Akathisia

Akathisia

1. Akathisia Summarized by: Ade Wijaya, MD Lohr, J. B., Eidt, C. A., Alfaraj, A. A., & Soliman, M. A. (2015). The clinical challenges of akathisia.  CNS spectrums ,  20 (S1), 1-16.

2. Outline: Introduction Subtype Etiology Risk factors D ifferential diagnosis Pathophysiology Assestment Treatment Summary

3. Introduction Coined by the Czechoslovakian neuropsychiatrist, Ladislav Hascovecin 1901 Psychiatric  movement disorder A sensorimotor disorder Extrapyramidal

4. Subtype by Duration Several months

5. Other Subtypes Parkinson’s disease (PD) Post-encephalitic parkinsonism

6. Etiology Drug-induced akathisia Antipsychotics Antidepressants Other drugs Akathisia in parkinsonian condition Spontaneous akathisia

7. Antipsychotic-induced Akathisia F irst-generation antipsychotics 8–76% of treated patients Lower incidence in 2 nd generation antipsychotics Antidepressant-induced Akathisia SSRI

8. Azithromycin Calcium channel blockers, Lithium, Anti-dopaminergic anti-emetics (such as prochlorperazine and metaclopramide) Dopamine-depleting agents (reserpine and tetrabenazine) Recreational drugs: - gamma-hydroxybutyrate ( GHB ) - methamphetamine - 3,4-methylenedioxymethamphetamine (MDMA , ecstasy ) - cocaine Other drugs

9. Akathisia in parkinsonian condition Parkinson disease Post-encephalitic parkinsonism, Cortico-basal degeneration ( CBD) Multiple system atrophy ( MSA ) L-Dopo related

10. Risk Factors for Drug-Induced Akathisia Schizophrenia Bipolar disorder Higher dose Rapid dose increase Traumatic brain injury Cancer Iron deficiency A dvance age F emale

11. Differential Diagnosis Anxiety Agitation with medical conditions Psychomotor agitation Tics and Tourette disorder Antipsychotic-induced tardive dyskinesia Antipsychotic-induced dystonia Antipsychotic-induced parkinsonian tremor RLS and PLMD

12. Pathophysiology Blockade of mesocortical dopaminergic pathways Generalized reduction in dopamine in the brain  increase noradrenergic activity Assestment Clinical observation and patient report Barnes Akathisia Rating Scale (BARS)

13. Treatment Treatment aimed at the cause Reduce or switch medications, observe until 6 weeks (due to withdrawal akathisia) Correct Fe in iron deficiency Anticholinergic drugs (such as biperiden , trihexyphenidyl, and benztropine) Beta-blockers ( such as propranolol and metoprolol) Serotonin 5-HT2A antagonists (such as mianserin, mirtazapine , and cyproheptadine) Vitamin B6 , n-acetylcysteine, tetrabenazine, and benzodiazepine Piracetam, buspirone, opiates, clonidine, bromocriptine, amantadine

14. Summary 1. Akathisia is a complex, confusing, and under-recognized problem that causes considerable suffering 2. Sensorimotor movement disorder 3. EPS 4. Treatment aimed at the cause

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