Psychiatria pre prax 4/2021

Antipsychotic-induced akathisia and its management

Antipsychotic-induced akathisia is a clinically relevant neuropsychiatric condition and typically presents as psychomotor restlessness. Basically, it is defined as an inability to remain still accompanied by inner turmoil. The exact pathophysiology is not very well known, but it is believed that there is an imbalance of monoaminergic neurotransmission, most likely between the core and the shell of the nucleus accumbens. Akathisia may be managed by different treatment approaches, including antipsychotic dose reduction, switching to other medication or adding beta-blockers, benzodiazepines, anticholinergic agents or serotonergic 5-HT 2A antagonists. However, early identification and management are critical as antipsychotic-induced akathisia is strongly associated with treatment nonadherence.

Keywords: antipsychotics, akathisia, beta-blockers, anticholinergic drugs, mirtazapine