© 2006 The Royal College of Psychiatrists
Correspondence |
Akathisia as a risk factor for suicide
Department of Psychiatry, Royal South Hants Hospital, Brintons Terrace, Southampton SO14 0YG, UK.
Department of Psychiatry, Royal South Hants Hospital, Southampton, UK
Correspondence: E-mail: lh4{at}soton.ac.uk
EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL
Hawton et al (2005) have produced a comprehensive, systematic review of risk factors for suicide in schizophrenia. The study questions the fundamental procedures that are an integral part of our clinical assessment of this vulnerable group of patients. Suicide is notoriously difficult to predict because of the rarity of the event, the obvious ethical problems of designing informative studies and the uncertainty about risk factors. However, although there is no study of akathisia and suicide that fulfils their strict inclusion criteria, there is more research available than the case reports mentioned (for example, Chow et al, 1997; Hansen, 2001; Hansen et al, 2004). We found no association between akathisia and suicidality in a group of 90 patients with treatment-resistant schizophrenia (Hansen et al, 2004). Akathisia may, however, have a very different impact on patients at different stages of their illness and according to the duration of treatment. Akathisia emerging early in treatment or after increases in dosages may be the more malignant in terms of distress.
Hawton et al also identified agitation (motor restlessness), impulsivity and depression as risk factors but not akathisia. However, akathisia could contribute to or be confused with any of these three identified risk factors.
There is also evidence that akathisia can occur as a consequence of antidepressant treatment, which is common in patients with schizophrenia (Muller-Oerlinghausen & Berghofer, 1999; Hansen & Wilkinson, 2001). Whether there is an additive effect of antipsychotic and antidepressant medication on the intensity and duration of akathisia is not yet known. None the less, in our opinion, it would be premature to exclude akathisia from a role in the complex web of factors that lead to suicide in schizophrenia and perhaps also in other conditions.
REFERENCES
- Chow, L. Y., Chung, D., Leung, V., et al (1997) Suicide attempt due to metoclopramide-induced akathisia. International Journal of Clinical Practice, 51, 330 –331.[Medline]
- Hansen, L. (2001) A critical review of akathisia – and its possible association with suicidal behaviour. Human Psychopharmacology, 16, 495 –505.[CrossRef][Medline]
- Hansen, L. & Wilkinson, D. (2001) Drug induced akathisia, suicidal ideation and its treatment in the elderly. International Journal of Geriatric Psychiatry, 9, 231 –233.
- Hansen, L., Jones, R. & Kingdon, D. (2004)
No association between akathisia or parkinsonism and suicidality in treatment
resistant schizophrenia. Journal of
Psychopharmacology, 18, 384
–387.
[Abstract/Free Full Text] - Hawton, K., Sutton, L., Haw, C., et al
(2005) Schizophrenia and suicide: systematic review of risk
factors. British Journal of Psychiatry,
187, 9
–20.
[Abstract/Free Full Text] - Muller-Oerlinghausen, B. & Berghofer, A. (1999) Antidepressants and suicidal risk. Journal of Clinical Psychiatry, 60, 94 –99.
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