Is there constitutional and morphological predisposition to akathisia in schizophrenic patients receiving antipsychotic therapy?

Objective: to identify constitutional and morphological predisposition to akathisia in schizophrenic patients receiving antipsychotic therapy.Materials and methods. 250 patients with schizophrenia receiving basic antipsychotic therapy were studied, aged 40 [32; 50] years old; disease duration was 13 [7; 22] years. The age when the schizophrenic process manifested itself was 23 [19; 30] years. Clinical evaluation of akathisia was performed using the Barnes Akathisia Scale (BARS, BAS), so akathisia was detected in 92 (36.8%) patients. All persons included in the study underwent an anthropometric survey according to the Bunak’s method. Statistical analysis was performed using Statistica for Windows software (V. 12.0), the odds ratio was estimated using the MedCalc® online calculator.Results. The comparative analysis of the Rees – Eysenk body index and Tanner stages in groups of schizophrenic patients receiving antipsychotic therapy with and without akathisia showed no significant differences between them (p = 0.317 and p = 0.347, respectively). Comparison of groups in the distribution of constitutional and morphological types also revealed no statistical differences (p = 0.189). Patients with the andromorphic type of somatic sexual differentiation increased the risk of antipsychotic-induced akathisia (OR = 1.73; 95% CI: 1.02–2.94; p = 0.039) almost twofold.Conclusion. Attribution of patients to different constitutional and morphological types does not play a role in the development of antipsychotic-induced akathisia, unlike attribution to andromorphic somatic sexual differentiation types, which significantly increases its risk.

Akathisia: Prevalence and risk factors in patients with psychosis and bipolar disorder

IntroductionAkathisia is probably the most common and one of the most distressing of the movement disorders associated with antipsychotic drugs. Little is known about its prevalence and its risk factors in real-world psychotic and bipolar patients to date.ObjectivesThe main objective of this study was to determine the prevalence of akathisia and to determine the risk factors and the treatments associated with it in a sample of Tunisian patients with schizophrenia, schizoaffective or bipolar disorder.MethodsSeventy-four patients with schizophrenia, schizoaffective or bipolar disorder were included and assessed with a validated scale: the Barnes Akathisia scale (BAS). Ongoing psychotropic treatments were recorded.ResultsThe global prevalence of akathisia (as defined by a score ≥ 2 on the global akathisia subscale of the BAS) was 20.5%. Akathisia was significantly more common in patients with schizophrenia or schizoaffective disorder than in patients with Bipolar disorder (27.5% vs 9.4%; P = 0.049). However, the prevalence of akathisia did not differ according to sex, age, the illness duration, the presence of a comorbid anxiety disorder, the number of antipsychotics used, the type of the used antipsychotic (first vs second-generation), the antipsychotic chlorpromazine-equivalent total dosage, the use of benzodiazepines or anticholinergics, or the reported drug compliance.ConclusionsAkathisia seems to be more common in some psychiatric disorders than in others such as schizophrenia or schizoaffective disorder. Longitudinal studies would be required to draw any firm conclusions concerning the factors involved in the emergence of akathisia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

What about the hidden face of Akathisia?

IntroductionAkathisia is commonly known for its objective components such as rocking while standing or sitting and lifting feet. However, little is known about its psychiatric impact that can even lead to suicidal attempts.ObjectivesThe aim of this study is to investigate the main psychiatric symptoms associated with akathisia in a Tunisian sample of patients under treatment for Schizophrenia, Schizoaffective or Bipolar Disorder.MethodsFifteen patients were diagnosed with akathisia using the Barnes Akathisia Scale. Psychiatric symptoms related to akathisia such as mood lability, sadness, anxiety, aggressivity, suicidal ideation, insomnia and social and professional impairment were assessed.ResultsThe average age of the sample was 47 years. The average antipsychotic chlorpromazine-equivalent total dosage was 1756 mg. All patients reported at least one psychiatric symptom imputed to akathisia. These were: mood lability (n = 11), inner restlessness (n = 10), anxiety (n = 10), sadness (n = 10), aggressivity (n = 6), and insomnia (n = 12). Eight patients described suicidal ideation and five confessed having committed a suicide attempt. Four and ten said akathisia had professional and social impact respectively. The prevalence of psychiatric symptoms did not differ according to sex, age, diagnosis, illness duration, presence of a comorbid anxiety disorder, the number and types of antipsychotics used, the antipsychotic chlorpromazine-equivalent total dosage or the reported drug compliance.ConclusionsPsychiatric symptoms resulting from Akathisia remain frequently undetected. Special interest by the clinician is required to elicit these symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Akathisia: Prevalence and risk factors in a community-dwelling sample of patients with schizophrenia. Results from the multi-center FACE-SZ Dataset

The main objective of this study was to determine the prevalence of akathisia in a community-dwelling sample of patients with schizophrenia, and to determine the effects of treatments and the clinical variables associated with akathisia. Three hundred and seventy-two patients with schizophrenia or schizoaffective disorder were systematically included in the network of FondaMental Expert Center for Schizophrenia and assessed with validated scales. Akathisia was measured with the Barnes Akathisia Scale (BAS). Ongoing psychotropic treatment was recorded. The global prevalence of akathisia (as defined by a score of 2 or more on the global akathisia subscale of the BAS) in our sample was 18.5%. Patients who received antipsychotic polytherapy were at higher risk of akathisia and this result remained significant (adjusted odd ratio = 2.04, P = .025) after controlling the influence of age, gender, level of education, level of psychotic symptoms, substance use comorbidities, current administration of antidepressant, anticholinergic drugs, benzodiazepines, and daily-administered antipsychotic dose. Our results indicate that antipsychotic polytherapy should be at best avoided and suggest that monotherapy should be recommended in cases of akathisia. Long-term administration of benzodiazepines or anticholinergic drugs does not seem to be advisable in cases of akathisia, given the potential side effects of these medications.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment of neuroleptic-induced akathisia with the 5-HT2 antagonist mianserin

BackgroundSerotonin (5-HT): dopamine imbalance may underlie neuroleptic-induced akathisia.AimTo evaluate the efficacy of the 5-HT2 antagonist, mianserin in neuroleptic-induced akathisia.MethodsThirty neuroleptic-treated patients with schizophrenia were randomly allocated in a double-blind design to receive either mianserin (15 mg/day) or placebo for five days. Patients were assessed at baseline and on Days 3 and 5 by the Barnes Akathisia Scale (BARS), as well as by other relevant clinical rating scales.ResultsCompared with the placebo group, the mianserin-treated patients showed a significant reduction in all four BARS subscales by Day 5, with mean reductions in the BARS global score of 9.9% and 52.2%, respectively (P=0.006). Response to treatment (a reduction of at least two points on the BARS global subscale), was noted in six patients (40%) in the mianserin group and only one patient (9.1%) in the placebo group (P=0.04, log odds ratio 2.23).ConclusionsMianserin at a low dose may be a promising therapeutic option for patients with acute neuroleptic-induced akathisia.

Abnormal Movements in Never-Medicated Indian Patients with Schizophrenia

BackgroundHistorical records suggest dyskinesia was observed in severely ill institutionalised patients with schizophrenia in the pre-neuroleptic era More recent work has not found dyskinesia in never-medicated younger and middle aged patients. The present study complements this recent work and avoids the confounders of severity of illness and institutionalism by examining elderly patients in a wide variety of community settings.MethodMovement disorders were examined in 308 elderly individuals in Madras, India, using the Abnormal Involuntary Movements Scale, the Simpson and Angus Parkinsonism Scale and the Barnes Akathisia Scale. Patients' mental state was assessed by the Positive and Negative Syndrome Scale.ResultsDyskinesia was found in 15% of normal subjects (n=101, mean age 63 years), 15% of first degree blood relatives of younger schizophrenic patients (n=103, mean age 63 years), 38% of never medicated patients (n=21, mean age 65 years) and 41 % of medicated patients (n=83, mean age 57 years). The respective prevalences for Parkinsonism were 6%, 11 %, 24% and 36%; and for akathisia 9%, 5%, 21 % and 23%. Dyskinesia was associated with negative schizophrenic symptoms.ConclusionsDyskinesia in elderly schizophrenic patients is an integral part of the illness and not associated with antipsychotic medication.

Movement Disorder in Never and Minimally Treated Nigerian Schizophrenic Patients

Two hundred and forty-two Nigerian schizophrenic patients (63% male, 37% female), whose mean age was 42 years and length of illness 12 years, were examined for movement disorders using the Abnormal Involuntary Movements Scale, the Simpson and Angus Parkinsonism Scale and the Barnes Akathisia Scale. Twelve patients had never received antipsychotic medication; and none of these had dyskinesia. Dyskinesia was found in 5 of 49 patients (10%) who had taken medication throughout the course of their illness for a total of up to 3 months, 13 of 74 (18%) who had taken medication for 4–12 months, 14 of 41 (34%) for 1–5 years, and 29 of 66 (45%) who had taken medication for more than 5 years. Of 77 patients who were receiving antipsychotic medication at the time of examination, 9 (12%) had Parkinsonism and 12 (15%) akathisia. Examination of the patients' mental state by the Positive and Negative Syndrome Scale showed an association between dyskinesia and positive, but not negative, schizophrenic symptoms. Nigerian patients showed a low level of negative symptoms.