In 1950 when antipsychotic medicines were first given to treat schizophrenia, patients started complaining of certain neurological side effects (an adverse or unwanted secondary effect). One of these is akathisia (psychomotor restlessness). In medical terms ‘it is an involuntary movement disorder’. The sufferer has a strong urge for moving, without getting any relief after the movement. They have an intense sense of restlessness, agitation and anxiety. As these feelings are hard to describe the diagnosis for akathisia gets very difficult and is often misdiagnosed. Even antidepressants, antiemetic, antihistamines, and psychoactive substances can cause this side effect. The word akathisia is derived from Greek meaning ‘without-not-sitting’.
AKATHISIA CAUSES AND SYMPTOMS
There are no direct causes for akathisia, but it is the side effects of medicines. Medicines that have been scientifically proven to have this side effect are Methyldopa, levodopa, dopamine agonists, amphetamine, methamphetamine, MDMA, GBH, Cinnarizine, flunarizine, Tricyclics, Metoclopramide, prochlorperazine, cinnarizine and many other drugs. The first symptom that the patients show is restlessness or the inability to sit in one place for a few minutes. This is also marked with tension, insomnia, anxiety, panic, discomfort, weepiness and the patient is also emotionally very weak. Many patients characterized their feeling as a foreign force, forced over the body and kept it in motion. They feel an inner sense of restlessness. They cross and uncross their legs, keep pacing about, cannot stand still, shift weight on their foot while standing or rub their soles while lying down in short are very uncomfortable. As the patient does not get enough satisfaction while performing the desired action, it leads to severe depression.
A major factor for Akathisia is non compliance of medicine especially anti-psychotic drugs. So when the dose increases in a psychotic patient, the level of akathisia also increases, this leads to reluctance in taking medicines, which in turn increase the risk of suicide and violence.
AKATHISIA DIAGNOSIS AND TREATMENT
It is difficult to distinguish between akathisia and other disorder as their symptoms overlap each other. A patient’s reliable information on the inner feelings goes a long way in diagnosing the problem. Mostly the patients complain that these purposeless movements are involuntary or they have dont control over their activity like tapping of the feet or walking in a place. However other physical movements like restless legs, anger, depression, body pain are also involved. Parkison’s disease and schizophrenia patients are most prone t this side effect. Doctors also keep in mind the medication, medical history of the patient while looking for symptoms of akathisia. Most of the time lowering the dose of the medicine that is causing the side effect, help in reducing or eliminating the problem in itself. An ancient method was to give anticholinegic medication benztropine (Cogentin). But this is no longer in use as even this medicine had its own side effects like muscle spasms & tremors. Other choices of treatment like give additional supplement to suppress the disorder are Benzodiazepines like clonazepam (Klonopin), beta-blockers such as propranolol (Inderal) or metoprolol, antihistamine cyproheptadine, , , clonidine, mianserin or ritanserin, opiods, and amitriptyline. Studies have also revealed, the vitamin B6 is also an effective way for treating akathisia, though it is still being researched.
Behavioral treatment is still the best form of non-invasive treatment for akathisia, but there is always a debate on its long term benefits, as it provides only modest results. This method uses ‘distraction’ as its tool and can be tried on patients who dont respond to anti-akathisia medicines.
Barnes Akathisia Scale is a rating scale used by physicians to assess akathisia on subjective and objective terms. It most widely used rating scale for akathisia also known as BAS or BARS. There are two other variant of chronic akathisia and akathisia – pseudoakathisia. Older patients with a long history of anti-psychotic treatment are prone to pseudoakathisia. They do not show any signs of restlessness but is associated with high incidence of the dyskinesia. Chronic akathisia develops not during the course of medicines nor with the increase in the dosage of the medicine but during withdrawal of drugs.
This is not a life threatening disorder, but stopping the medicine that is causing it can prove to be harmful. The effectiveness of the medication hugely depends on the severity of the disorder as the patient can become resistant to the drugs.