The present status of akathisia

Article Abstract:

Akathisia (also called acathisia) is characterized by the inability to sit down; even the thought of doing so can cause great anxiety. This review discusses current knowledge concerning akathisia, particularly drug-induced akathisia (DIA). The disorder is a common side effect of antipsychotic medication, prescribed for psychiatric patients to control hallucinations and delusions. It is also seen in medical and surgical patients. While a universal definition of akathisia does not yet exist, there are two components of the disorder: a subjective feeling of unease or discomfort resulting in an inability to stay still and a compulsion to move (although movement brings little relief), and the objective, observable, component of restless movements. The clinical features, causes and predisposing factors, diagnosis, and possible underlying physiologic features are described. The symptoms of akathisia usually start within a few days of beginning an antipsychotic medication regimen, depending on the drug prescribed. Several subtypes have been identified: (1) Drug-induced, which can be acute, chronic, or take the form of pseudoakathisia (apparent restlessness with no subjective symptoms); or (2) Non-drug-related, including restless legs syndrome or Ekbom's syndrome (stiffness and heaviness in the legs), akathisia secondary to brain disease, and the hysterical form (a neurotic symptom). Symptoms similar to akathisia are sometimes seen in association with generalized anxiety disorder or major depression. Akathisia may also appear during drug withdrawal. The causes of akathisia are not known. Some current theories are discussed. Treatment for drug-induced acute akathisia involves reducing the dose of or eliminating the offending drug. Treatment for chronic akathisia is more difficult and that condition is best prevented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Complications and side effects, Antipsychotic drugs, Antipsychotic agents, Tardive dyskinesia, Drug-induced dyskinesia

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Florid refractory schizophrenias that turn out to be treatable variants of HLA-associated narcolepsy

Article Abstract:

Narcoleptic patients often have hallucinations. They are typically treated with stimulant drugs. If they become psychotic, stimulant-induced psychosis is suspected. Recent research has linked the molecular genetics of narcolepsy to DR2 and DQ1 markers of the human leukocyte antigen (HLA) system. The HLA system is a complex of specific molecules on the body's cells that indicate to the immune system that the cell is not 'foreign'; certain antigens have been correlated with certain diseases. Between 95 and 100 percent of nonpsychotic narcoleptics have been found to have the HLA-DR2 and, or HLA-DQ1 markers. Since some narcoleptic patients become psychotic before treatment with stimulants, an association between narcolepsy and schizophrenia may exist. To evaluate this possibility, five Caucasian women diagnosed with schizophrenia and prone to auditory and visual hallucinations, poor response to neuroleptics (antipsychotic drugs), and excessive sleeping habits, were studied. They were given a structured interview which included a lengthy symptom checklist. Blood samples were collected and analyzed for HLA antigens. The patients were treated with trials of various stimulants (such as methylphenidate). Brief case reports of the five women are presented. All had extremely severe florid symptoms (e.g., self-mutilation and hallucinations), and responded well to the stimulants, which induced dramatic reductions in psychotic symptoms. All five were found to have HLA typing consistent with narcolepsy. Since schizophrenia tends to deteriorate rather than improve with stimulant use, these findings seem to indicate that schizophrenia may include separate classes of biological entities that result in similar observable diagnostic criteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

HLA histocompatibility antigens, HLA antigens, Schizophrenia, Narcolepsy

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