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The Assessment and Treatment of Antipsychotic-Induced Akathisia.

Pringsheim, T; Gardner, D; Addington, D; Martino, D; Morgante, F; Ricciardi, L; Poole, N; Remington, G; Edwards, M; Carson, A; et al. Pringsheim, T; Gardner, D; Addington, D; Martino, D; Morgante, F; Ricciardi, L; Poole, N; Remington, G; Edwards, M; Carson, A; Barnes, TRE (2018) The Assessment and Treatment of Antipsychotic-Induced Akathisia. Can J Psychiatry, 63 (11). pp. 719-729. ISSN 1497-0015 https://doi.org/10.1177/0706743718760288
SGUL Authors: Edwards, Mark John James Morgante, Francesca Ricciardi, Lucia

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Abstract

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. 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. 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, 5HT2A antagonists, benzodiazepines, and vitamin B6. 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.

Item Type: Article
Additional Information: Pringsheim, T; Gardner, D; Addington, D; Martino, D; Morgante, F; Ricciardi, L; Poole, N; Remington, G; Edwards, M; Carson, A; et al., The Assessment and Treatment of Antipsychotic-Induced Akathisia, The Canadian Journal of Psychiatry (Volume: 63 issue: 11) pp. 719-729. Copyright © 2018 (The Author(s)). DOI: 10.1177/0706743718760288
Keywords: antipsychotics, evidence-based medicine, extrapyramidal syndromes, antipsychotics, extrapyramidal syndromes, evidence-based medicine, antipsychotics, evidence-based medicine, extrapyramidal syndromes, 11 Medical And Health Sciences, 17 Psychology And Cognitive Sciences, Psychiatry
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Can J Psychiatry
ISSN: 1497-0015
Language: eng
Dates:
DateEvent
1 November 2018Published
23 April 2018Published Online
1 April 2018Accepted
Publisher License: Publisher's own licence
PubMed ID: 29685069
Web of Science ID: WOS:000453467200002
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111003
Publisher's version: https://doi.org/10.1177/0706743718760288

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