Posted by River1924 on January 25, 2003, at 21:31:53
In reply to Re: Abilify and akathisia, posted by River1924 on January 25, 2003, at 21:18:18
http://www.ascp.com/public/pubs/cc/1998/supp4a.shtml
Akathisia
Akathisia may appear within the first few hours of antipsychotic initiation, but usually takes two to three days (and sometimes weeks) to appear and can resolve spontaneously. Akathisia is defined as a feeling of motor restlessness and strong urge to move around. Patients present with agitation, in-creased aggression, jitteriness, in-ability to sit still, tapping of feet, rocking, and sometimes insomnia. Signs and symptoms may resemble dyskinesias (impairment of voluntary movement resulting in incomplete movements), Hunt- ington’s chorea (a hereditary disease characterized by ceaseless occurrence of a variety of rapid, highly complex jerky movements that appear well coordinated but are involuntary and accompanied by mental deterioration), or worsening of psychotic conditions, making diagnosis difficult. Often this may result in an inappropriate increase in the antipsychotic dose, worsening the adverse effect. Illicit drug use, caffeine, and other stimulants may exacerbate akathisia. Iron deficiency may also be associated with akathisia.
Treatment for Akathisia
Although akathisia may resolve spontaneously, it may impede treatment progress and lead to noncompliance, suicidal or assaultive ide-ation, and worsening of psychotic symptoms. If appropriate for the patient, lowering the dose of the causative agent will usually be effective. Other treatment options include anticholinergic agents, benzodiazepines, amantadine, and propranolol. Switching to a low potency or atypical antipsychotic agent is an important option in refractory cases. Anticholinergics, amantadine, and diphenhydramine appear to be less effective in the treatment of akathisia than for other extrapyramidal side effects.
Lipophilic beta-blockers (propranolol, metoprolol, etc.) are more effective in treating akathisia than are benzodiazepines. Since beta-blockers work on the adrenergic system and the effect of the benzodiazepines is mediated through the inhibitory neurotransmitter gamma-aminobutyric acid, their efficacy supports the theory that neurotransmitter systems other than dopamine or acetylcholine are involved in akathisia.
poster:River1924
thread:129761
URL: http://www.dr-bob.org/babble/20030125/msgs/137556.html