China 
Africa 
Explore chapters and articles related to this topic
Psychopharmacology
Published in Ad (Sandy) Macleod, Ian Maddocks, The Psychiatry of Palliative Medicine, 2018
Ad (Sandy) Macleod, Ian Maddocks
Akathisia is a subjective feeling of ‘inner’ restlessness and a drive to move. It may be be particularly distressing. Desperation may be so severe that suicide is considered.23,24 The motor restlessness is a response to the emotional distress and to peripheral tactile hypersensitivity. The movements are semi-purposeful and repetitive (e.g. pacing, fidgeting, difficulties sitting or standing, rocking, leg swinging). In palliative medicine akathisia should be considered an emergency. The prevalence in cancer patients may be as high as 5%.25 Akathisia may be caused by typical and atypical antipsychotics, SSRIs, calcium channel blockers and anti-emetics. It is often forgotten that anti-emetic medications, many of which are phenothiazine derivatives, are a significant cause of akathisia in cancer patients. High dosage and rapid dose escalation are risk factors as is a history of psychiatric illness, particularly bipolar depression.26 The differential diagnoses include restless legs syndrome, acute anxiety, dyskinesia, and drug and psychotropic medication withdrawal states. Cessation of the drug and as required anticholinergic agents are generally rapidly effective, sometimes within minutes. Benzodiazepines may also be used with effect.
Restless legs syndrome and neuropsychiatric disorders
Published in S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, Sleep and Psychosomatic Medicine, 2017
Schizophrenia is a chronic disorder that affects the thoughts and cognitions of the sufferer. It is hypothesized to be induced by a functional excess of dopamine in the mesolimbic tract of the brain. Thus, antipsychotics, which act on dopamine receptors and antagonize their action, have been found to be effective in the treatment of schizophrenia. However, antipsychotics may produce some adverse effects that can mimic RLS. One of these is akathisia, which appears early during the course of treatment. Akathisia is characterized by inner motor restlessness, making it difficult for the person to sit in one place. This is more commonly seen during phases of inactivity and thus may be more severe at night. However, unlike RLS, these symptoms are widespread in the body, and patients do not complain about the sensory aspects of RLS. Nevertheless, it is a known fact that antipsychotics can induce RLS. A number of candidate genes have been identified as being associated with this condition, and these are depicted in Table 6.1.
Questions and Answers
Published in David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly, MRCPsych Paper I One-Best-Item MCQs, 2017
David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly
Answer: E. Tardive dyskinesia is a syndrome of involuntary movements developing in the course of long-term exposure to antipsychotics. Akathisia is a subjective restlessness, associated with an urge to move a part or all of the body. Torticollis is characterised by involuntary tonic contractions or intermittent spasms of neck muscles and can occur in tardive dyskinesia. A stereotypy is a spontaneous repetitive movement that is not goal directed. [A. pp. 93–5, F. p. 89]
Aripiprazole for the treatment of schizophrenia: Recommendations of a panel of Spanish experts on its use in clinical practice
Published in International Journal of Psychiatry in Clinical Practice, 2023
David Fraguas, David Almenta Gallego, Sergio Arques-Egea, Marcos Gómez-Revuelta, Carlos Gómez Sánchez-Lafuente, Daniel Hernández Huerta, Daniel Núñez Arias, Beatriz Oda Plasencia-García, Carlos Parro Torres, Samuel Leopoldo Romero-Guillena, Elena Ros Cucurul, Cecilio Alamo
In patients being treated with aripiprazole who present akathisia, the following can be considered on a case-by-case basis: (i) reduction of aripiprazole’s dose (without reducing it below the effective threshold), (ii) β-blocking drugs (e.g., propranolol), (iii) antagonists of the 5-HT2A receptor (e.g., mirtazapine), (iv) benzodiazepines, or (v) vitamin B6. Treatment of antipsychotic-induced akathisia should be personalised, and reducing antipsychotic doses, ceasing polypharmacy, and switching to another antipsychotic should be considered before the use of adjuvants. If the latter is justified, β-blockers should be the first option, taking into account their contraindications. If these are contraindicated, not well tolerated, or long-term pharmacological management of akathisia is anticipated, 5-HT2A receptor antagonists should be considered. Benzodiazepines are the next treatment option for akathisia but should be restricted to short-term management. Finally, only when other adjuvants have failed and the patient shows persistent akathisia should vitamin B6 be considered with caution because of the possibility of causing severe and irreversible neuropathy if its use is extended over time (Pringsheim et al., 2018) (LE: 1–).
Up-to-date expert opinion on the safety of recently developed antipsychotics
Published in Expert Opinion on Drug Safety, 2020
Laura Orsolini, Domenico De Berardis, Umberto Volpe
Compared to aripiprazole, brexpiprazole displays a lower intrinsic activity at D2 receptors, with a more potent activity at 5-HT2A receptors, which may explain its theoretically lower propensity to induce EPS [20]. Moreover, brexpiprazole lacks a significant 5-HT2C antagonism which may reduce its propensity to induce weight gain, and metabolic syndrome [15]. Brexpiprazole displays moderate but not high levels of affinity for the histaminergic system which may explain its unlikely to induce sedation and somnolence [21]. Like aripiprazole, brexpiprazole displays minimal effects on QTc prolongation [22]. Most AEs are mild-to-moderate severity, and the occurrence of activating (e.g. akathisia, insomnia, anxiety, restlessness) versus sedating (e.g. sedation, somnolence) AEs are low [19]. Akathisia may occur mainly during the first 3 weeks of treatment [23–25].
Is restless legs syndrome related with depression/anxiety disorders or medications used in these disorders? A cross-sectional, clinic-based study
Published in Psychiatry and Clinical Psychopharmacology, 2019
Davut Ocak, Vahap Ozan Kotan, Salih Cihat Paltun, Makbule Çiğdem Aydemir
A statistically significant difference was found in the presence of RLS among the patients treated with combinations of SSRI or SNRI with different drugs in our study. Percentage of RLS in only SSRI-using patients was significantly lower than those using combinations of SSRI + quetiapine, SSRI + mirtazapine and SSRI + trazodone. We found that SSRI + quetiapine combination significantly seems to cause more RLS in our study compared to SSRI monotherapy. This finding seems consistent with the literature. Semiz et al. found that quetiapine increases RLS risk especially among antipsychotics in studies examining RLS association with antidepressant monotherapies and antipsychotic monotherapies [38,40]. Quetiapine and RLS association is frequently encountered in the literature. Quetiapine, which has been used for more than 20 years and licenced for the treatment of depression, is known to have good hypnotic properties. Therefore it is used just before bedtime because of its properties. Quetiapine is observed to be more related to RLS than other second-generation antipsychotics [41–43]. In a review of the relationship between quetiapine and RLS, seven cases were presented and six of them developed RLS with quetiapine + antidepressant drug combination [44]. In one of the cases, quetiapine-induced symptoms were defined as akathisia, but it was reported that the symptoms worsened at nights. Although symptoms of akathisia and RLS seem to overlap. Main symptom of RLS is the problem of moving the limbs that exists at nights. Akathisia continues with intense restlessness throughout the day. The fact that misdiagnosis of quetiapine-induced RLS as akathisia may explain the scarcity of quetiapine-induced RLS cases in the literature.