Summary about Disease
Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness accompanied by motor restlessness. Individuals with akathisia often feel an irresistible urge to move, and they may pace, fidget, rock, or cross and uncross their legs. It's a distressing condition that can occur as a side effect of certain medications, particularly antipsychotics. The term comes from the Greek words "a-" (meaning without) and "kathēsis" (meaning sitting).
Symptoms
The primary symptom is a feeling of inner restlessness and an inability to sit or stand still. Other symptoms may include:
Pacing
Fidgeting
Rocking back and forth
Shifting weight from one foot to another
Crossing and uncrossing legs
Anxiety
Irritability
Insomnia
Feeling tense or on edge
Depression These symptoms can range in severity from mild unease to intense distress.
Causes
The most common cause of akathisia is medication, particularly:
Antipsychotics: Especially first-generation (typical) antipsychotics, but also some second-generation (atypical) antipsychotics.
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can sometimes cause akathisia.
Anti-nausea medications: Such as metoclopramide and prochlorperazine.
Calcium channel blockers
Certain medications used to treat vertigo Less common causes include:
Parkinson's disease
Traumatic brain injury
Encephalitis
Iron deficiency
Withdrawal from certain medications
Medicine Used
Treatment for akathisia typically involves:
Reducing or discontinuing the offending medication: This is the first and most important step, if possible and safe.
Beta-blockers: Such as propranolol, can help reduce the physical symptoms of restlessness.
Benzodiazepines: Such as lorazepam or clonazepam, can help with anxiety and restlessness, but are used cautiously due to the risk of dependence.
Anticholinergics: Such as benztropine, can be helpful, particularly if akathisia is caused by antipsychotics.
Vitamin B6: Some studies suggest that high doses of vitamin B6 may be helpful in some cases.
Clonidine: An alpha-2 adrenergic agonist that can help reduce anxiety and restlessness.
Cyproheptadine: An antihistamine with antiserotonergic properties that has shown some efficacy.
Is Communicable
No, akathisia is not a communicable disease. It is a side effect of medication or a symptom of an underlying medical condition, and cannot be transmitted from person to person.
Precautions
If you are starting a medication known to cause akathisia, precautions include:
Discussing the risk with your doctor: Be aware of the potential side effects and what to watch out for.
Starting with the lowest effective dose: This can help minimize the risk of side effects.
Monitoring for symptoms: Pay attention to any feelings of restlessness or an urge to move, and report them to your doctor immediately.
Avoiding abrupt discontinuation of medications: This can sometimes worsen akathisia or cause other withdrawal symptoms.
Maintaining adequate hydration and nutrition: While not a direct prevention, overall health can influence medication response.
How long does an outbreak last?
The duration of akathisia can vary greatly depending on the cause:
Medication-induced: Akathisia may start within days or weeks of starting a medication and can last as long as the medication is taken. Symptoms may resolve within days or weeks of stopping the medication, but in some cases, it can persist for months.
Withdrawal-related: Akathisia that occurs during medication withdrawal may last for several weeks.
Underlying medical condition: The duration of akathisia caused by an underlying condition will depend on the treatment and course of that condition.
How is it diagnosed?
Diagnosis is primarily clinical, based on a careful assessment of the patient's symptoms. There are no specific blood tests or imaging studies to diagnose akathisia. The doctor will typically:
Take a thorough medical history: Including a list of all medications the patient is taking.
Perform a physical and neurological examination: To rule out other conditions.
Ask about the patient's subjective experience of restlessness: How it feels, what triggers it, and what makes it better or worse.
Observe the patient for signs of motor restlessness: Such as pacing, fidgeting, or rocking.
Use standardized rating scales: Such as the Barnes Akathisia Rating Scale (BARS), to assess the severity of akathisia.
Timeline of Symptoms
The onset and progression of akathisia symptoms can vary:
Acute Akathisia: Develops within days or weeks of starting or increasing the dose of a medication.
Chronic Akathisia: Persists for more than six months.
Tardive Akathisia: A delayed-onset akathisia that can occur after long-term exposure to certain medications, particularly antipsychotics. It may persist even after the medication is discontinued.
Withdrawal Akathisia: Occurs during the process of discontinuing certain medications. Symptoms may fluctuate in intensity throughout the day, and may be worsened by stress, caffeine, or other stimulants.
Important Considerations
Akathisia can be very distressing: It can significantly impact quality of life and lead to anxiety, depression, and suicidal thoughts.
It's often misdiagnosed: It can be mistaken for anxiety, agitation, or psychosis.
Early recognition and treatment are important: To prevent the condition from becoming chronic and to improve the patient's well-being.
Patients should work closely with their doctors: To find the best treatment strategy, which may involve adjusting medications, adding other medications to manage symptoms, or exploring non-pharmacological approaches.
Self-treating is not recommended: It's essential to seek professional medical advice for diagnosis and management.