Diagnosing And Treating Akathisia
Akathisia is a disorder where the patient feels compelled to move at all times. The need is especially urgent in their legs. Individuals who have this condition basically cannot sit still, and this inability gives the illness its name. Patients tap and stomp their feet, fidget, cross, uncross and shuffle their legs, or pace the floor. In many cases, the movement only stops when the patient's legs or feet are too tired to move.
But even when the individual rests, they still feel the compulsion to keep moving. Other akathisia patients feel as if they are going to jump out of their skin or suffer from bouts of panic. Akathisia is often a side effect of medication taken for conditions such as schizophrenia, especially older antipsychotics.
Physical Exam And Rule Out Other Conditions
Not everyone who is afflicted with restlessness has akathisia. Restless leg syndrome, for example, is a disorder where the patient has a nearly uncontrollable compulsion to move their legs. The urge is made worse when the patient lies down and is worse at night when they are trying to sleep. Other conditions that might mimic akathisia are periodic limb movement disorder and tardive dyskinesia, a disorder where the patient is subject to involuntary bodily movements that often involve the face.
A diagnosis of akathisia requires the doctor to note how the patient moves their body, especially their legs and feet, listen to the patient's description of their symptoms, conduct a physical exam, and rule out other conditions. The Barnes Akathisia rating scale helps with the diagnosis and gives the doctor an idea of the severity of the problem.
Change In Antipsychotic Medication
If the akathisia is a side effect of a medication, it may be eased by a change in antipsychotic medication. The doctor may taper the patient off the old medication and prescribe another one to treat their symptoms. If the patient must be on an antipsychotic medication, the doctor might switch them to a newer type. These newer antipsychotic medications have a lower risk for akathisia, though they are not risk-free.
The best practice is for the doctor to prescribe the smallest effective dose initially and increase the dosage over time should it be necessary. Other medications used to treat akathisia are those that block the parasympathetic nerve impulses that control involuntary muscles, as well as high blood pressure and anti-viral medications.
Beta-Blockers
Other medications effective at relieving akathisia are beta-blockers or beta-adrenergic antagonists. They are often the first medication doctors recommend for their patients with akathisia. Scientists do not know exactly how beta-blockers work, but they probably block the neurotransmitters that affect dopamine pathways. The usual dose of beta-blocker is between ten and thirty milligrams taken three times a day.
They are contraindicated for patients who have respiratory problems such as asthma or chronic obstructive pulmonary disease because beta antagonists also cause the airways to narrow. Even if the patient does not have these problems, a beta antagonist needs to be taken under a doctor's supervision. Some of these cause a drop in both heart rate and blood pressure.
Antidepressants
Antidepressants are also used to treat akathisia, even though there are types of antidepressants that can put a patient at risk for the disorder in the first place. However, some have been shown to be effective at relieving the symptoms of akathisia, such as mirtazapine, which is taken orally in tablet form and is prescribed by the doctor. As with beta antagonists, doctors do not know how mirtazapine works, though it may raise levels of the neurotransmitter serotonin in the brain. Interestingly, doctors believe akathisia itself may be caused by an imbalance between serotonin and dopamine in the central nervous system.
Vitamin B6
Vitamin B6 is one of the B-complex vitamins. It is a water-soluble vitamin, which means its excreted in the urine and needs to be taken regularly even if the individual taking it does not have a medical condition. Vitamin B6 has also been shown to be an effective treatment for akathisia. Patients who took the vitamin had improved physical and psychological symptoms after taking six hundred milligrams a day by mouth twice a day for about nine months.
Doctors also noticed they improved on the Barnes Akathisia rating scale. It is not known exactly how pyridoxine works, but in healthy individuals, it supports the functioning of DNA and RNA, balances sodium and potassium in the body, and helps the normal functioning of the musculoskeletal and nervous systems.