Akathisia (or "acathisia") is an often extremely unpleasant subjective sensation of "inner" restlessness that manifests itself with an inability to sit still or remain motionless, hence the origin of its name: Greek a (without) + kathesis (sitting). Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines, thioxanthenes and haloperidol (Haldol), and rarely, antidepressants. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // G00-G99 - Diseases of the nervous system (G00-G09) Inflammatory diseases of the central nervous system (G00) Bacterial meningitis, not elsewhere classified (G01) Meningitis in bacterial diseases classified elsewhere (G02) Meningitis in other infectious and parasitic diseases classified elsewhere (G03) Meningitis due to other and unspecified causes (G04) Encephalitis, myelitis... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Phenothiazines are the largest of the 5 main classes of antipsychotic drugs. ... Xanthene Flupenthixol Thioxanthene is a molecule in which the oxygen in a xanthene molecule is replaced with a sulfur. ... Haloperidol (sold under the tradenames Aloperidin, Bioperidolo, Brotopon, Dozic, Duraperidol (Germany), Einalon S, Eukystol, Haldol, Halosten, Keselan, Linton, Peluces, Serenace, Serenase, Sigaperidol) is a conventional, or typical, butyrophenone antipsychotic drug. ... An antidepressant is a medication used primarily in the treatment of clinical depression. ...

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 indescribable 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. There have been cases of patients who have attempted to jump out of moving vehicles because they were unable to remain motionless in the seat. This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ... Look up dysphoria in Wiktionary, the free dictionary. ...

It is not unknown to have patients (who have been treated most often with neuroleptic antipsychotics for psychotic episodes or prochlorperazine for nausea) to bolt out of hospitals or emergency rooms due to this odd and disconcerting emotion and feelings.

Partly because the condition is difficult for the patient to describe, it is often misdiagnosed. When misdiagnosis occurs in antipsychotic neuroleptic-induced akathisia, more antipsychotic neuroleptics may be prescribed, potentially worsening the symptoms. High functioning patients have decribed the feeling as a sense of inner tension and torment or chemical torture from the inside out.

Akathisia makes many patients act out in violent fits of rage throwing and breaking things or harming others. Ironically antipsychotic drugs are many times prescribed as “mood stabilizers” but then have the opposite intended effect, which often leads to increased doses further escalating the symptoms when the intent was to ameliorate the symptoms.

The presence and severity of akathisia can be measured using the Barnes Akathisia Scale.^[1][2] The complete reference to this article is: T. R. E. Barnes, A Rating Scale for Drug-Induced Akathisia, British Journal of Psychiatry, vol 154, pp. ...

Description

Healy, et. al. (2006), described the following regarding akathisia: tension, insomnia, a sense of discomfort, motor restlessness, and marked anxiety and panic. Increased labile affect can result, such as weepiness. Interestingly, in some people the opposite response to SSRIs occurs, in the form of emotional blunting; but sufficient clinical research has not yet been made in this area.^[3] Labile affect or Pseudobulbar affect refers to the pathological expression of laughter, crying, or smiling. ...

Jack Henry Abbot (1981) described the effects of akathisia produced by neuroleptic drugs: The Young and the Restless, see Jack Abbott (Y&R). ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ...

These drugs, in this family, do not calm or sedate the nerves. They attack. They attack from so deep inside you, you cannot locate the source of the pain ... The muscles of your jawbone go berserk, so that you bite the inside of your mouth and your jaw locks and the pain throbs. For hours every day this will occur. Your spinal column stiffens so that you can hardly move your head or your neck and sometimes your back bends like a bow and you cannot stand up. The pain grinds into your fiber ... You ache with restlessness, so you feel you have to walk, to pace. And then as soon as you start pacing, the opposite occurs to you; you must sit and rest. Back and forth, up and down you go in pain you cannot locate, in such wretched anxiety you are overwhelmed, because you cannot get relief even in breathing. Torture is defined by the United Nations Convention Against Torture as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he... Torture is defined by the United Nations Convention Against Torture as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he... Torture is defined by the United Nations Convention Against Torture as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he...

—Jack Henry Abbot, In the Belly of the Beast (1981/1991). Vintage Books, 35-36. Quoted in Robert Whitaker, Mad in America (2002, ISBN 0738207993), 187.

In the Belly of the Beast is a book written by Jack Abbott and published in 1981. ...

Causes

Akathisia is most often the side effect of certain drugs - commonly seen in the antipsychotics, and less so in the others listed below: The term antipsychotic is applied to a group of drugs used to treat psychosis. ...

• Typical or atypical antipsychotics, such as haloperidol (Haldol), droperidol, olanzapine (Zyprexa), aripiprazole (Abilify); Pimozide is especially infamous for causing akathisia.
• SSRIs, such as paroxetine (Paxil).^[3]
• Other antidepressants, such as the tricyclics and trazodone
• Certain antihistamines, such as promethazine and diphenhydramine (Benadryl).
• Certain anti-emetic drugs, particularly the dopamine blockers, such as metoclopramide (Reglan) and prochlorperazine (Compazine).
• Certain drugs of abuse, such as GHB, methamphetamine and MDMA when administered in excessive doses.

The 2006 U.K. study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as "agitation, emotional lability, and hyperkinesis (overactivity)".^[3] The study further points out that misuse of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia. Healy, et. al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can "exacerbate psychopathology." The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebos showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%). The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Droperidol (Dropletan®) is an antidopaminergic drug used as an antiemetic and antipsychotic. ... Olanzapine (oh-LAN-za-peen, sold as Zyprexa®, Zyprexa Zydis®, or in combination with fluoxetine, as Symbyax®) was the third atypical antipsychotic to gain approval by the Food and Drug Administration (FDA) and has become one of the most commonly used atypical antipsychotics. ... Aripiprazole (produced by Otsuka Pharmaceutical Co,. Ltd. ... Pimozide (sold as Orap®) is an antipsychotic drug. ... Serotonin Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders. ... Paroxetine or paroxetine hydrochloride is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ... Chemical structure of the tricyclic antidepressant amitriptyline. ... Trazodone (trade names Desyrel, Molipaxin, Trittico, Thombran, Trialodine) is a psychoactive compound with sedative, anxiolytic, and antidepressant properties. ... An antihistamine is a drug which serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions, through action at the histamine receptor. ... Promethazine is a first-generation H1 receptor antagonist antihistamine and antiemetic medication. ... Diphenhydramine hydrochloride (trade name Benadryl, as produced by Pfizer, or Dimedrol outside the U.S.) is an over-the-counter (OTC) antihistamine and sedative. ... An antiemetic is a drug that is effective against vomiting and nausea. ... Dopamine is a phenethylamine naturally produced by the human body. ... Metoclopramide (INN) (IPA: ) is a potent dopamine receptor antagonist used for its antiemetic and prokinetic properties. ... Prochlorperazine is a highly potent neuroleptic, which is 10 to 20-times more potent than chlorpromazine. ... Gamma-hydroxybutyrate (4-hydroxybutanoic acid, C4H8O3) is both a drug and a naturally occurring compound found in the mammalian brain, where it might function as a neurotransmitter. ... This article is about the psychostimulant, d-methamphetamine. ... ecstasy and religious ecstasy MDMA, most commonly known today by the street name ecstasy, is a synthetic entactogen of the phenethylamine family whose primary effect is to stimulate the brain to rapidly secrete large amounts of serotonin, causing a general sense of openness, empathy, energy, euphoria, and well-being. ... Dyskinesia refers to an impairment of voluntary movement. ... Psychopathology is a term which refers to either the study of mental illness or mental distress, or the manifestation of behaviors and experiences which may be indicative of mental illness or psychological impairment. ... SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... “Placebo effect” redirects here. ...

Treatment

Treatment includes the discontinuation or reduction of dose of the causative agent and the use of typical or atypical antipsychotics (also called major tranquilizers) to reduce the agitation and anxiety. Unfortunately, these neuroleptic antipsychotics are often the cause of the condition and may cause irreversible akathisia in some cases.^{[citation needed]} While the administration of these drugs may temporarily ameliorate the symptoms, there is a serious risk of worsening the condition over the longterm. The term antipsychotic is applied to a group of drugs used to treat psychosis. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ...

Therefore, some consider the drug of choice for the treatment of akathisia to be propranolol, along with other beta blockers such as metoprolol. The antihistamine cyproheptadine is also effective, though with shorter effect than beta blockers. Second-line treatments include benztropine and diphenhydramine (marketed as Benadryl), though excess use of diphenhydramine may worsen symptoms. Most of the clinical cases of akathisia can be prevented by not administering the drugs that cause the condition. Propranolol (INN) (IPA: ) is a non-selective beta blocker mainly used in the treatment of hypertension. ... Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ... “Minax” redirects here. ... Periactin® (cyproheptadine hydrochloride) is an antihistaminic and antiserotonergic agent. ... Benztropine (Cogentin®) is an anticholinergic drug principally used for the treatment of: Drug-induced parkinsonism, akathisia and acute dystonia; Parkinson disease; and Idiopathic or secondary dystonia. ... Diphenhydramine hydrochloride (trade name Benadryl, as produced by Pfizer, or Dimedrol outside the U.S.) is an over-the-counter (OTC) antihistamine and sedative. ...

Recent studies have shown that vitamin B₆ is effective for the treatment of neuroleptic induced akathisia. Many also claim marijuana can ease symptoms of akathisia. ^[4] Pyridoxine Vitamin B6 is a water-soluble vitamin. ... A Cannabis sativa plant The drug cannabis, also called marijuana, is produced from parts of the cannabis plant, primarily the cured flowers and gathered trichomes of the female plant. ...

References

See also

• Agitation (emotion)
• Anxiety
• Psychomotor agitation

This page is a candidate to be moved to Wiktionary. ... This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ... Psychomotor agitation is a series of unintentional and purposeless motions that stem from mental tension of an individual. ...

External links

• DSM-IV: Neuroleptic Induced Acute Akathisia at behavenet.com
• Information on treating this condition and copies of original research papers at akathisiasupport.org
• Nasrallah H, Brecher M, Paulsson B (2006). "Placebo-level incidence of extrapyramidal symptoms (EPS) with quetiapine in controlled studies of patients with bipolar mania". Bipolar Disord 8 (5 Pt 1): 467-74. PMID 17042884.