Akathisie

Akathisia is a movement disorder defined by an inner sense of restlessness and a compelling urge to move, often accompanied by observable fidgeting, pacing, rocking, or inability to sit still. It is most commonly associated with medications that affect dopamine signaling in the brain, particularly antipsychotics that block D2 receptors. It can also occur with other dopamine-blocking drugs and, less frequently, with certain antidepressants or other medications.

The condition usually emerges after starting or increasing the dose of a causative drug, but it can appear at any time during treatment. Risk factors include higher drug dose, rapid dose changes, and a history of movement disorders. Symptoms can range from mild to severe and may cause significant distress, anxiety, insomnia, and functional impairment.

The prevailing view of its pathophysiology involves reduced dopaminergic activity in the nigrostriatal pathway, with possible contributions from serotonergic systems and other neural networks. The exact mechanisms remain incompletely understood.

Diagnosis is clinical, based on history and examination. There is no laboratory test for akathisia. Clinicians may use standardized scales such as the Barnes Akathisia Rating Scale to quantify severity and monitor response. Differential diagnosis includes anxiety disorders, agitation, obsessive-compulsive symptoms, and other drug-induced movement disorders.

Management starts with addressing the offending drug—reducing the dose, discontinuing the agent, or switching to a different medication with a lower risk of akathisia. Symptomatic treatment commonly includes propranolol or a benzodiazepine for short-term relief; sometimes anticholinergic agents are used. In refractory cases, VMAT2 inhibitors such as tetrabenazine, valbenazine, or deutetrabenazine may be considered. Ongoing monitoring and adjustment of psychiatry treatment are essential to reduce recurrence.