Akathisia, antipsychotic-induced

Nausea and sometimes vomiting may occur because of activation of 5-HT3 receptors. Tolerance generally develops to this within 7-10 days. A syndrome of agitation, which seems identical to the akathisia sometimes induced by antipsychotic drugs, may occur early in treatment in a small proportion of patients and is usually an indication to stop the SSRI. 

Psychiatric Side Effects. Antipsychotic-induced akathisia, akinesia, and dysphoria may have unfortunate sequelae, resulting in what has been termed behavioral toxicity. Akathisia has resulted in impulsivity and in extreme cases, violence and suicide. Akinesia, characterized by diminished spontaneity, results in symptoms of apathy and withdrawal, often mistaken for the negative symptoms of schizophrenia these patients may actually appear depressed on formal evaluation. 

Dopamine receptors (D, D, D ) Antipsychotics (e.g., haloperidol, clozapine, thioridazine, nemonapride) Antipsychotic response (D, Dj, D ), antipsychotic-induced tardive dyskinesia (Dj) and acute akathisia (Dj), hyperprolactinemia in females (D )... 

Clonazepam is a benzodiazepine that is used predominantly in epilepsy, panic disorder, and mania, and also appears to be effective in relieving antipsychotic drug-induced akathisia (1). The use of clonazepam in psychiatric disorders is complicated by significant drowsiness in a majority of patients, and additional behavioral problems in children (SEDA-19, 34). 

Propranolol also is used to treat various arrhythmias (Chapter 34), myocardial infarction (Chapter 31), congestive heart failure (Chapter 33), pheochromocytoma, and migraine (prophy-lactically). Propranolol also has been used for several off-label indications including parkinsonian tremors (sustained-release only), akathisia induced by antipsychotic drugs, variceal bleeding in portal hypertension, and generalized anxiety disorder. 

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