Akathisia---An Insane Side-Effect of Sanity Treatment

[Guest guest]

Mental hospitals are supposed to be, or ought to be, places where so-

called " insane " people can go to calm down. Unfortunately, most any

anti-psychotic drug they are given will result in them suffering from

an anything but calm condition known as " akathisia. " Here's a

description of it. Believe me, it is NO FUN AT ALL, not being able to

sit still, or to control one's leg movements, or to stop feeling

restless, no matter how one tries. And to think mental hospitals

supposedly exist to help and to cure those deemed " insane... " Note

that the literature below says, " First try this; if that doesn't

work, try this; if that doesn't work, give this a try. " Makes it

sound as easy as screwing in and out different light bulbs into a

socket. IT AIN'T THAT EASY! This is a person's BRAIN and BODY and

LIFE we are talking about. Each change can take a week or two or more

for the doctor to decide whether or not it is having the desired

effect, and meanwhile, the person being given(or forced to take)each

drug is suffering SEVERE mental anguish! Note, too, that if other

stuff fails, then one should try BETA BLOCKERS! All of this leads me

to say that for most psychiatrists, treating an " insane " person is

like trying to level the legs on an off-balance chair, with no level

place to set it down, and no proper tools to do the job with. End

result: a chair with no legs=a client in worse shape than

when " treatment " began.

 

Scottish Medical Journal

Editorials/Comments

October 2001

 

AKATHISIA - A BRIEF REVIEW

D E Nelson

The Orchard Clinic

Royal Edinburgh Hospital

Morningside Terrace

Edinburgh

 

SMJ 2001;46: 133-134

 

Akathisia is a common and unpleasant side effect of many psychotropic

medications. Junior doctors are often slow to recognise it with

consequences for the patient which include reduced compliance,

exacerbation of psychotic symptoms and an increased risk of suicide

and violence. The word akathisia comes from the Greek meaning

literally " not to sit' and was initially used by Haskovec in 19021 to

refer to restless patients with hysteria and neurasthenia. Akathisia

is a relatively common side effect of antipsychotic medication,

although other drugs including antidepressants, metoclopramide, some

calcium channel blockers, dopamine agonists, amphetamine and

buspirone have all been shown to cause it. The symptoms consist of

objective and subjective components. Subjectively there are symptoms

of dysphoria including tension, panic, irritability and impatience2

and objectively there are movements usually taking the form of

shuffling of feet while sitting and pacing or rocking while standing.

Fidgety leg movements may occur while lying down.3 The differential

diagnosis includes agitation secondary to psychotic symptoms, the

restless legs syndrome, anxiety, drug withdrawal states and a number

of neurological disorders.

 

Clinical implications

Non-compliance is likely to be increased in patients suffering from

the unpleasant symptoms of akathisia. Associated severe anxiety may

exacerbate psychosis and there is an increased risk of suicide and

violence.4,5 Patients may not be able to distinguish akathisia from

the ongoing symptoms of illness leading to despair.6 Patients are

also at increased risk of developing tardive dyskinesia.7 It is

important that akathisia is recognised and treated appropriately as

misdiagnosis and a further increase in antipsychotic medication

dosage may further exacerbate the condition.

 

Epidemiology

Studies have reported incidences ranging between 20 and 75%.1,3

Varying diagnostic approaches and differences in study populations

account for much of the difference in incidence quoted. Gender does

not seem to influence occurrence8 however it appears that acute

akathisia and pseudoakathisia are more common in men and chronic

akathisia is more common in women.2 There is no evidence any one race

is particularly vulnerable.8 The risk is increased with higher

potency drugs, higher dose, increased rate of dose escalation, the

presence of extrapyramidal side effects (EPSEs), and parenteral

administration.8,9 Age does not have a significant influence on the

occurrence of acute akathisia.10

 

Pathophysiology

The underlying cause of akathisia is still far from clear.4 There

appears to be dopamine receptor blockade in the mesocortical dopamine

system. PET studies show D2 receptor occupancy in the striatum plays

a role12 and noradrenergic and serotonergic systems also appear to he

involved.13 Antipsychotics with potent 5HT receptor antagonism show a

lower incidence of akathisia and some 5HT2 antagonists eg

cyproheptadine, have therapeutic efficacy. There is a possible

association between low iron status and akathisia which was initially

described by Ekbom in his investigation of patients with restless

legs syndrome.4,11

 

Classification

There have been a number of subtypes of akathisia proposed, although

a lack of consensus in the use of the terms is evident. Most authors

refer to acute, tardive, chronic, withdrawal and pseudoakathisia.

Acute akathisia has an onset within hours or days, however some

authors suggest the onset may be up to six months after an increase

in dosage.7 Tardive akathisia is generally taken to mean akathisia of

delayed onset (usually three months), not related to a recent change

in drug or dose.10,11 It has been found to be significantly

associated with tardive dyskinesia3 and some have proposed it to be a

variant where the trunk and limbs are most affected. Activation

procedures may help distiniguish between the two, for example finger

tapping may increase symptoms in tardive dyskinesia but decrease the

compulsion to move in akathisia. Chronic akathisia usually refers to

a persistence of symptoms for three months irrespective of the type

of onset. 10,11 Withdrawal akathisia starts within six weeks of

discontinuation or a significant dose decrease10 and pseudoakathisia

refers to a variant where there are objective symptoms but no

subjective awareness or distress. These individuals tend to display

more negative symptoms of psychotic illness.

 

(Message truncated: It contained " solutions " to the problems described here.

They of course were to take more (other) psychotropic medications. If anyone

wants that they can go to an allopathic site. Or just turn on any television.

Frank)