Akathisia is a common extrapyramidal symptom that is strongly associated with antipsychotic treatment. It also occurs with antiemetic and antidepressant drugs and may result in medication noncompliance. Akathisia is difficult to recognize and is often undiagnosed, despite its prevalence as an adverse effect.
Akathisia presents as motor restlessness caused by a constant urge to move. This urge is relieved during movement. Affected patients may be observed pacing and may be unable to remain standing or sitting still. The condition may also present with disturbed behavior involving feelings of fear, dread, agitation, aggression, anger, violence, or suicidal ideation, and it may result in insomnia. Less severe cases may involve only a subjective feeling of restlessness with no observable movement abnormalities.
The condition may appear soon after medication introduction or medication increase, as a result of long-term use, or during withdrawal. It may occur more often in women. Akathisia typically does not persist once identified and treated.
Related topic: Drug-induced movement disorders
Drug-induced akathisia
Alerts and Notices
Synopsis
Codes
ICD10CM:
G25.71 – Drug induced akathisia
SNOMEDCT:
230333002 – Drug-induced akathisia
G25.71 – Drug induced akathisia
SNOMEDCT:
230333002 – Drug-induced akathisia
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Anxiety (drug-induced anxiety or generalized anxiety disorder)
- Depressive disorders
- Drug-induced psychosis
- Restless legs syndrome – usually only present when a patient tries to rest
- Hyperthyroidism
- Peripheral neuropathy – patients may have dysesthesias of the skin with relief from physical activity such as walking, rubbing, or moving
- Alcohol or opiate withdrawal
- Stimulant overdose – amphetamines, caffeine
- Generalized pruritus – patients will describe an urge to scratch along with movement
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:12/19/2017
Last Updated:12/19/2017
Last Updated:12/19/2017