What is akithisia?
According to Lohr et al (2015) ‘’Akathisia is one of the most vexing problems in neuropsychiatry. Although it is one of the most common side effects of antipsychotic medications, it is often difficult to describe by patients, and is difficult to diagnose and treat by practitioners.’’ Additionally, ‘’akathisia is generally either underdiagnosed or misdiagnosed, which is a serious problem because it can lead to such adverse outcomes as poor adherence to medications, exacerbation of psychiatric symptoms, and, in some cases, aggression, violence, and suicide.’’ (Lohr et al, 2015).
‘’Akathisia is usually grouped with extrapyramidal movement disorders (ie, movement disorders that originate outside the pyramidal or corticospinal tracts and generally involve the basal ganglia). Yet, it can present as a purely subjective clinical complaint, without overt movement abnormalities.’’ (Lohr et al, 2015).
In Van Putten (1975)’s The many faces of Akathisia, it is stated that akathisia ‘’can be mistaken for an exacerbation of the original mental illness.‘’
‘’The inner agitation of akathisia is always subjectively stressful. Kalinowsky15 states that akathisia can be “more difficult to endure than any of the symptoms
for which [the patient] was originally treated” (Van Putten, 1975).
In my opinion (as someone who is not a healthcare professional), Van Putten’s article is outdated and incorrect in many respects.
However, as a patient who has experienced akathisia many times - I believe that it is worth thoroughly screening psychiatric patients for akathisia. In my own experience, clinicians often fail to recognise akathisia unless it fits within a very narrow interpretation (a patient pacing or being visibly restless/agitated). While this is certainly an indication of akathisia, it can also present in very subtle ways (whilst being excruciatingly painful).
I think that it may manifest in vastly different ways depending on how different individuals express feelings of distress. In some individuals, it may be invisible.
I believe that further research into patients’ subjective experiences of akathisia would be beneficial.
It is fairly easy to treat.
I also believe that patients taking psychiatric medication should be educated about akathisia and tardive dyskinesia. Many patients have no idea about these conditions, and therefore do not recognise symptoms as they arise. They may believe that their condition is deteriorating, without realising that there is a fairly simple solution which could alleviate some of their suffering (or a great deal of their suffering).
References:
Lohr, J. B., Eidt, C. A., Abdulrazzaq Alfaraj, A., & Soliman, M. A. (2015). The clinical challenges of akathisia. CNS Spectrums, 20(S1), 1–16. doi.org/10.1017/S1092852915000838
Van Putten, T. (1975). The many faces of Akathisia. Comprehensive Psychiatry, 16(1), 43–47. doi.org/https://doi.org/10.1016/0010-440X(75)90019-X
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