Abstract
Acute Akathisia is a movement disorder rather annoying; characterized by subjective feelings and objective signs of restlessness, which often presents as a side effect of neuroleptics, early treatment is necessary to ensure good adherence to treatment with antipsychotics and prevent relapses.
To describe the state of the art of available treatments for neuroleptic-induced acute akathisia, taking into account effectiveness and tolerability.
An electronic search in Pubmed, Science Alert, Springer link, SciELO, Ovid and Elsevier with specific eligibility criteria, obtaining 87 studies, of which were chosen 51 of them manually, according to their clinical relevance, topicality and level of evidence.
In this paper, we describe the results of the search.
The benzodiazepines, centrally acting lipophilic beta-blockers and anticholinergics, are the most studied drugs to treat this movement disorder, the first two have shown superiority; however, considerable research is still needed in this regard.
References
ADVOKAT C. A brief overview of iatrogenic akathisia. Clin Schizophr Relat Psychoses 2010;3(4):226-36.
MANTILLA C, SÁNCHEZ R. Incidencia y factores de riesgo para movimientos anormales inducidos por antipsicóticos. Acta Neurol Colomb. 2000;16(2):98-104.
CAROFF SN, HURFORDI, LYBRAND J, CAMPBELL EC. Movement disorders induced by antipsychotic drugs: implications of the Catie schizophrenia trial. Neurologic clinics 2011;29(1):127-48.
MILLER CH, HUMMER M, OBERBAUER H, KURZTHALER I, DE COL C, FLEISCHHACKER WW. Risk factors for the development of neuroleptic induced akathisia. Eur Neuropsychopharmacol 1997;7(1):51-5.
SACHDEV P. The epidemiology of drug-induced akathisia: Part I. Acute akathisia. Schizophr Bull 1995;21(3):431-49.
AMERICAN PSYCHIATRIC ASSOCIATION. Diagnostic and statistical manual of mental disorders. 5th ed. DSM - 5. Arlington, VA; 2013. p. 709-14.
ASOCIACIÓN AMERICANA DE PSIQUIATRÍA. DSM-IV-TR: Manual diagnóstico y estadístico de trastornos mentales. 4.a ed. , texto revisado. Barcelona: Masson; 2002.
SACHDEV P. The identification and management of drug induced akathisia. CNS Drugs 1989;4:28-46.
BLAISDELL GD. Akathisia: a comprehensive review and treatment summary. Pharmacopsychiatry 1994;27(4):139-46.
KUMAR R, SACHDEV PS. Akathisia and second-generation antipsychotic drugs. Curr Opin Psychiatry 2009;22(3):293-9.
IQBAL N, LAMBERT T, MASAND P. Akathisia: problem of history or concern of today. CNS Spectr. 2007;12(9 Suppl 14):1-13.
MILLER CH, FLEISCHHACKER WW. Managing antipsychotic-induced acute and chronic akathisia. Drug Saf. 2000;22(1):73-81.
LIMA AR, SOARES-WEISER K, BACALTCHUK J, BARNES TR. Benzodiazepines for neuroleptic-induced acute akathisia. Cochrane Database Syst Rev. 2002(1):CD001950.
GUEVARA C, ESCOBAR F, FONTECHA J. Restricción en pacientes agitados atendidos en unidades de cuidado médico primario. Rev. Fac. Med. 2004;52(3):199-211.
PARLAK I, ERDUR B, PARLAK M, ERGIN A, AYRIK C, TOMRUK O, ET AL. Midazolam vs. diphenhydramine for the treatment of metoclopramide-induced akathisia: a randomized controlled trial. Acad Emerg Med. 2007;14(8):715-21.
PUJALTE D, BOTTAI T, HUE B, ALRIC R, POUGET R, BLAYAC JP, ET AL. A double-blind comparison of clonazepam and placebo in the treatment of neuroleptic-induced akathisia. Clin Neuropharmacol. 1994;17(3):236-42.
BARTELS M, HEIDE K, MANN K, SCHIED HW. Treatment of akathisia with lorazepam. An open clinical trial. Pharmacopsychiatry 1987;20(2):51-3.
KUTCHER S, WILLIAMSON P, MACKENZIE S, MARTON P, EHRLICH M. Successful clonazepam treatment of neuroleptic-induced akathisia in older adolescents and young adults: a double-blind, placebo-controlled study. J Clin Psychopharmacol. 1989;9(6):403-6.
LIMA AR, BACALCTHUK J, BARNES TR, SOARES-WEISER K. Central action beta-blockers versus placebo for neuroleptic-induced acute akathisia. Cochrane Database Syst Rev. 2004(4):CD001946.
DUMON JP, CATTEAU J, LANVIN F, DUPUIS BA. Randomized, double-blind, crossover, placebo-controlled comparison of propranolol and betaxolol in the treatment of neuroleptic-induced akathisia. Am J Psychiatry 1992;149(5):647-50.
DOREVITCH A, DURST R, GINATH Y. Propranolol in the treatment of akathisia caused by antipsychotic drugs. South Med J. 1991;84(12):1505-6.
WELLS BG, COLD JA, MARKEN PA, BROWN CS, CHU CC, JOHNSON RP, ET AL. A placebo-controlled trial of nadolol in the treatment of neuroleptic-induced akathisia. J Clin Psychiatry 1991;52(6):255-60.
KRAMER MS, GORKIN RA, DIJOHNSON C, SHEVES P. Propranolol in the treatment of neuroleptic-induced akathisia (NIA) in schizophrenics: a double-blind, placebo-controlled study. Biol Psychiatry 1988;24(7):823-7.
ZUBENKO GS, LIPINSKI JF, COHEN BM, BARREIRA PJ. Comparison of metoprolol and propranolol in the treatment of akathisia. Psychiatry Res. 1984;11(2):143-9.
IRWIN M, SULLIVAN G, VAN PUTTEN T. Propranolol as a primary treatment of neuroleptic-induced akathisia. Hillside J Clin Psychiatry 1988;10(2):244-50.
DUPUIS B, CATTEAU J, DUMON JP, LIBERT C, PETIT H. Comparison of propranolol, sotalol, and betaxolol in the treatment of neuroleptic-induced akathisia. Am J Psychiatry 1987;144(6):802-5.
ADLER L, ANGRIST B, PESELOW E, CORWIN J, MASLANSKY R, ROTROSEN J. A controlled assessment of propranolol in the treatment of neuroleptic-induced akathisia. Br J Psychiatry 1986;149:42-5.
LIMA AR, WEISER KV, BACALTCHUK J, BARNES TR. Anticholinergics for neuroleptic-induced acute akathisia. Cochrane Database Syst Rev. 2004(1):CD003727.
RATHBONE J, SOARES-WEISER K. Anticholinergics for neuroleptic-induced acute akathisia. Cochrane Database Syst Rev. 2006(4):CD003727.
BASKAK B, ATBASOGLU EC, OZGUVEN HD, SAKA MC, GOGUS AK. The effectiveness of intramuscular biperiden in acute akathisia: a double-blind, randomized, placebo-controlled study. J Clin Psychopharmacol. 2007;27(3):289-94.
POYUROVSKY M. Acute antipsychotic-induced akathisia revisited. Br J Psychiatry 2010;196(2):89-91.
SCHERLE CE, TERROBA CJ, MAROT M. Utilidad del trihexifenidilo en la prevención de trastornos del movimiento inducidos por neurolépticos clásicos. Rev Mex Neuroci. 2014;15(3):147-51.
ZUBENKO GS, COHEN BM, LIPINSKI JF Jr, JONAS JM. Use of clonidine in treating neuroleptic-induced akathisia. Psychiatry Res. 1984;13(3):253-9.
ZUBENKO GS, BARREIRA P, LIPINSKI JF Jr. Development of tolerance to the therapeutic effect of amantadine on akathisia. J Clin Psychopharmacol. 1984;4(4):218-20.
LERNER V, BERGMAN J, STATSENKO N, MIODOWNIK C. Vitamin B6 treatment in acute neuroleptic-induced akathisia: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2004;65(11):1550-4.
STRYJER R, STROUS RD, BAR F, POYUROVSKY M, WEIZMAN A, KOTLER M. Treatment of neuroleptic-induced akathisia with the 5-HT2A antagonist trazodone. Clin Neuropharmacol. 2003;26(3):137-41.
RIBOSA-NOGUE R, PAGONHBARRAGA J, KULISEVSKY J. Efficacy of trazodone in antipsychotic-induced akathisia resistant to conventional treatment. Parkinsonism and Related Disorders 2012;18:902-3.
POYUROVSKY M, PASHINIAN A, WEIZMAN R, FUCHS C, WEIZMAN A. Low-dose mirtazapine: a new option in the treatment of antipsychotic-induced akathisia. A randomized, double-blind, placebo and propranolol-controlled trial. Biol Psychiatry 2006;59(11):1071-7.
HIEBER R, DELLENBAUGH T, NELSON LA. Role of mirtazapine in the treatment of antipsychotic-induced akathisia. Ann Pharmacother. 2008;42(6):841-6.
POYUROVSKY M, BERGMAN J, PASHINIAN A, WEIZMAN A. Beneficial effect of low-dose mirtazapine in acute aripiprazole-induced akathisia. Int Clin Psychopharmacol. 2014;29(5):296-8.
POYUROVSKY M, WEIZMAN A. Serotonin-based pharmacotherapy for acute neuroleptic-induced akathisia: a new approach to an old problem. Br J Psychiatry 2001;179:4-8.
POYUROVSKY M, WEIZMAN A. Serotonergic agents in the treatment of acute neuroleptic-induced akathisia: open-label study of buspirone and mianserin. Int Clin Psychopharmacol. 1997;12(5):263-8.
POYUROVSKY M, SHARDORODSKY M, FUCHS C, SCHNEIDMAN M, WEIZMAN A. Treatment of neuroleptic-induced akathisia with the 5-HT2 antagonist mianserin. Double-blind, placebo-controlled study. Br J Psychiatry 1999;174:238-42.
FISCHEL T, HERMESH H, AIZENBERG D, ZEMISHLANY Z, MUNITZ H, BENJAMINI Y, ET AL. Cyproheptadine versus propranolol for the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study. J Clin Psychopharmacol. 2001;21(6):612-5.
WEISS D, AIZENBERG D, HERMESH H, ZEMISHLANY Z, MUNITZ H, RADWAN M, ET AL. Cyproheptadine treatment in neuroleptic-induced akathisia. Br J Psychiatry 1995;167(4):483-6.
MELTZER H, ELKIS H, VANOVER K, WEINER D, VAN KAMMEN D, PETERS P, HACKSELL U. Pimavanserin, a selective serotonin (5-HT)2a-inverse agonist, enhances the efficacy and safety of risperidone, 2 mg/day, but does not enhance efficacy of haloperidol, 2 mg/day: comparison with reference dose risperidone, 6 mg/day. Schizophrenia Research 2012;141:144-52.
BLEICKARDT C, KAZDOBA T, JONES N, HUNTER J, HODGSON R. Antagonism of the adenosine A2A receptor attenuates akathisia-like behavior induced with MP-10 or aripiprazole in a novel non-human primate model. Pharmacology, Biochemistry and Behavior 2014;118:36-45.
FURUSE T, HASHIMOTO K. Fluvoxamine for aripiprazole-associated akathisia in patients with schizophrenia: a potential role of sigma-1 receptors. Annals of General Psychiatry 2010,9:11.
WALN O, JANKOVIC J. Zolpidem Improves Tardive Dyskinesia and Akathisia. Mov Disorders 2013;28(12):1748-9.
AVITAL A, GROSS-ISSEROFF R, STRYJER R, HERMESHA H, WEIZMANA A, SHILOH R. Zolmitriptan compared to propranolol in the treatment of acute neuroleptic-induced akathisia: A comparative double-blind study. European Neuropsychopharmacology 2009;19:476-82.
HANSEN LK, L'ALLEMAND T, THIRY F, BALDWIN DS. Structured relaxation in the treatment of akathisia: case series. Neuropsychiatric Dist Treat. 2010;6:269-71.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.