Akathisia

Clinic

• Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still.
• Usually, the legs are most prominently affected. Those affected may fidget, rock back and forth, or pace, while some may just have an uneasy feeling in their body. The most severe cases may result in aggression, violence, and/or suicidal thoughts. Akathisia is also associated with threatening behavior and physical aggression that is greatest in patients with mild akathisia, and diminishing with increasing severity of akathisia.

• Antipsychotic medication, particularly the first generation antipsychotics, are a leading cause.
• Other agents commonly responsible for this side-effect may also include selective serotonin reuptake inhibitors, metoclopramide, and reserpine, though any medication listing agitation as a side effect may trigger it. It may also occur upon stopping antipsychotics.
• The underlying mechanism is believed to involve dopamine.
• Diagnosis is based on the symptoms.
• It differs from restless leg syndrome in that akathisia is not associated with sleeping.
• However, despite a lack of historical association between restless leg syndrome and akathisia, this does not guarantee that the two conditions do not share symptoms in individual cases.

Signs / Symptoms

• Feeling nervous, uneasy, tense, twitchy, restless, and an inability to relax, insomnia, a sense of discomfort, motor restlessness, marked anxiety, and panic.
• Neuropathic pain similar to fibromyalgia and restless legs syndrome.
• When due to psychiatric drugs, the symptoms are side effects that usually disappear quickly and remarkably when the medication is reduced or stopped. However, tardive akathisia which has a late onset, may go on long after the medication is discontinued, for months and sometimes years.
• Visible signs of akathisia include repetitive movements such as crossing and uncrossing the legs, and constant shifting from one foot to the other.
• Other noted signs are rocking back and forth, fidgeting and pacing.
• However, not all observable restless motion is akathisia. For example, mania, agitated depression, and ADHD may look like akathisia, but the movements feel voluntary and not due to restlessness.