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Akathisa : a quick thread
“ I could not help it: the restlessness was in my nature; it agitated me to pain sometimes. “
Charlotte Brontë, Jane Eyre
Greek: kathizien means “to sit”
Akathisia literally mean
“unable to sit down”
“ I could not help it: the restlessness was in my nature; it agitated me to pain sometimes. “
Charlotte Brontë, Jane Eyre
Greek: kathizien means “to sit”
Akathisia literally mean
“unable to sit down”
As a rarity I can write a thread having actually experienced the symptom
How would I describe it?
Inner restlessness
Anxiety and dread
A NEED to move my legs
Insomnia
Exhausting
Time slows down
The worst three days if physical distress I have experienced
How would I describe it?
Inner restlessness
Anxiety and dread
A NEED to move my legs
Insomnia
Exhausting
Time slows down
The worst three days if physical distress I have experienced
What is akathisia?
A movement disorder characterized by
- waves of restlessness
- worse at rest and often when trying to sleep
- relieved by motor movement often walking or moving legs
- feelings of anxiety, unease and agitation
- “butterflies”
- muscle discomfort/pain
A movement disorder characterized by
- waves of restlessness
- worse at rest and often when trying to sleep
- relieved by motor movement often walking or moving legs
- feelings of anxiety, unease and agitation
- “butterflies”
- muscle discomfort/pain
Acute akathisia
Usually medication related
Drugs that cause dopamine blockade
-Antipsychotics: haloperidol, chlorpromazine, risperidone
-Anti-emetics: metoclopramide, levomepromazine, prochlorperazine
-Anti-depressants: SSRIs, TCAs often as part of serotonin syndrome
Usually medication related
Drugs that cause dopamine blockade
-Antipsychotics: haloperidol, chlorpromazine, risperidone
-Anti-emetics: metoclopramide, levomepromazine, prochlorperazine
-Anti-depressants: SSRIs, TCAs often as part of serotonin syndrome
Drug withdrawal
Drugs that boost dopamine and monoamine levels that are withdrawn too quickly
- Opioids
- Gabapentin/pregabalin
- Benzodiazepines
- Cocaine
- Anti-depressants
- Alcohol
Each withdrawal state has it own associated features and akathisa may be overlooked
Drugs that boost dopamine and monoamine levels that are withdrawn too quickly
- Opioids
- Gabapentin/pregabalin
- Benzodiazepines
- Cocaine
- Anti-depressants
- Alcohol
Each withdrawal state has it own associated features and akathisa may be overlooked
Remember physical drug tolerance and dependence are NOT drug addiction
A person who taking medication for a therapeutic reason who develops withdrawal on cessation is NOT addicted but has a degree of physical dependence.
We have a duty to reduce the stigma of addiction
A person who taking medication for a therapeutic reason who develops withdrawal on cessation is NOT addicted but has a degree of physical dependence.
We have a duty to reduce the stigma of addiction
Chronic akathisia
Acute akathisia resulting from the above drugs can persist for weeks/months after the offending agent or withdrawal state has ended.
Restless legs syndrome, Iron deficiency, Renal failure, Parkinson’s disease and fibromyalgia can all cause akathisia
Acute akathisia resulting from the above drugs can persist for weeks/months after the offending agent or withdrawal state has ended.
Restless legs syndrome, Iron deficiency, Renal failure, Parkinson’s disease and fibromyalgia can all cause akathisia
Impact on life cannot be understated
Insomnia
Weight loss
Anger and aggression
Depression
Self-harm
Substance abuse
Suicide
Misdiagnosis as psychosis or ADHD
The person may be able hide their symptoms for a while but this causes internal distress
Insomnia
Weight loss
Anger and aggression
Depression
Self-harm
Substance abuse
Suicide
Misdiagnosis as psychosis or ADHD
The person may be able hide their symptoms for a while but this causes internal distress
Diagnosis
Really important!
Too often the symptoms are mistaken for mental illness/agitation and the offending drug is increased or a second agent added
The Barnes akathisia rating scale is a useful reference to identify and monitor symptoms
https://simpleandpractical.com/wp-content/uploads/2014/09/Barnes-Akathisia-Rating-Scale-BARS.pdf
Really important!
Too often the symptoms are mistaken for mental illness/agitation and the offending drug is increased or a second agent added
The Barnes akathisia rating scale is a useful reference to identify and monitor symptoms
https://simpleandpractical.com/wp-content/uploads/2014/09/Barnes-Akathisia-Rating-Scale-BARS.pdf
Management
Remove the precipitant if possible
CAUTION
Speak to the specialist who started the medication. Do not discontinue anti-psychotics or other psychoactive agents without a confirmed plan for follow up with psychiatry or appropriate team.
Remove the precipitant if possible
CAUTION
Speak to the specialist who started the medication. Do not discontinue anti-psychotics or other psychoactive agents without a confirmed plan for follow up with psychiatry or appropriate team.
