Akathisia (psychomotor agitation): what it is, symptoms and causes

Restlessness and anxiety are common symptoms of the use and withdrawal of some medications and drugs. Akathisia is a particular case of psychomotor agitation which causes feelings 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.

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What is akathisia?

Akathisia is a syndrome characterized by a feeling of constant restlessness, both physiologically and mentally. This term is used mainly to describe adverse reactions to certain psychoactive substances or symptoms derived from the interruption of their consumption.

It manifests as an emotional state of the anxious type that can include only cognitive symptoms or also physical signs, mainly related to the need to stay in motion.

The word "akathisia" comes from the 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’akathisie, in 1901.

Although the akathisia is commonly associated with the use of typical antipsychotics As the haloperidol or drug withdrawal, it can also be caused by other medications and substances, as well as some types of brain injury.

• Related article: "Types of antipsychotics (or neuroleptics)"

Physical signs and clinical picture

Continual feelings of agitation are the cardinal symptom of akathisia. Depending on the intensity of the syndrome, this anxiety can manifest as psychological restlessness or even produce a extreme body discomfort. In particular, a large number of patients with akathisia describe discomfort and pain in the knees.

In many cases the 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, swinging the trunk, crossing the legs, or making complaining sounds.

These signs occur in reaction to feelings 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, which is why they are sometimes misdiagnosed wrong.

According to patients, constant movement helps to alleviate physical discomfort and pain to some extent; For example, walking and crossing or stretching the legs reduces uncomfortable sensations in the knees somewhat.

Psychological symptoms of akathisia

On a cognitive and emotional level symptoms such as dysphoria stand out (unpleasant feelings as opposed to euphoria), worry, irritability, emotional instability and the presence of dark thoughts.

The sensations become so annoying that many patients claim that they make them want to get out of their skin and even rip it off. People with drug-induced akathisia tend to reject drugs and strongly state that drugs are the cause of the discomfort, comparable to chemical torture.

Other anxious symptoms associated with restlessness are also common; in people with akathisia, the probability of suffering insomnia and difficulties falling asleep, as well as panic attacks as a consequence of the 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 mainly those that block the action of the 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 typical or first generation, which block dopamine D2 receptors. It can occur as a side effect due to drug potency, overdose, or withdrawal.

Some of the antipsychotics that carry a higher risk of developing akathisia and other symptoms extrapyramidal drugs are haloperidol, chlorpromazine, thiothixene, zuclopenthixol, olanzapine and risperidone.

2. Antidepressant drugs

Not only can the reduction of dopamine cause akathisia, but so can the increase in serotonin levels. Thus, some serotonergic drugs that are used mainly to treat depression are related to the appearance of this syndrome.

Among the antidepressants that cause akathisia the SSRIs or selective serotonin reuptake inhibitors stand out, such as paroxetine, fluoxetine and sertraline, and tricyclics, for example clomipramine and amitriptyline. Venlafaxine, which inhibits the reuptake of serotonin and norepinephrine, has also been associated with symptoms of akathisia.

3. Drug and substance withdrawal

When there is physical dependence on drugs or dopaminergic drugs, the interruption of consumption frequently causes akathisia in the context of the 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.

4. Other medications

Other medications that can cause akathisia include antiemetics, antihistamines, and pain relievers used to treat migraine headaches. 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 above all 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 medicines used to treat it, since they often alter the action of the dopamine. Levodopa is the most common drug in the management of the disease Parkinson's.