The Assessment and Treatment of Antipsychotic-Induced Akathisia

Tamara Pringsheim; David Gardner; Donald Addington; Davide Martino; Francesca Morgante; Lucia Ricciardi; Norman Poole; Gary Remington; Mark Edwards; Alan Carson; Thomas R.E. Barnes

doi:10.1177/0706743718760288

The Assessment and Treatment of Antipsychotic-Induced Akathisia

Tamara Pringsheim^*, David Gardner, Donald Addington, Davide Martino, Francesca Morgante, Lucia Ricciardi, Norman Poole, Gary Remington, Mark Edwards, Alan Carson, Thomas R.E. Barnes

^*Corresponding author for this work

Basic and Clinical Neuroscience

Research output: Contribution to journal › Review article › peer-review

44 Citations (Scopus)

Abstract

Background: Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia. Methods: We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework. Results: As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT _2A antagonists, benzodiazepines, and vitamin B6. Conclusion: The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.

Original language	English
Pages (from-to)	719-729
Number of pages	11
Journal	Canadian Journal of Psychiatry
Volume	63
Issue number	11
DOIs	https://doi.org/10.1177/0706743718760288
Publication status	Published - 1 Nov 2018

Keywords

antipsychotics
evidence-based medicine
extrapyramidal syndromes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/0706743718760288

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title = "The Assessment and Treatment of Antipsychotic-Induced Akathisia",

abstract = " Background: Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia. Methods: We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework. Results: As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT 2A antagonists, benzodiazepines, and vitamin B6. Conclusion: The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.",

keywords = "antipsychotics, evidence-based medicine, extrapyramidal syndromes",

author = "Tamara Pringsheim and David Gardner and Donald Addington and Davide Martino and Francesca Morgante and Lucia Ricciardi and Norman Poole and Gary Remington and Mark Edwards and Alan Carson and Barnes, {Thomas R.E.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2018.",

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doi = "10.1177/0706743718760288",

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AU - Pringsheim, Tamara

AU - Gardner, David

AU - Addington, Donald

AU - Martino, Davide

AU - Morgante, Francesca

AU - Ricciardi, Lucia

AU - Poole, Norman

AU - Remington, Gary

AU - Edwards, Mark

AU - Carson, Alan

AU - Barnes, Thomas R.E.

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N2 - Background: Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia. Methods: We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework. Results: As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT 2A antagonists, benzodiazepines, and vitamin B6. Conclusion: The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.

AB - Background: Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia. Methods: We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework. Results: As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT 2A antagonists, benzodiazepines, and vitamin B6. Conclusion: The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.

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JO - Canadian Journal of Psychiatry

JF - Canadian Journal of Psychiatry

IS - 11

ER -

The Assessment and Treatment of Antipsychotic-Induced Akathisia

Abstract

Keywords

UN SDGs

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