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Neuroleptic-induced akathisia: a review

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Abstract

Neuroleptic-induced akathisia (NIA) is a relatively common side effect of neuroleptics, in which patients complain of a subjective sense of restlessness usually referable to the legs and have characteristic motor movements. This paper will review: 1) history of spontaneously occurring syndromes of pathologic restlessness and NIA, 2) the clinical significance of NIA, 3) issues concerning the diagnosis and quantification of NIA, 4) treatments of NIA and 5) possible future directions for research in this area. Special attention will be paid to newer treatments for this syndrome, specifically beta-blockers.

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References

  • Adler L, Angrist B, Peselow E, Corwin J, Rotrosen J (1985) Efficacy of propranolol in neuroleptic-induced akathesia. J Clin Psychopharmacol 5:164–166

    Google Scholar 

  • Adler L, Angrist B, Peselow E, Corwin J, Maslansky R, Rotrosen J (1986) A controlled assessment of propranolol in the treatment of neuroleptic-induced akathisia. Br J Psychiatry 149:42–45

    Google Scholar 

  • Adler L, Angrist B, Peselow E, Reitano J, Rotrosen J (1987a) Clonidine in neuroleptic-induced akathisia. Am J Psychiatry 144:235–236

    Google Scholar 

  • Adler LA, Reiter S, Corwin J, Hemdal P, Angrist B, Rotrosen J (1987b) Differential effects of benztropine and propranolol in akathisia. Psychopharmacol Bull 23:519–521

    Google Scholar 

  • Adler LA, Reiter S, Angrist B, Rotrosen J (1987c) Pindolol and propranolol in neuroleptic-induced akathisia. Am J Psychiatry 144:1241–1242

    Google Scholar 

  • Ayd FJ (1960) Drug-induced extrapyramidal reactions: their clinical manifestations and treatment with akineton. Psychosomatics 1:143–150

    Google Scholar 

  • Ayd FJ (1961) A survery of drug-induced extrapyramidal reactions. JAMA 175:1054–1060

    Google Scholar 

  • Barnes TRE, Braude WM (1985) Akathisia variants and tardive dyskinesia. Arch Gen Psychiatry 42:874–878

    Google Scholar 

  • Barnes TRE, Braude WM (1986) Toward a more reliable diagnosis of akathisia (in reply). Arch Gen Psychiatry 43:1016

    Google Scholar 

  • Bartels M, Heide K, Mann K, Schied (1987) Treatment of akathisia with lorazepam: an open trial. Pharnacopsychiatry 20:51–53

    Google Scholar 

  • Beard GM (1880) A practical treatise on nervous exhaustion, 2nd edn. Wood, New York, pp 41–42

    Google Scholar 

  • Bing R (1919) A textbook of nervous diseases. (Allen CL trans) Rebman Company. New York, p 412

    Google Scholar 

  • Bing R (1923) Über einige bemerkenswerte Begleiterscheinungen der exrapyramidalen Rigidität (Akathesie — Mikrographie —Kinesia paradoxica). Schweiz Med Wochenschr 53:167–171

    Google Scholar 

  • Blom S, Ekbom KA (1961) Comparison between akathisia developing on treatment with phenothiazine derivative and the restless leg syndrome. Acta Med Scand 170:689–694

    Google Scholar 

  • Braude WM, Barnes TRE (1983) Late onset akathisia — an indicant of covert dyskinesia: two case reports. Am J Psychiatry 140:611–612

    Google Scholar 

  • Braude WM, Barnes TRE, Gore SM (1983) Clinical characteristics of akathisia. Br J Psychiatry 143:134–150

    Google Scholar 

  • Brown KW, Glen SE, White T (1987) Low serum iron status and akathisia. Lancet I:1234–1236

    Google Scholar 

  • Charney DS, Sternber DE, Kleber HD, Henninger GR, Redmond DE (1981) The clinical use of clonidine in abrupt withdrawal from methadone. Arch Gen Psychiatry 38:1273–1277

    Google Scholar 

  • Chouinard G, Annable L, Ross-Chouinard A, Nestoros JN (1979) Factors related to tardive dyskinesia. Am J Psychiatry 136:79–83

    Google Scholar 

  • Chouinard G, Ross-Chouinard A, Annable L, Jones BD (1980) Extrapyramidal rating scale. Can J Neurol Sci 7:233

    Google Scholar 

  • Crane GE (1972) Pseudoparkinsonism and tardive dyskinesia. Arch Neurol 27:426–430

    Google Scholar 

  • Cruickshank DM (1980) The clinical importance of cardioselectivity and lipophilicity in beta blockers. Am Heart J 100:160–178

    Google Scholar 

  • Delay J, Deniker P, Green A, Mordret M (1957) Le syndrome exitomoteur provoque pat les medicaments neuroleptiques. Press Med 65:1771–1774

    Google Scholar 

  • Derom E, Elinck W, Buylaert W, Van der Straeten M (1984) Which beta-blocker for the restless leg? Lancet I:857

    Google Scholar 

  • DiMascio A, Bernardo DL, Greenblatt D, Marder JE (1976) A controlled trial of amantadine in drug-induced extrapyramidal disorders. Arch Gen Psychiatry 33:559–602

    Google Scholar 

  • Donlon P (1973) The therapeutic use of diazepam for akathisia. Psychosomatics 14:222–225

    Google Scholar 

  • Drachman DA (1977) Central cholinergic system and memory. In: Lipton MA, DiMascio A, Killam KF (eds) Psychopharmacology: a generation of progress. Raven Press, New York, pp 28–233

    Google Scholar 

  • Drake RE, Ehrlich J (1985) Suicide attempts associated with akathisia. Am J Psychiatry 142:499–501

    Google Scholar 

  • Dupuis B, Catteau J, Dumon J-P, Libert C, Petit H (1987) Comparison of propranolol, sotalol, and betaxolol in the treatment of neuroleptic-induced akathisia. Am J Psychiatry 144:802–805

    Google Scholar 

  • Ekbom KA (1944) Astehnia Crurum Paraesthetica (“Irritable legs”). Acta Med Scand 118:197–209

    Google Scholar 

  • Ekbom KA (1960) Restless leg syndrome. Neurology 10:868–873

    Google Scholar 

  • Freyhan FA (1957) Psychomotility and parkinsonism in treatment with neuroleptic drugs. Arch Neurol Psychiatry 78:465–472

    Google Scholar 

  • Friis T, Christensen TR, Gerlach J (1982) Sodium valproate and biperiden in neuroleptic-induced akathisia, parkinsonism and hyperkinesia: a double-blind cross-over study with placebo. Acta Psychiatr Scand 67:178–187

    Google Scholar 

  • Frishman WM, Sonnenblick EH (1986) Beta-adrenergic blocking drugs. In: Hurst JW, Logue RB, Rackley CE, Sonnenblick EH, Wallace AG, Wenger NK (eds) The heart, 6th edn, McGrawhill, New York, pp 1606–1621

    Google Scholar 

  • Gagrat D, Hamilton J, Belmatier R (1978) Intravenous diazepam in the treatment of neuroleptic-induced dystonia or akathisia. Am J Psychiatry 135:1232–1233

    Google Scholar 

  • Gold MS, Redmond DE, Kleiber HD (1978) Clonidine blocks the acute opiate withdrawal syndrome. Lancet II:403–405

    Google Scholar 

  • Greendyke RM, Kanter DR (1987) Plasma propranolol levels and their effect on thioridazine and haloperidol concentrations. J Clin Psychopharmacology 7:178–182

    Google Scholar 

  • Guidicelli JF, Richer C, Ganansia J, Warrington S, Abriol C, Rulliere R (1983) Betaxolol: β-Adrenoceptor blocking effects and phamacolinetics in man. In: Morselli PL, Kilborn JR, Cavero I, Harrison DC, Langer SZ (eds) Betaxolol and other β-adrenoceptor antagonists. Raven Press, New York, pp 89–99

    Google Scholar 

  • Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55

    Google Scholar 

  • Haskovec L (1903) Nouvelles remarques sur l'akathisie. Nouv Iconograph Salpetrière 16:287–296

    Google Scholar 

  • Jeste DV, Wyatt RJ (1982) Understanding and treating tardive dyskinesia. The Guilford Press, New York London, p 64

    Google Scholar 

  • Kane JM, Woerner M, Weinhold P, Wegner J, Kinon B (1982) A prospecitive study of tardive dyskinesia development: preliminary results. J Clin Psychopharmacology 2:345–349

    Google Scholar 

  • Keckich WA (1978) Violence as a manifestation of akathisia. JAMA 240:2185

    Google Scholar 

  • Kendler (1976) A medical student's experience with akathisia. Am J Psychiatry 133:454–455

    Google Scholar 

  • Koch-Weser J (1979) Metroprolol. New Engl J Med 301:698–703

    Google Scholar 

  • Kruse W (1960) Treatment of drug-induced extrapyramidal symptoms. Dis Nerv Syst 21:79–81

    Google Scholar 

  • Kulik AV, Wilbur R (1983) Case report of propranolol (Inderal) pharmacotherapy for neuroleptic-induced akathisia and tremor. Prog Neuropsychopharmacol Biol Psychiatry 7:223–225

    Google Scholar 

  • Kutcher SP, Mackenzie S, Galarraga, Szalai J (1987) Clonazepam treatment of adolescents with neuroleptic-induced akathisia. Am J Psychiatry 144:823–824

    Google Scholar 

  • Langer SZ (1977) Presynaptic receptors and their role in the regulation of transmitter release. Br J Pharmacol 60:481–497

    Google Scholar 

  • Lipinski JF, Zubenko GS, Barriera P, Cohem BM (1983) Propranolol in the treatment of neuroleptic-induced akathisia. Lancet II:685–686

    Google Scholar 

  • Lipinski JF, Zubenko GS, Cohen BM, Barriera PJ (1984) Propranolol in the treatment of neuroleptic-induced akathisia. Am J Psychiatry 141:412–415

    Google Scholar 

  • Marsden CD, Jenner P (1980) The pathophysiology of extrapyramidal side-effects of neuroleptic drugs. Psychol Med 10:55–72

    Google Scholar 

  • Merrick EM, Schmitt PP (1973) A controlled study of the clinical effects of amantadine hydrochloride (Symmetrel). Curr Ther Res 15:552–558

    Google Scholar 

  • Munetz MR (1986) Akathisia variants and tardive dyskinesia. Arch Gen Psychiatry 43:1015

    Google Scholar 

  • Munetz MR, Cornes CL (1982) Distinguishing akathisia and tardive dyskinesia: A review of the literature. J Clin Psychopharmacol 3:343–350

    Google Scholar 

  • Neu C, DiMascio A, Demirgian E (1972) Antiparkinsonian medication in the treatment of extrapyramidal side-effects: single or multiple doses? Curr Ther Res 4:246–251

    Google Scholar 

  • Patterson JF (1986) Pseudoakathisia associated with atenolol. J Clin Psychopharmacol 6:390

    Google Scholar 

  • Ratey JJ, Sorgi P, Polakoff S (1985) Nadolol as a treatment for akathisia. Am J Psychiatry 142:640–642

    Google Scholar 

  • Reiter S, Adler L, Angrist B, Corwin J, Rotrosen J (1987a) Atenolol and propranolol in neuroleptic-induced akathisia. J Clin Psychopharmacol 7:279–280

    Google Scholar 

  • Reiter S, Adler L, Erle S, Duncan E (1987b) Neuroleptic-induced akathisia treated with pindolol. Am J Psychiatry 144:383–384

    Google Scholar 

  • Roehrich H, Gold MS (1987) Propranolol as adjunct to clonidine in opiate detoxification. Am J Psychiatry 144:1099–1100

    Google Scholar 

  • Shaw ED, Mann JJ, Widen P, Sinscheimer LM, Brunn RD (1986) A case of suicidal and homicidal ideation and akathisia in a double-blind neuroleptic crossover study. J Clin Psychopharmacol 6:196–197

    Google Scholar 

  • Shear K, Frances A, Weiden P (1983) Suicide associated with akathisia and depot fluphenazine treatment. J Clin Psychopharmacol 3:235–236

    Google Scholar 

  • Silver JM, Yudofsky SC, Kogan M, Katz BI (1986) Elevation of thioridazine plasma levels by propranolol. Am J Psychiatry 143:1290–1292

    Google Scholar 

  • Simpson GM (1977) Neurotoxicity of major tranquilizers. In: Roizin L, Shiroki H, Grcevic N (eds) Neurotoxicology. Raven Press. New York, p 3

    Google Scholar 

  • Simpson GM, Angus JWS (1970) A rating scale for extrapyramidal side-effects. Acta Psychiatry Scand [Suppl] 212:11–19

    Google Scholar 

  • Stahl SM (1985) Akathisia and tardive dyskinesia: changing concepts. Arch Gen Psychiatry 42:915–917

    Google Scholar 

  • Stenson RL, Donlon PT, Meyer JE (1976) Comparison of benztropine mesylate and amantdine HCl in neuroleptic-induced extrapyramidal symptoms. Compr Psychiatry 17:763–768

    Google Scholar 

  • Strang RR (1967) The symptom of restless legs. Med J Austr 24:1211–1213

    Google Scholar 

  • Trzepacz P, Violette EJ, Sateia MJ (1984) Opiates and restless legs. Am J Psychiatry 141:993–995

    Google Scholar 

  • Van Putten T (1974) Why do schizophrenic patients refuse to take their drugs. Arch Gen Psychiatry 31:67–72

    Google Scholar 

  • Van Putten T (1975) The many faces of akathisia. Compr Psychiatry 16:43–47

    Google Scholar 

  • Van Putten T, Marder SR (1987) Behavioral toxicity of antipsychotic drugs. J Clin Psychiatry [Suppl 9] 48:13–19

    Google Scholar 

  • Van Putten T, Mutalipassi LR, Malkin SR (1974) Phenothiazine induced decompensation. Arch Gen Psychiatry 30:102–105

    Google Scholar 

  • Van Putten T, May PRA, Marder SR (1984) Akathisia with haloperidol and thiothixene. Arch Gen Psychiatry 41:1036–1039

    Google Scholar 

  • Washton AM, Resnick RB (1981) Clonidine in opiate withdrawal: review and appraisal of clinical findings. Pharmacotherapy 1:140–146

    Google Scholar 

  • Weiden P (1985) Akathisia from prochlorperazine. JAMA 253:635

    Google Scholar 

  • Willis T (1985) The London practice of physic, 1st edn. Bassett and Crooke. London, p 404

    Google Scholar 

  • Wilson SA, Kinnier (1940) In: Bruce AN (ed) Neurology, vols 1 and 2. A William Wood book. Williams and Wilkins. Baltimore, p 118, (vol 1) and p 793 (vol 2)

    Google Scholar 

  • Wilcox JA, Tsuang J (1987) Amantadine and psychosis. Presented at the 42nd Annual Meeting of the Society of Biological Psychiatry, Chicago, Illinois, May 6–10

  • Zubenko GS, Cohen BM, Lipinski JF, Jonas JM (1984a) Use of clonidine in the treatment of akathisia. Psychiatr Res 13:253–259

    Google Scholar 

  • Zubenko GS, Garreira P, Lipinski JF (1984b) Development of tolerance to the therapeutic effect of amantadine on akathisia. J Clin Psychopharmacol 4:218–219

    Google Scholar 

  • Zubenko GS, Lipinski JF, Cohen BM, Barriera PJ (1984c) Comparison of metoprolol and propranolol in the treatment of akathisia. Psychiatr Res 11:143–148

    Google Scholar 

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Adler, L.A., Angrist, B., Reiter, S. et al. Neuroleptic-induced akathisia: a review. Psychopharmacology 97, 1–11 (1989). https://doi.org/10.1007/BF00443404

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