Akathisia is a movement disorder characterized by an inner sense of restlessness and the inability to stay still, and it is a common side effect of antipsychotic medications. It is often misdiagnosed as anxiety or agitation. The primary management strategy is to reduce the antipsychotic dose, switch to a different antipsychotic with a lower risk of akathisia, or add adjunctive medications such as beta-blockers or mirtazapine.
Symptoms
Symptoms
- An intense, subjective feeling of inner restlessness
- A constant, uncontrollable need to move, such as rocking, pacing, or shuffling the legs
- Difficulty sitting still/sleeping
- Emotional tension and unease
- The symptoms can be mistaken for worsening psychotic agitation
- Reduce the antipsychotic dose: This is often the first step, but may not always be feasible.
- Switch to a different antipsychotic: Some antipsychotics are less likely to cause akathisia.
- Adjunctive medications: When medication changes are not possible, other medications can be used to manage the symptoms. Commonly used options include:
- Beta-blockers (e.g., propranolol)
- Mirtazapine
- Clonazepam
- Clonidine
- Vitamin B6 (at high doses)
- Monitor for worsening symptoms: Akathisia is linked to an increased risk of noncompliance, aggression, and suicide, so it is crucial to manage it effectively.
- Clinical misdiagnosis: Akathisia can be easily mistaken for anxiety, agitation, or worsening of the underlying psychiatric condition, leading to incorrect treatment decisions, such as increasing the antipsychotic dose.
- Difficulty reporting: Patients may have trouble describing their symptoms, or they may become so accustomed to them that they do not report them, which can impact treatment.
- Onset: Acute akathisia can develop soon after starting an antipsychotic or increasing the dose.