Akathisia
| Akathisia | |
|---|---|
| Synonyms | acathisia |
| Common symptom-expression of akathisia | |
| Classification and external resources | |
| Specialty | Neurology, Psychiatry |
| ICD-10 | G21.1 |
| ICD-9-CM | 781.0, 333.99 |
| DiseasesDB | 32479 |
| eMedicine | neuro/362 emerg/338 |
| MeSH | D011595 |
Akathisia is a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting. People with akathisia are unable to sit or keep still, complain of restlessness, fidget, rock from foot to foot, and pace.
The term was coined by the Czech neuropsychiatrist Ladislav Haškovec (1866–1944), who described the phenomenon in 1901.
Antipsychotics (also known as neuroleptics), particularly the first generation antipsychotics, may cause akathisia. Other known causes include side effects of certain medications, and nearly any physical dependence-inducing drug during drug withdrawal. It is also associated with Parkinson's disease and related syndromes. The term is from Greek καθίζειν kathízein – "to sit", a- indicating negation or absence, lit. "inability to sit".
Akathisia may range in intensity from a sense of disquiet or anxiety, to excruciating discomfort, particularly in the knees. Patients typically pace for hours because the pressure on the knees reduces the discomfort somewhat; once their knees and legs become fatigued and they are unable to continue pacing, they sit or lie down, although this does not relieve the akathisia. At high doses or with potent drugs such as haloperidol (Haldol) or chlorpromazine (Thorazine/Largactil), the feeling can last all day from awakening to sleep. When misdiagnosis occurs in antipsychotic neuroleptic-induced akathisia, more antipsychotic neuroleptics may be prescribed, potentially worsening the symptoms. High-functioning patients have described the feeling as a sense of inner tension and torment or chemical torture. A term many sufferers use is the feeling like they want to "peel off their own skin." It feels like an agitated depression. This is problematic for many patients and doctors because many don't realize this is a drug-induced state; they simply write off the symptoms as a worsening of their mental illness or condition. The treatment for many doctors, then, is to raise the dose of the akathisia-causing medication. When the patient's condition gets even worse, they prescribe anti-anxiety medication, which are usually ineffective in mitigating the anxiety caused by akathisia, since the anxiety produced by the condition is generated in a different part of the brain than regular anxiety. Many patients show very little outer movement, and the akathisia affects the sufferer inside, causing feelings of despair, agitation, intense panic and worry, an augur of disaster that feels completely real, and in some cases, the person actually has a physical sensation of pain in the solar plexus area of the body that they claim feels hot to the touch, a burning ache that is unbearable. Neuro-psychologist Dr. Dennis Staker had drug-induced akathisia for two days. His description of his experience was this: "It was the worst feeling I have ever had in my entire life. I wouldn't wish it on my worst enemy." Many patients describe symptoms of neuropathic pain akin to fibromyalgia and restless legs syndrome. In Han et al. (2013), the authors describe restless legs syndrome's relation to akathisia, "Some researchers regard RLS as a 'focal akathisia' [in the legs]." Although these side effects disappear quickly and remarkably when the medication is stopped, tardive, or late-persisting akathisia may go on long after the offending drug is discontinued, sometimes for a period of years. 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.
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