Skip to main content
×
×
Home

Acute antipsychotic-induced akathisia revisited

  • Michael Poyurovsky (a1)
Summary

Akathisia remains one of the most prevalent and distressful antipsychotic-induced adverse events. Effective and well-tolerated treatment is a major unmet need in akathisia that merits a search for new remedies. Accumulating evidence indicates that agents with marked serotonin-2A receptor antagonism may represent a new class of potential anti-akathisia treatment.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Acute antipsychotic-induced akathisia revisited
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Acute antipsychotic-induced akathisia revisited
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Acute antipsychotic-induced akathisia revisited
      Available formats
      ×
Copyright
References
Hide All
1 Kane, JM, Fleischhacker, WW, Hansen, L, Perlis, R, Pikalov, A, Assunção-Talbott, S. Akathisia: an updated review focusing on second-generation antipsychotics. J Clin Psychiatry 2009; 70: 627–43.
2 Lieberman, JA, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005; 353: 1209–23.
3 Miller, DD, Caroff, SN, Davis, SM, Rosenheck, RA, McEvoy, JP, Saltz, BL, et al. Extrapyramidal side-effects of antipsychotics in a randomised trial. Br J Psychiatry 2008; 193: 279–88.
4 Kahn, RS, Fleischhacker, WW, Boter, H, Davidson, M, Vergouwe, Y, Keet, IP, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial. Lancet 2008; 371: 1085–97.
5 Sikich, L, Frazier, JA, McClellan, J, Findling, RL, Vitiello, B, Ritz, L, et al. Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. Am J Psychiatry 2008; 165: 1420–31.
6 Gao, K, Kemp, DE, Ganocy, SJ, Gajwani, P, Xia, G, Calabrese, JR. Antipsychotic-induced extrapyramidal side effects in bipolar disorder and schizophrenia: a systematic review. J Clin Psychopharmacol 2008; 28: 203–9.
7 Poyurovsky, M, Pashinian, A, Weizman, R, Fuchs, C, Weizman, A. Low-dose mirtazapine: a new option in the treatment of antipsychotic-induced akathisia. A randomized, double-blind, placebo- and propranolol-controlled trial. Biol Psychiatry 2006; 59: 1071–7.
8 Baskak, B, Atbasoglu, EC, Ozguven, HD, Saka, MC, Gogus, AK. The effectiveness of intramuscular biperiden in acute akathisia: a double-blind, randomized, placebo-controlled study. J Clin Psychopharmacol. 2007; 27: 289–94.
9 Barnes, TRE, McPhillips, MA. Critical analysis and comparison of the side-effect and safety profiles of the new antipsychotics. Br J Psychiatry 1999; 174 (suppl 38): 3443.
10 Poyurovsky, M, Weizman, A. Serotonin-based pharmacotherapy for acute neuroleptic-induced akathisia: a new approach to an old problem. Br J Psychiatry 2001; 179: 48.
11 Poyurovsky, M, Weizman, R, Weizman, A. Aripiprazole's receptor pharmacology and extrapyramidal side effects. Am J Psychiatry 2008; 165: 398.
12 Abbas, A, Roth, BL. Pimavanserin tartrate: a 5-HT2A inverse agonist with potential for treating various neuropsychiatric disorders. Expert Opin Pharmacother 2008; 9: 3251–9.
13 Avital, A, Gross-Isseroff, R, Stryjer, R, Hermesh, H, Weizman, A, Shiloh, R. Zolmitriptan compared to propranolol in the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study. Eur Neuropsychopharmacol 2009; 19: 476–82.
14 Varty, GB, Hodgson, RA, Pond, AJ, Grzelak, ME, Parker, EM, Hunter, JC. The effects of adenosine A2A receptor antagonists on haloperidol-induced movement disorders in primates. Psychopharmacology (Berl) 2008; 200: 393401.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Acute antipsychotic-induced akathisia revisited

  • Michael Poyurovsky (a1)
Submit a response

eLetters

Acute antipsychotic-induced akathisia

Jonathan Lyons, CT2 in Psychiatry
26 February 2010

In his editorial Poyurovsky (1) comprehensively reviews the common but under-recognised and under-treated problem of antipsychotic drug-induced akathisia.

Even though the author stresses the association between akathisia andsuicidal behaviour, we could not find evidence of a significant association (2, 3).

The author quotes his previous study (4) in which propranolol 160 mg improved akathisia in 30% of patients while propranolol had to be discontinued in 17% due to hypotension. Many patients do benefit with lower doses of propranolol, with lower risk of hypotension (5). In day-to-day clinical practice, when using antipsychotics and propranolol together,we have not come across any increased complexity in administration of titration as the author suggests.

The author attributes the anti-akathisia effect of mirtazapine to its5-HT2A antagonist effect. However, many antipsychotic drugs such as clozapine, olanzapine, quetiapine and risperidone which cause akathisia are known to have significant 5-HT2A antagonist effects. This may suggest that mirtazapine’s anti-akathisia effect may be related to something otherthan its 5-HT2A antagonist effects.

Declaration of interest: None

References:

1Poyurovsky M. Acute antipsychotic-induced akathisia revisited. Br JPsychiatry 2010; 196: 89-91.

2Healy D, Harris M, Tranter R, Gutting P, Austin R, Jones-Edwards G,et al. Lifetime suicide rates in treated schizophrenia: 1875-1924 and 1994-1998 cohorts compared. Br J Psychiatry 2006; 188: 223-228.

3Hansen L, Jones R, Kingdon D. No association between akathisia or parkinsonism and suicidality in treatment resistant schizophrenia. J Psychopharmacol (London, UK) 2004, 18, 384–387.

4Poyurovsky M, Pashinian A, Weizman R, Fuchs C, Weizman A. Low-dosemirtazapine: a new option in the treatment of antipsychotic-induced akathisia. A randomized, double-blind, placebo- and propranolol-controlledtrial. Biol Psychiatry 2006; 59: 1071-7.

5Adler L, Angrist B, Peselow E, Corwin J, Maslansky R, Rotrosen J. Acontrolled assessment of propranolol in the treatment of neuroleptic-induced akathisia. Br J Psychiatry 1986; 149: 42-5.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *