Akathisia
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Akathisia is an often extremely unpleasant subjective sensation of "inner" restlessness that manifests itself with an inability to sit still or remain motionless, hence its the origin of its name: Greek a (without) + kithesia (to sit). It is a common side effect of certain drugs, notably major tranquilizers, such as haldol and droperidol; SSRIs, such as paxil; tricyclic antidepressants, certain antihistamines, such as phenergan and Benadryl; and certain anti-emetic drugs, particularly the dopamine blockers (e.g. Reglan and Compazine).
Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still with overwhelming anxiety and severe dysphoria (manifesting as an almost undescribable sense of terror and doom). In the most severe cases, dysphoria can be so severe that the patient is literally compelled to take action, leading, possibly, to suicide attempts. It is not unknown to have patients literally run out of a hospital or emergency room.
Treatment includes the use of drugs and the discontinuation or reduction of dose of the causative agent. The drug of choice for the treatment of akathisia is propranolol, along with other beta blockers such as metoprolol. The antihistamine cyproheptadine is also equally effective, though with shorter effect than beta blockers. Second-line treatments include benztropine and benadryl, though excess use of benadryl may worsen symptoms.
The presence and severity of Akathisia is measured using the Barnes Akathisia Scale.
- T. R. E. Barnes, A Rating Scale for Drug-Induced Akathisia, British Journal of Psychiatry, vol 154, pp. 672-676, 1989
External links
- EM guidemap - Akathisia and restless leg syndrome (http://www.homestead.com/emguidemaps/files/akathisia.html)
- DSM-IV: Neuroleptic Induced Acute Akathisia (http://www.behavenet.com/capsules/disorders/niacuteakathisia.htm)