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7 - Clinical characteristics of tardive and chronic akathisia

from Part II - Drug-induced akathisia

Published online by Cambridge University Press:  12 September 2009

Perminder Sachdev
Affiliation:
The Prince Henry Hospital
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Summary

Introduction

The evidence for a tardive akathisia syndrome

There are a number of reasons why TA has not been universally accepted as a distinct syndrome. First, there is a relative dearth of investigations into this disorder. While TD has been extensively studied and a number of monographs on it have been published, only a few studies on TA have appeared in print. Second, no one feature of TA (discussed later) is pathognomonic of the disorder. While certain subjective reports and some motor signs can be considered to be highly characteristic, similar features can be seen in a number of other disorders. Akathisia is often mistakenly diagnosed (and dismissed) as restlessness or agitation, without a close analysis of the clinical features. A diagnostic laboratory investigation is not available, leaving the diagnosis to the vagaries of clinical judgement. Third, the strong overlap between TA and TD has suggested to some authors that TA should not be categorized as a separate disorder, but rather as a variation of the manifestations of TD. This has resulted in a reduced emphasis on the investigation of TA. Fourth, a temporal cause-and-effect relationship between neuroleptics and TA is difficult to establish. Not all patients treated with neuroleptics develop TA. It is a side-effect that develops after months or years of neuroleptic use. This is in contrast to AA, which develops within hours or days of drug initiation, thus establishing a more definitive causal relationship.

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Publisher: Cambridge University Press
Print publication year: 1995

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