Akathisia (psychomotor Agitation): What It Is, Symptoms And Causes
Restlessness and anxiety are common symptoms of use and withdrawal from some medications and drugs. Akathisia is a particular case of psychomotor agitation which presents with sensations of emotional dysphoria, as well as physical discomfort and pain.
In this article we will describe What is akathisia and what are the symptoms and causes? most common of this syndrome, considered a disorder by some professionals and rather a consequence of medical malpractice by others.
Akathisia is a syndrome characterized by a constant feeling of restlessness, both physiologically and mentally. This term is mainly used to describe adverse reactions to certain psychoactive substances or symptoms resulting from stopping their use.
It manifests itself as an anxious-type emotional state that may include only cognitive symptoms or also physical signs, fundamentally related to the need to stay moving.
The word “akathisia” comes from Greek and can be translated as “inability to sit.” It was coined by the Czech neuropsychiatrist Ladislav Haškovec, who first described this disorder in the article titled L’akathisiein 1901.
Although akathisia It is usually associated with the consumption of typical antipsychotics such as haloperidol or drug withdrawal, it can also be caused by other medications and substances, as well as some types of brain injury.
Physical signs and clinical picture
Continuous feelings of agitation are the cardinal symptom of akathisia. Depending on the intensity of the syndrome, this anxiety can manifest itself as psychological restlessness or produce a extreme discomfort in the body. In particular, a large number of patients with akathisia describe discomfort and pain in the knees.
In many cases, agitation causes the person to carry out movements of different types. Some characteristic behaviors of akathisia are walking without stopping, getting up and sitting down repeatedly, tapping the fingers, rocking the trunk, crossing the legs or making complaining sounds.
These signs occur in reaction to sensations of physical tension and diffuse pain. Other neuropathic disorders, such as restless legs syndrome and some cases of fibromyalgia, cause symptoms similar to those of akathisia, so they are sometimes misdiagnosed.
According to patients, constant movement helps to alleviate physical discomfort and pain to some extent; For example, walking and crossing or stretching your legs somewhat reduces uncomfortable sensations in your knees.
Psychological symptoms of akathisia
On a cognitive and emotional level symptoms such as dysphoria stand out (unpleasant feelings opposite to euphoria), worry, irritability, emotional instability and the presence of gloomy thoughts.
The sensations become so annoying that many patients report that they make them want to crawl out of their skin and even tear it off. People with drug-induced akathisia tend to reject them and firmly state that they are the cause of the discomfort, comparable to chemical torture.
The presence of other anxious symptoms associated with restlessness is also common; In people with akathisia, the probability of suffering insomnia and difficulties falling asleep, as well as panic attacks as a consequence of intense psychophysiological activation, increases.
Causes and risk factors
Akathisia is usually related to a alteration in dopamine levels a neurotransmitter involved in movement and many other functions, such as pleasure, learning, and motivation.
Therefore, the substances that cause this syndrome are above all those that block the action of dopamine in the central nervous system, that is, dopamine antagonists. However, akathisia can also be due to other causes.
1. Antipsychotic drugs
Akathisia has been described with great frequency in people undergoing long-term treatment with antipsychotics, especially the typical or first generation ones which block dopamine D2 receptors. It can occur as a side effect due to the potency of the drug, excessive dosage, or withdrawal.
Some of the antipsychotics that carry an increased risk of developing akathisia and other extrapyramidal symptoms include haloperidol, chlorpromazine, thiothixene, zuclopenthixol, olanzapine, and risperidone.
2. Antidepressant drugs
Not only can dopamine reduction cause akathisia, but so can the increase in serotonin levels. Thus, some serotonergic drugs that are mainly used to treat depression are related to the appearance of this syndrome.
Among the antidepressants that cause akathisia SSRIs or selective serotonin reuptake inhibitors stand out such as paroxetine, fluoxetine and sertraline, and tricyclics, such as clomipramine and amitriptyline. Venlafaxine, which inhibits the reuptake of serotonin and norepinephrine, has also been associated with symptoms of akathisia.
3. Abstinence from drugs and substances
When there is physical dependence on drugs or dopaminergic drugs, stopping consumption frequently causes akathisia in the context of withdrawal syndrome.
This happens with antipsychotics and antidepressants, described in the previous sections, but also with alcohol, cannabis, cocaine and opiates like heroin. Amphetamine stimulants have effects similar to those of cocaine, and barbiturates and benzodiazepines to those of alcohol.
Other medications that can cause akathisia to occur are antiemetics, antihistamines and analgesics used to treat migraine. In general, the higher the potency of the drug, the greater the likelihood of adverse reactions.
5. Parkinson’s disease
Akathisia has also been associated with Parkinson’s disease, which progressively deteriorates the central nervous system and is characterized mainly by motor, cognitive and emotional symptoms.
However, in these cases it is not always clear whether the akathisia is due to the disorder itself or to the medications used to treat it, since they often alter the action of dopamine. Levodopa is the most common drug in the management of Parkinson’s disease.
