Definition
Definition
Akathisia is the inability of some patients to remain seated or maintain the same position.
For some neuropsychiatrists, this term also refers to the inability of a patient to remain still for a few moments without feeling the need to walk or move.
Symptoms
Symptoms
Symptoms of akathisia are:
- The patient has the need to move, to walk, to stir constantly.
- Upon awakening, which is also disturbed in the majority of cases, some patients present with an increase in movements.
- The activity appears to slightly improve the clinical picture.
Pathophysiology
This constant need to move can be observed in:
- Le restless leg syndrome.
- La Parkinson's disease.
- When the patient takes certain neuroleptiques.
Medical exam
Physical examination
- The interrogation most often highlights the taking of psychotropic drugs (intended for the nervous system), antiemetics (to prevent vomiting).
- The interrogation also shows difficulty falling asleep, and an accentuation of symptoms in the evening.
Cause
Cause
The most common cause of akathisia is taking medications, and more precisely neuroleptiques. Other drugs are also responsible for the occurrence of akathisia, these are (non-exhaustive list):
- D'antiemetics (medications to prevent the patient from vomiting).
- D'Antidepressants belonging to the tricyclic or serotonergic family,
- D'antiparkinsonian drugs.
Although recent antidepressants are less likely to cause akathisia, it is nevertheless necessary to be careful of the harmful effects of this medication.
Treatment
Treatment
The treatments for akathisia are:
- The first treatment involves removing the drug that causes the “abnormal” movements.
- Some psychiatric specialists advocate the use of benzodiazepines, but only orally (in the form of tablets), never by injection. Indeed, in these conditions, there is a risk of cardio-respiratory disturbances occurring, requiring intensive care, which is not always possible in an emergency, especially when the treatment is carried out as part of a general medical consultation, for example.
- The management of this condition requires a psychological and psycho-behavioral approach.
- Verbalization (expressing oneself through language) most often allows the patient to progress favorably.
- The search for psychoaffective antecedents, dating back to childhood, as well as the patient's aggression through a relational disturbance with his relatives, his friends, his close circle, in general.
- Solving these problems has the advantage of also improving akathisia.
Evolution
Evolution
When the offending medication is stopped, the patient's symptoms decrease, sometimes stop.
Differential diagnosis
- Akathisia should not be confused with other psychiatric conditions, mainly of the schizophrenic type.
- Withdrawal during alcohol intoxication can sometimes give clinical pictures similar to those of akathisia. Questioning, if the patient does not deny his intoxication, allows the diagnosis to be guided.
- Restless legs syndrome is difficult to confuse with akathisia because in this condition, only the lower limbs are affected by repetitive movements.
- During tics, or the Tourette's disease, the gestures are clearer, faster, repetitive, and less often concern the lower limbs. On the other hand, tics are generally accompanied by the emission of sounds, or movements of the head, and more precisely of the face. This is the syndrome which is undoubtedly the most difficult to distinguish from akathisia. Indeed, it is possible, with the patient's agreement, to stop the tics for a few moments, most often for a short period.