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Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges - PubMed

Review

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

Haitham Salem et al. Curr Neuropharmacol. 2017.

Abstract

Background: Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies.] Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies.

Conclusion: Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent.

Keywords: Akathisia; agitation; anticholinergics; antipsychotics; benzodiazepines; extrapyramidal signs; movement disorders; neuroleptics.

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Figures

**Fig. (1)**
This figure depicts a practical guideline for management of akathisia. The first option is antipsychotic regimen adjustment. When this is not possible and/or not effective, it is a good clinical practice to consider the addition of an anti-akathisia agent. There is no evidence to fully support a specific agent (beta blocker, serotonin-based or anti-cholinergic; commonly used as first line approach) in detriment of others. The selection of an anti-akathisia agent must take into consideration patients’ clinical comorbidities and associated symptoms.

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Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges - PubMed