Akathisia

Akathisia is very uncomfortable for patients with clinical syndrome. It is often called restlessness, which very accurately conveys the essence of the emerging psychomotor disorders. With akathisia, a person has an almost irresistible physical need to change the position of the body and move, because of what he can not even sit still. It becomes difficult to fall asleep, but in a dream the akathisia subside, which distinguishes it from the restless leg syndrome.

What causes akathisia

Akathisia is usually one of the complications of ongoing medical therapy. It develops soon after the appointment of a new drug or an increase in the dose already received. Involvement of restlessness can also be caused by the withdrawal of ancillary drugs( eg, tranquilizers) or the addition of a substance potentiating the action of the basic drug to the therapy regimen.

The main drugs, the reception of which can lead to the development of acute akathisia:

• neuroleptics( a group of butyrophenones, phenothiazines, piperazines and thioxanthenes) - the most common cause, the use of these agents causes the most pronounced akathisia;
• antidepressants, predominantly belonging to SSRIs and SSRIs, less often akathisia occurs when TCAs are administered;
• lithium preparations;
• MAO inhibitors( infrequently);
• antiemetics of metoclopramide, promethazine and prochlorperazine;
• some antihistamines of the first generation( occasionally and with high doses);
• reserpine, which can be used in psychiatry and for the correction of arterial hypertension;
• preparations of levodopa;
• calcium antagonists.

Akathisia can develop not only on the background of taking medications, but also when they are abruptly canceled after prolonged treatment even in small doses. This occurs when neuroleptic and antidepressant therapy is complete. In some cases, restlessness enters the abstinence symptom-complex in the presence of dependence on opiates, barbiturates, benzodiazepines and alcohol.

The medical literature also describes cases of development of akathisia on the background of iron deficiency states, carbon monoxide poisoning. With Parkinson's disease( or a pronounced Parkinson's syndrome of non-drug aetiology), this syndrome can appear without an apparent connection with the administration of any medications.

Why akathisia occurs

The most common development of akathisia is associated with parkinson-like manifestations due to the effect of the drugs being taken on dopamine transmission in the brain. Some of them block directly the dopamine receptors in the nigrostear subcortical complex and the conductive paths that go from here. Others( for example, antidepressants) act indirectly, due to the competitive effects of serotonergic and dopaminergic systems.

It is also assumed that a certain role in the pathogenesis of akathisia is played by violations of opioid and noradrenergic transmission of nerve impulses in the central nervous system. But these changes are most likely complementary or secondary. But violations in the peripheral link of the nervous system have no significance for the development of the restlessness syndrome.

Clinical picture of

Akathisia is characterized by a feeling of inner tension and anxiety, which a person can describe as a feeling of anxiety. Mental and physical discomfort is often accompanied by irritability, instability of emotions with a tendency to a depressive background of mood. In the absence of pronounced motor manifestations, an insufficiently experienced or not very attentive doctor can accept this condition for other mental disorders. For example, agitated depression, affect inversion in bipolar affective disorder( manic-depressive psychosis according to the old classification) or even signs of psychosis development are diagnosed. Such erroneous interpretation of the mental component of akathisia leads to inadequate therapy, which can aggravate the existing restlessness syndrome.

Internal discomfort leads to the need to constantly change the position of the body, do something. Moreover, the actions performed are conscious, a person can, for a short time, by force of will suppress them, while remaining immobile. But diverting attention, entering into conversation or exhausting the possibility of internal control leads to a rapid resumption of stereotyped movements.

Motor anxiety in akathisia may have a different degree of severity. The load on the feet and knee joints alleviates the condition somewhat. Therefore, most often people with restlessness are shifted in a standing position( trampled), walk from corner to corner, try to march. In the sitting position, they shuffle their legs, change the position of the limbs, fidgeting, stand up, tapping their feet on the floor. Even in bed, a sufferer from akathisia can make overcoming movements with his feet. A severe degree of the syndrome with marked motor anxiety and strong psychoemotional stress leads to insomnia.

Forms of akathisia

The restlessness syndrome can be acute( with development within the first week after the initiation of therapy or increasing the dose of the drug), chronic( lasting more than 6 months).With prolonged neuroleptic therapy, akathisia may be late, in which case it develops a few months after the appointment of an antipsychotic and can persist even after its withdrawal. Separately, the so-called akathisia of withdrawal, which appears after the abrupt termination of the use of various psychotropic drugs, is singled out.

Depending on the clinical picture, the motor, psychic and sensory akathisia are isolated. In the latter case, unpleasant sensations appear in the lower limbs, often misdiagnosed as sensory coughs.

Diagnosis

No diagnostic studies are required to confirm the diagnosis of akathisia. The doctor assesses anamnesis, mental and motor disorders, necessarily determines the form and severity of restlessness. To standardize the clinical survey, a specially developed Barnes scale is used. And for the elimination of extrapyramidal disorders, other scales are used.

Akathisia should be differentiated with various impairments of the mental state, extrapyramidal complications of drug therapy and restless leg syndrome. It is important to identify the cause of restlessness, it will help the doctor to choose the necessary therapy and make the right decision regarding the medications.

Treatment of

To eliminate akathisia, it is necessary to stop using the drug that caused the development of this syndrome. If this can not be done, the doctor may decide to temporarily stop the neuroleptic or antidepressant therapy followed by the replacement of the drug. For example, such tactics are used in the treatment of acute psychotic state or depressive disorder, while supporting neuroleptic therapy. Sometimes it is effective to reduce the dose of the basic product with the addition of auxiliary medicines in the treatment regimen.

To reduce the severity of the symptoms used benzodiazepines, anticholinergic and anti-Parkinsonics of different groups, beta-blockers, amantadines, some anticonvulsants. Increase the effectiveness of therapy, B vitamins and nootropic drugs. Selection of the drug and its dosage is performed only by a doctor, often using a combination of medications of different groups. With a severe degree of akathisia, it is necessary to accelerate the excretion of the main drug from the body, for which an infusion therapy is prescribed.

The prognosis depends on the form, severity and cause of the akathisia. Even with the early onset of adequate therapy and the withdrawal of the main drug, symptoms can persist for a fairly long time. It depends on the sensitivity of different receptors, the stability of the metabolic disorders that developed in the brain and the concomitant pathology. At the first signs of the appearance of akathisia, it is necessary to inform the attending physician about it, which will allow us to work out the correct tactics for further therapy.