertoxic alcohol abuse state with compulsive craving manifestations

IntroductionAlcohol dysphoria is a pathognomonic, severe, and therapeutically resistant syndrome considerable for alcohol and drug-addicted patients. The term “dysphoria” (from Greek δυσφορέω to suffer, torment, annoy) means an abnormally low type of mood, characterized by anger, gloom, irritability, feelings of hostility to others. In addictology, it is often identified in the withdrawal syndrome structure.ObjectivesTo develop innovative improvement in treatment for alcohol dysphoria.MethodsValid clinical diagnostic, laboratory, biochemical, electrophysiological, psychological (scaling, testing), statistical methods identifying alcohol dependence complicated by dysphoria.ResultsThe proposed method involves a complex of anti-affective, anti-abstinence, anti-craving pharmacological agents and drug-free methods, and differs from those conventional, along with psychotherapeutic potentiation, by additional targeted pharmacological triad (peroral Carbamazepine 200 mg twice a day: in the morning and in the evening; intramuscular Halopril (Haloperidol) 1 ml (5 mg) daily; oral Sonapax 1 tablet (25 mg) three times a day for 3-5 day treatment) used for a new purpose. 17 patients experienced this method. Efficacy: alcohol dysphoria acute manifestations were relieved by our method within 3-5 days that 37.8% exceeds conventional treatment. In 15 minutes, patients decreased irritability, motor restlessness, stress, cravings for alcohol. In 30 minutes, the patients fell asleep. Sleep lasted 3.5 hours on average. Subsequently, patients denied craving for alcohol, calmed down emotionally and psychomotorically, wished to be treated for alcoholism. No dysphoric relapses were observed.ConclusionsThe proposed multimodality method alleviates alcohol-induced dysphoria, involving pharmacotherapeutic triad along with psychotherapeutic potentiation.

Tardive Dyskinesia: Assessing and Treating a Debilitating Side Effect of Prolonged Antipsychotic Exposure

Tardive Dyskinesia: Assessing and Treating a Debilitating Side Effect of Prolonged Antipsychotic Exposure

Prevalence and Predictors of Postictal Confusion After Electroconvulsive Therapy.

ObjectiveTo investigate the prevalence and predictors of postictal confusion (PIC) in patients who received electroconvulsive therapy (ECT).MethodsWe conducted chart reviews for 79 patients who were receiving inpatient ECT. Subjects with PIC were identified. PIC was defined by confusion, disorientation, motor restlessness, purposeless movement, and nonresponse to verbal commands following ECT within an hour, intravenous benzodiazepine was necessary to manage disturbed behavior. Multivariable logistic regression analysis was used to examine the association of PIC with demographic and clinical variables.ResultsPrevalence of PIC was 36.7%. In 912 ECT sessions, the occurrence of PIC was 86 times. Patients with PIC (n = 29) had significant higher body mass index (BMI) (27 ± 6.6 kg/m2 vs 24.1 ± 5.2 kg/m2, t = −2.22, df = 77, p = 0.029) than patients without PIC (n = 50). PIC associated with BMI (Pearson correlation = 0.25, p = 0.029). BMI was significant predictor of PIC after adjusting for other covariates (odds ratio = 0.91, 95% CI= 0.83–0.99, p < 0.035).ConclusionPIC was not uncommon in patients receiving ECT. BMI was an independent predictor of PIC. Psychiatrists should be aware of the risks of PIC in patients with high BMI receiving ECT.