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Akathisia: Prevalence and Associated Dysphoria in an In-patient Population with Chronic Schizophrenia

Published online by Cambridge University Press:  02 January 2018

Simon M. Halstead
Affiliation:
Graylingwell Hospital, Chichester PO14 4PQ, formerly Lecturer (Registrar), Charing Cross and Westminster Medical School
Thomas R. E. Barnes*
Affiliation:
Charing Cross and Westminster Medical School, St Dunstan's Road, London W6 8RP
Jeremy C. Speller
Affiliation:
Plymouth Community Unit, Nuffield Clinic, Plymouth PL4 8NQ, formerly Clinical Research Fellow, Charing Cross and Westminster Medical School
*
Correspondence

Abstract

In a sample of 120 long-stay in-patients who fulfilled DSM–III–R criteria for schizophrenia, chronic akathisia and pseudoakathisia were relatively common, with prevalence figures of 24% and 18%, respectively. Compared with patients without evidence of chronic akathisia, those patients with the condition were significantly younger, were receiving significantly higher doses of antipsychotic medication, and were more likely to be receiving a depot antipsychotic. Patients who experienced the characteristic inner restlessness and compulsion to move of akathisia also reported marked symptoms of dysphoria, namely tension, panic, irritability and impatience. The findings support the suggestion that dysphoric mood is an important feature of akathisia. Male patients appeared to be at an increased risk of pseudoakathisia. No significant relation was found between chronic akathisia and tardive dyskinesia, although there was a trend for trunk and limb dyskinesia to be commonest in patients with chronic akathisia while orofacial dyskinesia was most frequently observed in those with pseudoakathisia. Akathisia may mask the movements of tardive dyskinesia in the lower limb. There was no evidence that akathisia was associated with positive or negative symptoms of schizophrenia nor with depression.

Type
Papers
Copyright
Copyright © 1994 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APP.Google Scholar
Andreasen, N. C. (1989) The Scale for the Assessment of Negative Symptoms (SANS): Conceptual and theoretical foundations. British Journal of Psychiatry, 155 (suppl. 7), 4952.10.1192/S0007125000291496Google Scholar
Baldessarini, R. J. (1978) Chemotherapy. In The Harvard Guide to Modern Psychiatry (ed. A. M. Nicholi). Cambridge, Mass.: Harvard University Press.Google Scholar
Barnes, T. R. E. (1989) A rating scale for drug-induced akathisia. British Journal of Psychiatry, 154, 672676.10.1192/bjp.154.5.672CrossRefGoogle ScholarPubMed
Barnes, T. R. E. (1990) Movement disorder associated with antipsychotic drugs: the tardive syndromes. International Review of Psychiatry, 2, 243254.10.3109/09540269009026606Google Scholar
Barnes, T. R. E. & Braude, W. M. (1985) Akathisia variants and tardive dyskinesia. Archives of General Psychiatry, 42, 874878.10.1001/archpsyc.1985.01790320042006Google Scholar
Barnes, T. R. E., Halstead, S. M. & Little, P. W. A. (1992) Relationship between iron status and chronic akathisia in an in-patient population with chronic schizophrenia. British Journal of Psychiatry, 161, 791796.10.1192/bjp.161.6.791CrossRefGoogle Scholar
Barnes, T. R. E., & Trauer, T. (1982) Reliability and validity of a tardive dyskinesia videotape rating technique. British Journal of Psychiatry, 140, 508515.10.1192/bjp.140.5.508CrossRefGoogle ScholarPubMed
Braude, W. M., Barnes, T. R. E. & Gore, S. M. (1983) Clinical characteristics of akathisia. A systematic investigation of acute psychiatric inpatient admissions. British Journal of Psychiatry, 143, 139150.10.1192/bjp.143.2.139Google Scholar
Davis, J. M. (1976) Comparative doses and costs of antipsychotic medication. Archives of General Psychiatry, 33, 858861.10.1001/archpsyc.1976.01770070088010Google Scholar
Drake, R. E. & Ehrlich, J. (1985) Suicide attempts associated with akathisia. American Journal of Psychiatry, 142, 499501.Google ScholarPubMed
Ekbom, K. A. (1960) Restless legs syndrome. Neurology, 10, 868873.10.1212/WNL.10.9.868Google Scholar
Gibb, W. R. G. & Lees, A. J. (1986) The clinical phenomenon of akathisia. Journal of Neurology, Neurosurgery and Psychiatry, 49, 861866.10.1136/jnnp.49.8.861Google Scholar
Kekich, W. A. (1978) Violence as a manifestation of akathisia. Journal of the American Medical Association, 240, 2185.Google Scholar
Krawiecka, M., Goldberg, D. & Vaughan, M. (1977) A standardised psychiatric assessment scale for rating chronic psychotic patients. Acta Psychiatrica Scandinavica, 55, 299308.10.1111/j.1600-0447.1977.tb00174.xCrossRefGoogle ScholarPubMed
Kumar, B. B. (1979) An unusual case of akathisia. American Journal of Psychiatry, 136, 1088.Google Scholar
Marder, S. R., Van Putten, T., Wirshing, W. C., et al (1991) Subjective experiences of extrapyramidal side-effects in schizophrenia. In Biological Psychiatry (ed. G. Racagni et al). Amsterdam: Elsevier Science.Google Scholar
Munetz, M. R. & Cornes, C. L. (1982) Akathisia, pseudoakathisia and tardive dyskinesia. Comprehensive Psychiatry, 23, 345352.10.1016/0010-440X(82)90084-0Google Scholar
Rey, M.-J., Schulz, P., Costa, C., et al (1989) Guidelines for the dosage of neuroleptics. I: Chlorpromazine equivalents of orally administered neuroleptics. International Clinical Psychopharmacology, 4, 95104.10.1097/00004850-198904000-00001CrossRefGoogle ScholarPubMed
Schulte, J. R. (1985) Homicide and suicide associated with akathisia and haloperidol. American Journal of Forensic Psychiatry, 6, 37.Google Scholar
Shaw, E. D., Mann, J. J., Weiden, P. J., et al (1986) A case of suicidal and homicidal ideation and akathisia in a double-blind neuroleptic crossover study. Journal of Clinical Psychopharmacology, 6, 196197.10.1097/00004714-198606000-00024Google Scholar
Shear, K., Frances, A. & Weiden, P. (1983) Suicide associated with akathisia and depot fluphenazine treatment. Journal of Clinical Psychopharmacology, 3, 235236.10.1097/00004714-198308000-00006Google Scholar
Simpson, G. M. & Angus, J. W. S. (1970) A rating scale for extrapyramidal side-effects. Acta Psychiatrica Scandinavica, 212 (suppl. 44), 1119.10.1111/j.1600-0447.1970.tb02066.xCrossRefGoogle ScholarPubMed
Snaith, R. P., Bridge, G. W. K. & Hamilton, M. (1976) The Leeds scales for the self-rating of anxiety of depression. British Journal of Psychiatry, 128, 156165.10.1192/bjp.128.2.156Google Scholar
Van Putten, T. (1974) Why do schizophrenic patients refuse to take their drugs? Archives of General Psychiatry, 31, 6772.10.1001/archpsyc.1974.01760130049008CrossRefGoogle ScholarPubMed
Van Putten, T., Mutalipassi, L. R. & Malkin, M. D. (1974) Phenothiazine induced decompensation. Archives of General Psychiatry, 30, 102105.10.1001/archpsyc.1974.01760070080012CrossRefGoogle ScholarPubMed
Weiden, P. (1985) Akathisia from prochlorperazine Getter). Journal of the American Medical Association, 253, 635.10.1001/jama.1985.03350290037017Google Scholar
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