135 - References

References

Schizophrenia and related psychoses CHAPTER 1 Notes ■ ■Akathisia can be difficult to diagnose with certainty and is commonly overlooked or misdiagnosed in clinical practice. Clinical physical examination schedules for EPS and akathisia have been proposed.34,35 ■ ■Evaluate the efficacy of each treatment option over at least 1 month if possible. Some effect may be seen after a few days, but it may take much longer to become apparent in those with chronic akathisia. ■ ■Withdraw previously ineffective add-­on akathisia treatments before starting the next option in the algorithm. ■ ■Combinations of treatments may be considered for refractory cases, if carefully monitored. ■ ■Other possible treatments for acute akathisia that have been investigated include vitamin B6,16,36,37 pregabalin,38 diphenhydramine,39 trazodone25,40 and zolmitriptan.41,42 Always read the primary literature before considering any of the treatment options. ■ ■Parenteral midazolam (1.5mg) has been successfully used to prevent akathisia associated with IV ­metoclopramide,43 suggesting a specific therapeutic effect for midazolam against akathisia and perhaps benzodiazepines more generally. ■ ■In some cases where agitation/akathisia are recognised as short-­lived effects of antipsychotic medication when initiated (e.g. with aripiprazole, cariprazine), prophylactic or rescue benzodiazepines may be prescribed for a limited period. Clinical experience suggests this practice can be effective. (Continued) References

1. Demyttenaere K, et al. Medication-­induced akathisia with newly approved antipsychotics in patients with a severe mental illness: a systematic review and meta-­analysis. CNS Drugs 2019; 33:549–566.
2. Chow CL, et  al. Akathisia and newer second-­generation antipsychotic drugs: a review of current evidence. Pharmacotherapy 2020; 40:565–574.
3. Martino D, et al. Movement disorders associated with antipsychotic medication in people with schizophrenia: an overview of Cochrane reviews and meta-­analysis. Can J Psychiatry 2018; 63:706743718777392.
4. Wu H, et al. Antipsychotic-­induced akathisia in adults with acute schizophrenia: a systematic review and dose-­response meta-­analysis. Eur Neuropsychopharmacol 2023; 72:40–49.
5. Braude WM, et al. Clinical characteristics of akathisia: a systematic investigation of acute psychiatric inpatient admissions. Br J Psychiatry 1983; 143:139–150.
6. Barnes TRE. A rating scale for drug-­induced akathisia. Br J Psychiatry 1989; 154:672–676.
7. Ferré S, et al. Restless legs syndrome, neuroleptic-­induced akathisia, and opioid-­withdrawal restlessness: shared neuronal mechanisms? Sleep 2024; 47:zsad273.
8. Walters AS. Restless legs syndrome, neuroleptic-­induced akathisia, and the iron opioid dopamine link. Sleep 2024; 47:zsae008.
9. Seemuller F, et al. Akathisia and suicidal ideation in first-­episode schizophrenia. J Clin Psychopharmacol 2012; 32:694–698.
10. Seemuller F, et al. The relationship of akathisia with treatment emergent suicidality among patients with first-­episode schizophrenia treated with haloperidol or risperidone. Pharmacopsychiatry 2012; 45:292–296.
11. Miller CH, et al. Managing antipsychotic-­induced acute and chronic akathisia. Drug Saf 2000; 22:73–81.
12. Berardi D, et al. Clinical correlates of akathisia in acute psychiatric inpatients. Int Clin Psychopharmacol 2000; 15:215–219.
13. Yoshimura B, et al. Incidence and predictors of acute akathisia in severely ill patients with first-­episode schizophrenia treated with aripiprazole or risperidone: secondary analysis of an observational study. Psychopharmacology (Berl) 2019; 236:723–730.
14. Pringsheim T, et al. The assessment and treatment of antipsychotic-­induced akathisia. Can J Psychiatry 2018; 63:719–729.
15. Stroup TS, et al. Management of common adverse effects of antipsychotic medications. World Psychiatry 2018; 17:341–356.
16. Gerolymos C, et al. Drug efficacy in the treatment of antipsychotic-­induced akathisia: a systematic review and network meta-­analysis. JAMA Netw Open 2024; 7:e241527.
17. Fleischhacker WW, et al. The pharmacologic treatment of neuroleptic-­induced akathisia. J Clin Psychopharmacol 1990; 10:12–21.
18. Sachdev P. The identification and management of drug-­induced akathisia. CNS Drugs 1995; 4:28–46.
19. Kumar R, et al. Akathisia and second-­generation antipsychotic drugs. Curr Opin Psychiatry 2009; 22:293–299.
20. Miller DD, et al. Extrapyramidal side-­effects of antipsychotics in a randomised trial. Br J Psychiatry 2008; 193:279–288.
21. Rummel-­Kluge C, et al. Second-­generation antipsychotic drugs and extrapyramidal side effects: a systematic review and meta-­analysis of head-­to-­head comparisons. Schizophr Bull 2012; 38:167–177.
22. Kane JM, et al. Akathisia: an updated review focusing on second-­generation antipsychotics. J Clin Psychiatry 2009; 70:627–643.
23. Adler L, et al. A controlled assessment of propranolol in the treatment of neuroleptic-­induced akathisia. Br J Psychiatry 1986; 149:42–45.
24. Fischel T, et al. Cyproheptadine versus propranolol for the treatment of acute neuroleptic-­induced akathisia: a comparative double-­blind study. J Clin Psychopharmacol 2001; 21:612–615.
25. Laoutidis ZG, et al. 5-­HT2A receptor antagonists for the treatment of neuroleptic-­induced akathisia: a systematic review and meta-­analysis. Int J Neuropsychopharmacol 2014; 17:823–832.

134 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 1 26. Poyurovsky M, et  al. Treatment of antipsychotic-­induced akathisia: role of serotonin 5-­HT(2a) receptor antagonists. Drugs 2020; 80:871–882. 27. Poyurovsky M. Acute antipsychotic-­induced akathisia revisited. Br J Psychiatry 2010; 196:89–91. 28. Shams-­Alizadeh N, et al. Trazodone as an alternative treatment for neuroleptic-­associated akathisia: a placebo-­controlled, double-­blind, clinical trial. J Clin Psychopharmacol 2020; 40:611–614. 29. Rathbone J, et al. Anticholinergics for neuroleptic-­induced acute akathisia. Cochrane Database Syst Rev 2006; (4):CD003727. 30. Baskak B, et al. The effectiveness of intramuscular biperiden in acute akathisia: a double-­blind, randomized, placebo-­controlled study. J Clin Psychopharmacol 2007; 27:289–294. 31. Vanegas-­Arroyave N, et  al. An evidence-­based update on anticholinergic use for drug-­induced movement disorders. CNS Drugs 2024; 38:239–254. 32. Weiss D, et al. Cyproheptadine treatment in neuroleptic-­induced akathisia. Br J Psychiatry 1995; 167:483–486. 33. Zubenko GS, et al. Use of clonidine in treating neuroleptic-­induced akathisia. Psychiatry Res 1984; 13:253–259. 34. Gervin M, et al. Assessment of drug-­related movement disorders in schizophrenia. Advances in Psychiatric Treatment 2000; 6:332–341. 35. Cunningham Owens D. A Guide to the Extrapyramidal Side Effects of Antipsychotic Drugs. Cambridge: Cambridge University Press; 1999. 36. Miodownik C, et al. Vitamin B6 versus mianserin and placebo in acute neuroleptic-­induced akathisia: a randomized, double-­blind, controlled study. Clin Neuropharmacol 2006; 29:68–72. 37. Lerner V, et al. Vitamin B6 treatment in acute neuroleptic-­induced akathisia: a randomized, double-­blind, placebo-­controlled study. J Clin Psychiatry 2004; 65:1550–1554. 38. De BD, et  al. Reversal of aripiprazole-­induced tardive akathisia by addition of pregabalin. J Neuropsychiatry Clin Neurosci 2013; 25:E9–E10. 39. Friedman BW, et al. A randomized trial of diphenhydramine as prophylaxis against metoclopramide-­induced akathisia in nauseated emergency department patients. Ann Emerg Med 2009; 53:379–385. 40. Stryjer R, et al. Trazodone for the treatment of neuroleptic-­induced acute akathisia: a placebo-­controlled, double-­blind, crossover study. Clin Neuropharmacol 2010; 33:219–222. 41. Gross-­Isseroff R, et al. The 5-­HT1D receptor agonist zolmitriptan for neuroleptic-­induced akathisia: an open label preliminary study. Int Clin Psychopharmacol 2005; 20:23–25. 42. Avital A, et al. Zolmitriptan compared to propranolol in the treatment of acute neuroleptic-­induced akathisia: a comparative double-­blind study. Eur Neuropsychopharmacol 2009; 19:476–482. 43. Erdur B, et al. A trial of midazolam vs diphenhydramine in prophylaxis of metoclopramide-­induced akathisia. Am J Emerg Med 2012; 30:84–91.