II. Definitions

  1. Akathisia
    1. Motor restlessness or psychomotor aggitation typically as a medication-related Extrapyramidal Side Effect
    2. May present as inability to sit still, pacing or wringing hands

III. Pathophysiology

  1. Decreased Dopaminergic activity in the mesocortical pathway
    1. Mesocortical Pathway originates in the ventral tegmental area
    2. Mesocortical Pathway projects to the limbic system and prefrontal cortex
  2. Mesocortical pathway typically inhibits motor function
    1. When this pathway is inihibited, unwanted involuntary movement occurs
  3. Other effects
    1. Decreased Dopaminergic activity in ventral tegmental area may increases Serotonin and Norepinephrine activity

IV. Symptoms

  1. Tense and ucomfortable Sensation
  2. Timing
    1. Onset may be abrupt with rapid infusion of IV medications (e.g. Compazine, metoclopramide)

V. Signs

  1. Leg fidgety movement
  2. Pacing
  3. Inability to sit still
  4. Rocking from foot to foot, shifting weight while standing

VI. Causes: Medication-Induced Acute Akathisia

VIII. Management

  1. Reduce medication dose or switch to alternative medication
  2. Acute symptomatic management
    1. Beta Blockers
      1. Propranolol 40-80 mg orally daily
    2. Serotonin Antagonists (5HT-2A)
      1. Mirtazapine 15 mg orally daily
      2. Cyproheptadine (Periactin) 8-16 mg orally daily
    3. Benzodiazepines
      1. Clonazepam 0.5 to 1 mg daily to twice daily
      2. Diazepam 5-15 mg orally daily
    4. Anticholinergics
      1. Benztropine (Cogentin) 1-4 mg orally daily
    5. Other agents
      1. Amantadine 100 mg orally daily
      2. Clonidine 0.1 mg orally daily to twice daily

IX. Prevention

  1. Infuse Compazine or Metoclopramide over 30 minutes in a bag (e.g. D5W) instead of a bolus over minutes

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Related Studies

Ontology: Neuroleptic-induced acute akathisia (C0236835)

Concepts Disease or Syndrome (T047)
ICD10 G25.71
SnomedCT 22719003
DSM4 333.99
English Neuroleptic-Induced Acute Akathisia, acute neuroleptic-induced akathisia (diagnosis), acute neuroleptic-induced akathisia, Neuroleptic induced acute akathisia, Neuroleptic induced akathisia, acute, Neuroleptic-induced acute akathisia, Neuroleptic-induced acute akathisia (disorder)
Spanish acatisia aguda inducida por neurolépticos (trastorno), acatisia aguda inducida por neurolépticos