Akathisia [Antipsychotic induced movement disorder]

Akathisia [Antipsychotic induced movement disorder]
Akathisia is a neuropsychiatric syndrome that can occur as an adverse effect of antipsychotic medications and manifests as psychomotor restlessness. In recent years, akathisia has additionally been found to occur in certain individuals as an adverse effect of with calcium channel blockers, antiemetics, anti-vertigo drugs, cocaine, and sedatives used in anesthesia. Akathisia is defined as an inability to remain still. It is a neuropsychiatric syndrome that is associated with psychomotor restlessness. The individual with akathisia will generally experience an intense sensation of unease or an inner restlessness that usually involves the lower extremities. This results in a compulsion to move. In most cases the movement is repetitive. The individual may cross, uncross, swing, or shift from one foot to the other. To the observer, this may appear as a persistent fidget.
Akathisia is frequently associated with the use of antipsychotics (neuroleptics), but it can also complicate the use of selective serotonin reuptake inhibitors (SSRIs). Other causes of akathisia include anxiety disorders, drug withdrawal or discontinuation states, early serotonin syndrome, restless legs syndrome, iron deficiency anemia and endocrinopathies. It is therefore important to find the underlying cause by identifying drug precipitants and associated psychopathology and excluding general medical causes. The pathophysiology of akathisia is not fully understood, but a combination of hypodopaminergic and hyperserotonergic neurotransmission may be implicated. This hypothesis is supported by the emergence of akathisia following the initiation of antipsychotics or SSRIs, but also from the observation that dopamine agonists can alleviate psychomotor agitation associated with restless legs syndrome
Akathisia can have a significant negative impact on quality of life and is associated with increased suicidality. Treatment of this distressing condition is difficult and treatment options are limited.
Antipsychotic-induced akathisia may be managed by reducing the dose of the offending agent or switching to an alternative antipsychotic agent. Beta-blockers such as propranolol and benzodiazepines have historically been used for the treatment of akathisia although the amount of high-quality data supporting their use is limited. Anticholinergic agents such as benztropine may be utilized if concomitant pseudoparkinsonism is present. Mirtazapine may also be utilized for the management of akathisia. Low-dose mirtazapine has been found to be as effective as beta-blockers and may be considered first-line therapy.
When using beta-blockers, clinicians should be aware of the risk of bradycardia and hypotension. Many other agents, including vitamin B6, have been used to treat akathisia, but there are no randomized controlled trials to determine their efficacy
Antipsychotic-induced akathisia may be managed by reducing the dose of the offending agent or switching to an alternative antipsychotic agent.
Beta-blockers such as propranolol and benzodiazepines have historically been used for the treatment of akathisia although the amount of high-quality data supporting their use is limited.
Anticholinergic agents such as benztropine may be utilized if concomitant pseudoparkinsonism is present.
Unfortunately, once akathisia has developed it can take months for the disorder to subside. Case reports exist indicating that this movement disorder also increases the risk of suicidality. Hence, all patients with akathisia need to be closely monitored and the family should be educated about the impact of akathisia

[@AkathisiaWarrior]

Ugh, there is so much more though that you all don’t seem to know. Thanks for trying I guess. Maybe talk to people who actually have it. And not just the people who get it on a med.

[@larrylanberg3552]

My experience with Akathesia: It felt, physically, like an electric motor was implanted at the base of my spine, where the tail bone meets. Because the motor kept running I could not sit still at all. *Torture*. I wanted so badly to relax and sleep but I could not.
I tried alcohol - didn't work. I tried a strong Benzo - it too wouldn't stop the damn motor from running. This lasted for 48 hours plus, then started wearing off. It was awful and can't forget it, even though it was decades ago.
It was precipitated by me taking 2 Navane tablets, recreationally. Because I was young and stupid. I never, ever want to go through Akathesia hell again.

[@manzoorali9045]

Sir it's highly informative
But according my clinical experience Aripiprazole is increasing risk of akathasia

[@SureshBadaMath]

Important observation

[@karanshah3618]

Respected Sir thank you for making such amazing educational and informative videos. A request to make video on NDPS Act, its amendments and practical tips for practicing Psychiatrist. A sample of documentation for record keeping will be much helpful. Specially benzodiazepines as it is used very commonly in the opd.

[@SureshBadaMath]

I will try to do it. NDPS Act is very vast
I will try to do what is relevant to healthcare professionals

[@karanshah3618]

@@SureshBadaMath Thank you sir. How to maintain records of benzodiazepines that are included in NDPS in case of self dispensing and when prescription given for outside pharmacy.

[@dr.franciscanishatotalheal]

Thank you sir.

[@SureshBadaMath]

Welcome

[@user-iw4zn2lr5q]

​@@SureshBadaMath😊😊😊😊

[@endfinity3521]

I have Refractory OCD means you can guess how severe it is and not responding to first line treatments. So I had tried risperidone & aripiprazole along with SSRI but it caused me Akathisia (physical pain and severe restless leg syndrome due to taking antipsychotics

[@drsanthoshgoud]

18:24 Sir Clozapine and olanzapine are ok..But Aripiprazole is the most common culprit for Akathisia , till Cariprazine came ( in my limited experience). Today I start Aripiprazole 5mg , the patient comes next day with severe restlessness . Apart from Akathisia nausea is also a common side effect for most patients report in my practice sir. Thank you

[@hananb7763]

Thank you for this video. I now have a disagreement with the docters of my husband. I think it's Acathisia, and they think it's catatonia. My husband cannot sit. Very restless legs when sitting. Wants to walk. Even when stil, he keeps moving his legs as if he is walking. When lying down the restlessness in his legs diminishes.
Het is on depakine 2 x 500 mg for epilepsie and Lorazepam 3 mg for sleeping. And if needed several times 's day 1 mg. The Ema found Acathisia to be a side effect of lorazepam. He has not the signs for catatonia. What is your opinion?

[@SureshBadaMath]

Without examining the patient, opinion given online may not be correct.
I am sorry.
Please take a parallel in person consultation opinion from another doctor

[@mahalaxmim107]

Good morning sir can you make a video for NEUROLOGICAL ASSESSMENT sir

[@SureshBadaMath]

Thank you very much for the suggestion
I will start working on it

[@drsanthoshgoud]

Sir congrats and thank u very much for chosing nice topics. Mirtazapine definitely is very good option. But I have come across 2 or 3 cases where Akathsia is worsened after adding Mirtazapine. A combination of Propranol and Diazepam helped for these patients.

[@SureshBadaMath]

Excellent observations

[@AkathisiaWarrior]

Benzos cause Akathisia. Are they planning on staying on those meds for life?

[@kevk741]

Mirtazapine and Benzodiazepines both cause akathisia. I’ve seen lives ruined adding Mirtazapine. I received chronic akathisia from stopping Klonopin. I pace 24hrs-40hrs at a clip and sleep for 4-6hrs at 40mths off meds. It’s not just antipsychotics. There is many ways to simulate a dopamine blockade.

[@jyotichaudhary769]

Sir please make a video on benzodiazepine 🙏

[@SureshBadaMath]

Thank you very much for the suggestion

[@bidyutmukherjee789]

🎉🟩Prof.Sures Bada Math is always best. Please stay safe and healthy and happy with your family and all yours too. 🟩🎉

[@SureshBadaMath]

Thank you very much for your kind wishes and prayers