Akathisia

Akathisia is a pronounced syndrome of constant anxiety and reluctance to sit in one place. In this state, a person can not stay in one position for a long time, he needs to constantly move. He is able to take the same pose for a long time. This leads to constant discomfort. This pathology is manifested by a number of motor disorders. There are also sensory disorders.

[1], [2], [3], [4], [5]

Causes of the akathisia

It has long been recognized that the main source of the development of the disease is associated with a violation of the normal functioning of the visual portion of the cerebral cortex. Relatively affected and systems classified as limbic. This manifestation is correlated with a change in the sensitivity and irritability of most receptors. This can be a noradrenergic and dopaminergic system. The subcortical structure of the brain lends itself to a negative influence.

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

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

[6], [7], [8],

Akathisia caused by neuroleptics

Akathisia caused by neuroleptics develops mainly in patients who take typical drugs like dopamine receptors. Lead to negative consequences can serve as an increased dose, as well as a rapid increase in dosage.

To cause akathisia is also atypical antipsychotics. This is especially dangerous for patients who have affective disorders. A greater risk of side effects in this case is present. The risk group includes middle-aged people and the female sex. With organic brain lesions and the systematic use of alcohol, the likelihood of developing acacia is increased.

The symptomatology of the disease includes sensory and motor components. The first type includes uncomfortable inner sensations. At the same time, a person understands that discomfort causes him to act. True, it is not possible to finally describe what he feels. Sensations can carry a general character. These include anxiety, irritability and internal tension.

The second component is predominantly motor, it is characterized by movements that are repetitive in nature. The patient starts to fidget in the chair, constantly change his posture, toss his foot on his leg and repeat a series of continuous actions. Everything happens consciously, a person simply can not stop. Patients often shift from one foot to the other, spring on their socks or march on the ground.

This disease often becomes the reason for ignoring patients with a special regimen for taking medication. Constant discomfort can increase due to thoughts of suicide. Even a mild form of the disease brings a lot of discomfort. It leads to the refusal of the patient to take medicine and causes the neglect of the disease. Often on this basis, there are acts of violence and suicide.

[9], [10], [11], [12]

Pathogenesis

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

[13], [14], [15]

Symptoms of the akathisia

Symptoms of akathisia are diverse, but mostly manifested in the form of anxiety and irritability. As mentioned above, the disease has two main components. One component of them is decisive, the subsequent one is not so obvious.

The first component is called sensory. It is characterized by a manifestation of acute internal discomfort. It is they who induce 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 shows itself usually with a vague internal fear, constant tension, often changing mood, increased irritability. Often the patient also has pain in the lower extremities.

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

[16]

Akathisia and insomnia

Akathisia and insomnia are two symptoms that "walk" with each other. Due to violations in the brain, a person gradually stops controlling his actions. He can not sit still and must therefore be in motion.

If the patient does not sleep, his strength will run out quickly. 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 can start attending suicidal thoughts. If you do not start to fix the problem in the early stages, then eventually it will lead to an intractable form of the disease. It is characterized by a violent attitude towards one's own body and a desire to commit suicide.

[17], [18], [19], [20], [21], [22], [23],

Diagnostics of the akathisia

Diagnosis of akathisia is a rather serious process. The fact is that it is difficult for patients to express their feelings, especially to describe them. Therefore, they can not tell the doctor that they are worried about them. Indications are constantly changing. This simply misleads the doctor. After all, the description can cause both a suspicion of a simulation, and lead to an incorrect diagnosis. But the problem is also that all this leads the patient into a rage. Therefore, he tries to give the doctor all the false testimony.

Sensations of the patient simply lead him into a state of despair and neurasthenia. After all, he can not really explain what is happening to him. This often leads to depressive inclinations, up to the desire to commit suicide. In such a situation, the doctor must apply all his knowledge. After all, he should not only identify the type of disorder in a person, but also understand the reason for this action. Moreover, you need to relate everything to the taking of specific drugs and anamnesis.

[24], [25], [26], [27]

Burns akathisia scale

Scale akatizii Burns allows you to determine what state a person is, or rather characterize it. For the test, you need to examine the patient. A person must take a sitting position, then a free form (at least 2 minutes in each position). Identified in another situation, the symptoms should also be documented. Subsequently, with the help of direct conversation, the sensations that the patient experiences should be revealed.

Based on the results obtained, conclusions are drawn. So, 0 - normal articular movements. At 1 - motor anxiety is observed. The person starts shuffling his feet, stepping from one foot to the other, hanging around. When 2 - identify the above symptoms. For 3, the intensity of movements is characteristic. The patient is unable to remain stationary during the entire examination.

If you look at the test from the patient's awareness of motor anxiety, then 0 means his complete absence. For 1 is characterized by unintentional anxiety. At 2 it is impossible to keep your feet at rest. For 3 - a constant desire to stay in motion.

As for the experience of motor anxiety, then at zero it is absent, at 1 - weak, 2 - average, 3 - expressed. There is also a global assessment of the human condition, with 1 - doubtful, 2 - mild, 3 - average, 4 - distinct, 5 - pronounced.

[28], [29]

Treatment of the akathisia

The treatment of akathisia is individual and is prescribed only after examination. The best and only true way is a complete cancellation or a significant reduction in the dosage of the medication used, which caused unpleasant symptoms. True, this can not always be done, and there are objective reasons for this. This is mainly due to the mental health of the patient. With the withdrawal of used drugs, his state of health can deteriorate sharply.

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

There are several basic ways to eliminate the disease. Antiparkinsonian drugs are actively used. Among them are Biperiden, Benztropin and Trihexyphenidyl. These drugs are usually prescribed in parallel with antipsychotics to prevent the disease or eliminate their unexpected side effects. 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, Dimeadrol, Atarax and Amitriptyline are suitable. An additional plus in using medication data is that they have ways to have a sedative effect and thereby calm the person. Means reduce excitement, internal tension and insomnia. Doses are assigned individually.
• Tranquilizers. They significantly reduce the activity of the disease. These drugs save the patient from a sense of anxiety, constant insomnia and spontaneously arising excitement. They are mainly prescribed in those rare cases when it is not possible for the medical worker 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 are able to reduce the effect of neuroleptics, reduce anxiety.
• Anticonvulsants. Often, with acacia, they have a good effect. Among the recommended drugs include Valproate, Gabapentin and Pregabalin. They have a pronounced anti-anxiety activity.
• Weak opioids. Weak opioids are considered to be particularly effective in akathisia. These include Codeine, Propoxyphene, Hydrocodone.
• Treatment of late form of akathisia. With this form, it is worth repealing the main drug and replacing it with an atypical antipsychotic. In this case, Clozapine and Olanzapine are suitable. Dosages of all the above medicines are prescribed by a doctor. The standard treatment scheme does not exist.

Treatment of akathisia by alternative means

Treatment of akathisia using alternative means 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 serious consequences.

But, despite this, there are some good home recipes. The first is aimed at removing increased excitability. For its preparation it is necessary to take 150 ml of flower baskets of ordinary chamomile, 100 ml of flowers of hawthorn prickly, grass of dried flowers and coronals of motherwort. All this is carefully mixed together and taken one tablespoon an hour after eating.

Another recipe implies the use of the roots of goose eye goose and hemlock in a 1: 1 ratio. In total, 4 tablespoons of this collection are taken and filled with a liter of water. After that, everything is boiled. Tincture should be left for the night. Take 100 grams 4 times a day before a snack or a full meal.

In order to improve the overall condition, it is worth brewing 2 tablespoons finely chopped roots of wild rose, pour a glass of water and boil over low heat for 20 minutes. After that, the broth should be allowed to cool, then strain it. Drink the remedy 30 minutes before meals, half the glass.

Phenazepam in akathisia

Often, patients are prescribed phenazepam for akathisia. The medicine perfectly fights with various neurotic, neurotic-like and psychotic states. Phenazepam has a sedative effect, and mainly anti-anxiety action. Not many neuroleptics are able to have such a result.

Assign the medication as tablets, for ingestion. In the outpatient conditions, 0.25-0.5 mg 2-3 times a day is enough. If a person is in the hospital, then take 3-5 mg. With the elimination of epilepsy, the daily dose can be significantly increased, eventually it is 2-10 mg.

Despite its high effectiveness, the drug can cause a number of side effects. These include the violation of normal coordination of movements, muscle weakness, drowsiness and dizziness. There are also contra-indications. Use the remedy is not possible with muscle weakness and severe impairment of kidney and liver function. Naturally, during pregnancy, medication is not taken.

Prevention

Prevention of akathisia is to limit the use of typical antipsychotics. Especially in those situations when they are contraindicated. This applies to patients with severe affective disorders.

Before starting an antipsychotic therapy, a doctor should carefully examine the patient. After all, incorrectly selected treatment can cause the development of extrapyramidal disorders in humans. If the patient is taking antipsychotics, he should be examined frequently and monitored for his condition. After the slightest excess of a dose can lead to the development of acacia. To prevent this process can both relatives of the patient, and he himself. It is important to monitor his condition and, at the appearance of strange symptoms, immediately send a person to an appointment with a specialist.

Neuroleptics often cause disturbances in consciousness. They are able to act in the opposite direction. Instead of calming the person, the medicines cause him to have an increased excitability. It is necessary to fight this state correctly. Best of all, do not let him. A timely call to a doctor and a properly calculated dose will never lead to the development of acacia.

[30], [31], [32], [33], [34], [35]

Forecast

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

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

Naturally, to say that everything will be good or bad is difficult. As mentioned above, it all depends on the degree of the disease. The first form requires constant control over the patient. It is morally difficult to transfer all these hardships, but, nevertheless, favorable forecasts in this case are great. The second form is more optimistic, but, all the same, it requires considerable control. It is necessary not to make mistakes with medications for treatment, constantly monitor patients and provide assistance to them. In this case, the outlook will be favorable.

[36], [37], [38], [39]