Akathisia drug-induced

The most common forms of EPS that occur early in the course of treatment include acute dystonic reactions (ADRs), drug-induced Parkinsonism, and akathisia. The ADRs are involuntary muscle spasms or contractions. An ADR typically involves muscles in the neck and/or the extraocular muscles, and can be painful and... 

Barnes, T. (1989) A rating scale for drug-induced akathisia. Br J Psychiatry 154 672-676. 

These alkaloids contain pyrrole or modified pyrrole, e.g. pyrrolidine, ring system. The simplest example of this class is nicotine. A pyrrolidine ring is the central structure of the amino acids proline and hydroxyproline. These alkaloids are also found in many drug preparations, e.g. procyclidine hydrochloride, which is an antichohnergic drug mainly used for the treatment of drug-induced Parkinsonism, akathisia and acute dystonia. 

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. 

This chapter will describe some of the most common, reversible, drug-induced neurological reactions acute dystonia acute akathisia parkinsonism and a broad, ill-defined category called dysphoria. All of them tend to begin early in treatment but can start later on as well. Chapters 4 and 5 will review the sometimes delayed and often persistent adverse reactions, including irreversible forms of akathisia and dystonia. 

Akathisia is a drug-induced reaction characterized by compelling feelings of restlessness, tension, or anxiety that drive a person to move his or her body (Jeste et al., 1986 Weiner et al., 1983). People with akathisia find it difficult to sit or to keep their feet still. Some will walk in place, pace frantically, or search out activities that keep them on the move. I have evaluated patients with permanent akathisia (tardive akathisia see chapter 4) who, for their entire lives, are trapped in perpetual suffering. The neurological distress produced by this drug-induced condition can become so extreme that even the most spellbound, relatively indifferent patient will feel tortured. 

Drug-induced akathisia, dystonia, and parkinsonism can produce extreme discomfort. They can be disabling and feel like torture (see chapter 3 for details). In brief, akathisia can become an inner torment and anguish that drives the individual into hyperactivity. 

Sachdev, P., Kruk, J. (1994). Clinical characteristics and predisposing factors in acute drug-induced akathisia. Archives of General Psychiatry, 51, 963-974. 

A therapeutic role for nefazodone 100 mg bd has been suggested in the treatment of neuroleptic drug-induced extrapyramidal signs, based on the results of a placebo-controlled, randomized study in 49 patients (197). There were no differences in akathisia or tardive dyskinesia between the two groups. However it should be noted that nefazodone has been withdrawn in most countries owing to the risk of severe liver damage. 

Two cases of acute neuroleptic drug-induced akathisia in patients with traumatic paraplegia have been published (219). The authors emphasized the possibility of drug-induced akathisia when patients with traumatic paraplegia or other physical disabilities develop increasing restlessness and an inability to sit or lie still. 

Kasantikul D. Drug-induced akathisia and suicidal tendencies in psychotic patients. J Med Assoc Thai 1998 81(7) 551-4. 

The low prevalence of akathisia in patients taking clozapine has led to the proposal that clozapine should be used to treat patients with neuroleptic drug-induced chronic akathisia (76,77). 

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). 

Extrapyramidal Symptoms. Acute ex-trapyramidal symptoms (EPS) consists of drug-induced parkinsonism (DIP), akathisia, and dystonia. Because of a common link to diminished CNS dopamine function at D2 receptors, DIP and idiopathic Parkinson s disease are indistinguishable. As in Parkinson s... 

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