Overview

Akathisia is a condition characterized by a feeling of inner restlessness or agitation and an overwhelming urge to move or pace. It is a form of extrapyramidal symptoms (EPS) which is a group of movement disorders that can occur as a side effect of certain medications, particularly antipsychotics and antidepressants. Akathisia can also be caused by underlying medical conditions such as Parkinson's disease, or as a result of a traumatic brain injury. Symptoms of akathisia can include restlessness, anxiety, fidgeting, pacing, and an inability to sit still. It can also cause difficulty sleeping, depression, and even suicidal thoughts.

Diagnosis of akathisia is based on the patient's symptoms and physical examination, and by ruling out other potential causes of the symptoms. There are several rating scales that can be used to assess the severity of akathisia.

Treatment options for akathisia include medication adjustments, beta blockers and other medications. In some cases, psychotherapy and other non-pharmacological therapies may also be beneficial in managing symptoms.

What is Akathisia? 

Akathisia is a movement disorder characterized by an inner restlessness and a feeling of unease, often accompanied by an inability to sit still or stay in one place. It can be a side effect of certain medications, particularly antipsychotics and antidepressants, and can also occur as a symptom of certain medical conditions. The severity of akathisia can range from mild to severe, and it can have a significant impact on a person's quality of life. 

The word akathisia derives from Greek, meaning not to sit. As a result, akathisia refers to a mental state that creates an intense need to move or restlessness, primarily in the legs. Akathisia is a side effect of medication used to treat another illness or disorder, not a condition in and of itself. It is frequently a side effect of earlier antipsychotic medications used to treat disorders like schizophrenia.

What Causes Akathisia?

Akathisia is a movement disorder characterized by a feeling of inner restlessness and a compulsion to move. It can be caused by various factors, including certain medications, particularly antipsychotic drugs, selective serotonin reuptake inhibitors (SSRIs), and metoclopramide, as well as brain injury, Parkinson's disease, and chronic conditions such as end-stage kidney disease. In some cases, the cause of akathisia is not known.

What Are the Types of Akathisia?

Akathisia is a movement disorder characterized by an inner restlessness and a compulsion to move. It can be classified into three types:

1. Acute akathisia: This type of akathisia develops within a few hours to days of taking a medication, such as antipsychotics. It is usually reversible when the medication is discontinued.
2. Tardive akathisia: This type of akathisia develops after a person has been taking a medication for an extended period of time, typically weeks to months. It is often irreversible and can persist even after the medication is discontinued.
3. Chronic idiopathic akathisia: This type of akathisia has no known cause and can occur in people who have not taken any medications. It is a rare form of akathisia that is often difficult to treat.

What Are Akathisia Symptoms? 

The symptoms of akathisia can include:

• A feeling of inner restlessness or unease
• An overwhelming urge to move or pace
• Rocking back and forth or shifting from foot to foot
• Crossing and uncrossing legs frequently
• Difficulty sitting still or remaining in one position
• Fidgeting or squirming
• Agitation or anxiety
• Difficulty sleeping
• Depression
• Suicidal thoughts It's worth mentioning that these symptoms could be caused by other conditions as well and a proper medical examination is needed to make a proper diagnosis.

How is Akathisia Diagnosed?

Akathisia is typically diagnosed based on the patient's symptoms and a physical examination. The primary diagnostic tool for akathisia is the Barnes Akathisia Scale (BAS), which is a self-reported questionnaire that assesses the severity of akathisia symptoms. The BAS is widely used in clinical practice and research.

A healthcare provider may also use the Abnormal Involuntary Movement Scale (AIMS) to evaluate for tardive dyskinesia, a related movement disorder that can occur alongside akathisia.

Additionally, a healthcare provider may conduct a physical examination to observe the patient's movements and assess the presence and severity of restlessness, fidgeting, and other physical symptoms of akathisia.

It is also important to rule out other conditions that may present with similar symptoms, such as anxiety or depression, as these can occur alongside akathisia.

Overall, a combination of clinical assessment, patient's history, symptoms, and physical examination is used to diagnose Akathisia.

How is Akathisia Treated?

Akathisia is typically treated with medication adjustments, specifically reducing the dosage or changing to a different medication that does not cause akathisia as a side effect. In some cases, a medication called a beta blocker may be prescribed to alleviate symptoms. In severe cases, antipsychotic medication may be prescribed. It is important to work closely with a healthcare professional to find the best treatment plan. Psychotherapy and other non-pharmacological therapies may also be beneficial in managing symptoms.

A number of medications have been used to treat the symptoms of akathisia, including:

• Beta-blockers, such as Hemangeol and Inderal (propranolol)
• Anticholinergic medications, such as Cogentin (benztropine) and Akineton (biperiden)
• 5-HT2A antagonists, such as Tolvon (mianserin), Remeron (mirtazapine), Desyrel (trazodone), and Periactin (cyproheptadine)
• Vitamin B6 in high doses 

Akathisia is often treatable if recognized and treated early, and the individual is able to discontinue the medicine causing the problem. When the medicine dosage is reduced, akathisia frequently subsides. Symptoms may persist for several weeks or months.

Untreated, the prognosis is worse, and symptoms can have a negative impact on a person's quality of life. The illness has also been linked to an increased risk of anxiety, depression, and suicidal ideation.

Can Akathisia Be Prevented?

Akathisia can sometimes be prevented by being aware of the potential side effects of certain medications, and by closely monitoring for symptoms when starting a new medication or adjusting the dosage of an existing one. However, in some cases, it may not be possible to prevent akathisia, particularly if it is caused by an underlying medical condition or is a known side effect of a necessary medication. It is important to work closely with a healthcare professional to carefully weigh the benefits and risks of any medication and to monitor for symptoms that may indicate the development of akathisia.

Akathisia vs. Tardive Dyskinesia

Akathisia and tardive dyskinesia are both forms of extrapyramidal symptoms (EPS) that can occur as a side effect of certain medications, particularly antipsychotics. However, they are different conditions with distinct symptoms.

Akathisia is characterized by a feeling of inner restlessness or agitation and an overwhelming urge to move or pace. Symptoms can include restlessness, anxiety, fidgeting, pacing, and an inability to sit still.

Tardive dyskinesia, on the other hand, is characterized by involuntary movements, particularly of the face, tongue, and limbs. Symptoms can include facial grimacing, lip smacking, tongue protrusion, and rapid eye blinking. Other symptoms can include difficulty speaking, swallowing, and breathing.

Both conditions can have a significant impact on a person's quality of life and can be distressing for the sufferer. It is important to work closely with a healthcare professional to find the best treatment plan for both conditions.

Coping with Akathisia

Coping with akathisia can be challenging, as the symptoms can be distressing and impact a person's quality of life. However, there are several strategies that may help:

1. Medication adjustments: Working closely with a healthcare professional to find the best treatment plan, including reducing the dosage or changing to a different medication that does not cause akathisia as a side effect.
2. Exercise: Regular exercise can help alleviate symptoms of restlessness and agitation.
3. Relaxation techniques: Techniques such as deep breathing, meditation, and yoga can help reduce symptoms of anxiety and agitation.
4. Distraction: Engaging in activities that can distract from the symptoms, such as listening to music, reading, or watching a movie.
5. Support: Talking to friends, family, or a therapist can be helpful in dealing with the emotional impact of the condition.
6. Pacing: Pacing around a room or taking a walk can help alleviate the urge to move, providing an outlet for the restlessness.
7. Keeping a diary: Keeping a record of symptoms and triggers can help identify patterns and inform treatment decisions.

It is important to remember that the condition can be managed with the help of healthcare professionals and that it is not something to be ashamed of. It is crucial to seek help if the symptoms are severe and affecting daily life.

When should I see my healthcare provider about Akathisia? 

It is important to see a healthcare provider if you suspect you may have akathisia. Symptoms of akathisia can include a feeling of inner restlessness or agitation, an overwhelming urge to move or pace, and difficulty standing still or sitting still. If you are experiencing these symptoms, it is important to see a healthcare provider as soon as possible, as early treatment can help alleviate symptoms and prevent the condition from worsening. It is also important to see a healthcare provider if you are taking a medication that is known to cause akathisia as a side effect, as they may be able to adjust the dosage or switch to a different medication. It is important to work closely with a healthcare professional to find the best treatment plan.

Conclusion 

In conclusion, Akathisia is a condition characterized by a feeling of inner restlessness or agitation and an overwhelming urge to move or pace. It can be caused by certain medications, particularly antipsychotics, or by underlying medical conditions. Early treatment is important to alleviate symptoms and prevent the condition from worsening. 

Treatment options include medication adjustments, beta blockers and antipsychotic medication. In some cases, psychotherapy and other non-pharmacological therapies may also be beneficial in managing symptoms. It is important to be aware of the potential side effects of certain medications, and to closely monitor for symptoms when starting a new medication or adjusting the dosage of an existing one. It is crucial to work closely with a healthcare professional to carefully weigh the benefits and risks of any medication and to monitor for symptoms that may indicate the development of akathisia.