Akathisia

Akathisia is a pronounced syndrome of constant anxiety and unwillingness to sit still. In this condition, a person cannot stay in one position for a long time; he needs to move constantly. He is able to take the same position for a long time. This leads to constant discomfort. This pathology manifests itself in a number of movement disorders. Sensory disorders also occur.

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Causes akathisias

It has long been recognized that the main source of the disease development is associated with the disruption of the normal functioning of the visual part of the cerebral cortex. The systems classified as limbic also suffer relatively. Such a manifestation is compared with a change in the sensitivity and irritability of most receptors. This may be the noradrenergic and dopaminergic system. The subcortical structure of the brain is subject to negative influence.

This manifestation is considered quite common for patients who have to take neuroleptic and antiemetic drugs or antidepressants of various groups and psychostimulants. This symptom can also develop with severe drug addiction. There have been cases of pathology development against the background of iron deficiency in the body, Parkinson's disease, gas poisoning.

It is impossible to single out the causes of the problem's development. They are associated with serious disorders that may arise due to heredity and the influence of negative factors.

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Neuroleptic-induced akathisia

Neuroleptic-induced akathisia occurs primarily in patients taking typical dopamine receptor-like drugs. High doses and rapid increases in dosage can lead to adverse effects.

Atypical antipsychotics can also cause akathisia. This is especially dangerous for patients with affective disorders. There is a high risk of side effects in this case. Middle-aged people and women are at risk. With organic brain damage and systematic alcohol consumption, the likelihood of developing akathisia increases.

The symptoms of the disease include sensory and motor components. The first type includes uncomfortable internal sensations. At the same time, a person understands that it is discomfort that motivates him to act. However, it is impossible to definitively describe what he feels. The sensations can be general in nature. These include anxiety, irritability, and internal tension.

The second component is primarily motor, characterized by movements that are repetitive. The patient begins to fidget in the chair, constantly change their position, cross their legs and repeat a series of continuous actions. Everything happens consciously, the person simply cannot stop. Patients often shift from one foot to the other, bounce on their toes or march in place.

This disease often causes the patient to ignore the special regimen of taking medications. Constant discomfort can be aggravated by thoughts of suicide. Even a mild form of the disease brings a lot of discomfort. It leads to the patient's refusal to take medications and causes the disease to become neglected. Often, acts of violence and suicide occur on this basis.

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Pathogenesis

How and what causes the pathogenic causes of akathisia has not yet been reliably studied.

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Symptoms akathisias

The symptoms of akathisia are varied, but mostly manifest as anxiety and irritability. As mentioned above, the disease has two main components. One component is decisive, while the other is less obvious.

The first component is called sensory. It is characterized by the manifestation of acute internal discomfort. It is they that motivate a person to perform certain specific actions. They are always carried out consciously, sometimes even under the control of the patient himself. The sensory component usually manifests itself as a vague internal fear, constant tension, frequently changing mood, increased irritability. Often the patient also experiences pain in the lower extremities.

The second component is called motor. A person constantly repeats a specific movement. Each patient has his own set of movements, and they rarely repeat themselves. Some people walk incessantly, others can dance in place, others swing their bodies chaotically, others jump on a chair, etc. Often, as soon as they start moving, patients scream and moo loudly. As soon as the peak of activity begins to subside, the sounds disappear.

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Akathisia and insomnia

Akathisia and insomnia are two symptoms that "go" together. Due to disturbances in the brain, a person gradually ceases to control his actions. He cannot sit still and therefore must be on the move.

If the patient does not sleep, his strength will quickly run out. But, due to the fact that a person constantly needs to move, he will spend energy and will feel much worse. Without rest, the patient may begin to have suicidal thoughts. If you do not start to eliminate the problem at an early stage, then over time it will lead to an advanced form of the disease. It is characterized by a violent attitude towards one's own body and a desire to commit suicide.

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Diagnostics akathisias

Diagnosis of akathisia is quite a serious process. The thing is that it is difficult for patients to express their feelings, much less describe them. Therefore, they cannot tell the doctor what is bothering them. The indications are constantly subject to change. This simply misleads the doctor. After all, the description can both raise suspicions of simulation and lead to an incorrect diagnosis. But the problem is that all this makes the patient furious. Therefore, he tries with all his might to give the doctor false indications.

The patient's feelings simply lead him to a state of despair and neurasthenia. After all, he cannot really explain what is happening to him. This often leads to the emergence of depressive tendencies, up to the desire to commit suicide. In such a situation, the doctor must apply all his knowledge. After all, he must not only identify the type of disorder in a person, but also understand the reason for this action. Moreover, it is necessary to connect everything with the intake of specific drugs and anamnesis.

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Burns Akathisia Scale

The Burns Akathisia Scale allows you to determine the state of a person, to characterize it more precisely. To conduct the test, you need to examine the patient. The person needs to take a sitting position, then a free form (at least 2 minutes in each position). Symptoms identified in another situation should also be recorded. Subsequently, with the help of a direct conversation, the sensations that the patient experiences should be identified.

Based on the results obtained, conclusions are made. Thus, 0 - normal joint movements. At 1 - motor restlessness is observed. The person begins to shuffle his feet, shift from foot to foot, and stamp his feet. At 2 - the symptoms described above are revealed. For 3, the severity of movements is characteristic. The patient is unable to remain motionless throughout the examination.

If we look at the test from the point of view of the patient's awareness of motor restlessness, then 0 means its complete absence. For 1, unconscious restlessness is characteristic. At 2, there is an inability to keep the legs in a state of rest. For 3, there is a constant desire to remain in motion.

As for the experience of motor restlessness, at zero it is absent, at 1 – weak, 2 – average, 3 – pronounced. There is also a global assessment of the person’s condition, at 1 – doubtful, 2 – weak, 3 – average, 4 – distinct, 5 – pronounced.

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Treatment akathisias

Treatment of akathisia is individual and is prescribed only after examination. The best and only correct way is to completely cancel or significantly reduce the dosage of the medication used, which caused the unpleasant symptoms. However, this is not always possible, and there are objective reasons for this. This is mainly due to the mental health of the patient. When the drugs used are canceled, his health may deteriorate sharply.

The main component of treatment is the prescription of drugs that can enhance the effect of antipsychotics or antidepressants without causing their pronounced side effects. This will significantly reduce the doses of medications that provoke akathisia.

There are several main ways to eliminate the disease. Antiparkinsonian drugs are actively used. These include Biperiden, Benztropine and Trihexyphenidyl. These drugs are usually prescribed in parallel with antipsychotics to prevent the disease or eliminate their unexpected side effects. The dosage is prescribed only by the attending physician.

• Antihistamines and anticholinergics. They are not among the powerful drugs with a strong antihistamine effect. But they can be used in treatment. So, Diphenhydramine, Atarax and Amitriptyline are suitable. An additional advantage in using these medications is that they can have a sedative effect and thus calm a person. The drugs reduce agitation, internal tension and insomnia. Doses are prescribed individually.
• Tranquilizers. They significantly reduce the activity of the disease. These drugs save the patient from anxiety, constant insomnia and spontaneously arising excitement. They are mainly prescribed in those rare cases when the medical worker is unable to conduct a detailed diagnosis of the course of the disease.
• Beta blockers. Some experts believe that they are effective in treating the disease. These include Propranolol, Nadolol and Metoprolol. They can reduce the effect of neuroleptics and reduce anxiety.
• Anticonvulsants. They often have a good effect in akathasia. Recommended drugs include Valproate, Gabapentin and Pregabalin. They have a pronounced anti-anxiety effect.
• Weak opioids. Weak opioids are considered particularly effective for akathisia. These include Codeine, Propoxyphene, and Hydrocodone.
• Treatment of late akathisia. In this form, it is worth stopping the main drug and replacing it with an atypical neuroleptic. In this case, Clozapine and Olanzapine will do. The dosage of all the above medications is prescribed by a doctor. There is no standard treatment regimen.

Treatment of akathisia with folk remedies

Treatment of akathisia with folk remedies is used extremely rarely. After all, this is a serious disease that requires a professional approach. If the mild form of the disease is neglected, there is a risk of causing serious consequences.

But, despite this, there are several good home recipes. The first is aimed at relieving increased excitability. To prepare it, take 150 ml of flower baskets of common chamomile, 100 ml of flowers of prickly hawthorn, immortelle grass and motherwort corollas. All this is thoroughly mixed together and taken one tablespoon an hour after eating.

Another recipe involves using the roots of silverweed and hemlock in a 1:1 ratio. Take 4 tablespoons of this mixture and pour in a liter of water. Then bring everything to a boil. Leave the tincture to brew overnight. Take 100 g 4 times a day before a snack or a full meal.

In order to improve the general condition, it is worth brewing 2 tablespoons of finely chopped rose hip roots, pouring them with a glass of water and boiling over low heat for 20 minutes. After that, the decoction should be allowed to cool, then strain it. The remedy should be drunk 30 minutes before meals, half a glass.

Phenazepam for akathisia

Often, patients are prescribed phenazepam for akathisia. The medication is excellent in combating various neurotic, neurosis-like and psychotic conditions. Phenazepam has a sedative effect, and mainly an anti-anxiety effect. Not many neuroleptics are capable of producing such a result.

The medication is prescribed as tablets for oral administration. In outpatient settings, 0.25-0.5 mg 2-3 times a day is sufficient. If a person is in hospital, then 3-5 mg is taken. When eliminating epilepsy, the daily dose can be significantly increased, ultimately it is 2-10 mg.

Despite its high efficiency, the medicine can cause a number of side effects. These include impaired normal coordination of movements, muscle weakness, drowsiness and dizziness. There are also contraindications. The drug cannot be used in case of muscle weakness and severe kidney and liver dysfunction. Naturally, the medicine is not taken during pregnancy.

Prevention

Prevention of akathisia consists of limiting the use of typical neuroleptics. Especially in situations where they are contraindicated. This concerns patients with severe affective disorders.

Before starting antipsychotic therapy, the doctor should carefully examine the patient. After all, incorrectly selected treatment can cause the development of extrapyramidal disorders in a person. If the patient takes neuroleptics, he should be examined frequently and his condition should be monitored. After all, the slightest excess of the dose can lead to the development of akathasia. Both the patient's relatives and the patient himself can prevent this process. It is important to monitor his condition and, if strange symptoms appear, immediately send the person to see a specialist.

Neuroleptics often cause disturbances of consciousness. They can act in the opposite direction. Instead of calming a person, medications cause increased excitability. This condition must be dealt with correctly. It is best not to allow it. Timely visit to a doctor and a correctly calculated dose will never lead to the development of akathasia.

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Forecast

The prognosis of akathisia depends entirely on the form of the disease. Naturally, the causes also play a significant role. It is difficult to make a prognosis with the drug form of the disease. After all, the course of treatment is about 6-8 months. This is a difficult time, the patient's condition must be constantly monitored.

In the abstinence form of akathasia, the prognosis is positive. After all, the duration of treatment is short and does not exceed 20 days. Both cases are variable.

Naturally, it is difficult to say whether everything will be good or bad. As mentioned above, everything depends on the degree of the disease. The first form requires constant monitoring of the patient. It is morally difficult to endure all these hardships, but, nevertheless, favorable prognoses in this case are great. The second form is more optimistic, but still requires considerable monitoring. It is necessary not to make a mistake with medications for treatment, constantly monitor the patient and provide him with assistance. In this case, the prognosis will be favorable.

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