Celia Loneragan

The present status of akathisia.

Akathisia is a common and distressing side effect of antipsychotic and some other psychotropic medications. This paper reviews the current state of knowledge of its clinical features, pathophysiology, and treatment. Restless legs syndrome and akathisia associated with Parkinsons disease are discussed in so far as they help understand drug-induced akathisia. The complexity of the disorder, and the difficulty in characterizing and quantifying it, may explain why researchers have relatively neglected akathisia for so long. The recent upsurge of research interest promises the hope of a better understanding of its pathophysiology so that effective therapy may result.

Intravenous Benztropine and Propranolol Challenges in Acute Neuroleptic-induced Akathisia

We challenged six patients suffering from acute neuroleptic-induced akathisia (NIA) with intravenous benztropine (2 mg), propranolol (1 mg), and placebo (saline) using a random, double-blind cross-over design to examine the effects of the drugs on the subjective, objective, and global manifestations of NIA. Benztropine produced a significant amelioration of NIA, more apparent in its subjective component. Propranolol failed to produce a significant improvement overall in any of the akathisia measures, with only one patient showing clinical improvement. The patients demonstrated considerable placebo effect and marked variation in their responses to the drugs.

Acute drug-induced akathisia is not associated with low serum iron status

The iron status of 50 consecutively admitted psychiatric patients due to be started on neuroleptic medication was examined. Fifteen of the patients developed akathisia in the 2 weeks of follow-up. The patients did not differ significantly from the 35 non-akathisic patients in serum iron and transferrin levels and haemoglobin values. The findings do not support the postulated association between low serum iron status and acute neuroleptic-induced akathisia.

Intravenous benztropine and propranolol challenges in tardive akathisia

We challenged five patients suffering from tardive akathisia (TA) with intravenous benztropine (2 mg), propranolol (1 mg) and placebo (saline) using a random, double-blind cross-over design to examine the effects of the drugs on the subjective, objective and global manifestations of neuroleptic-induced akathisia. Benztropine produced a marginally significant, and propranolol a significant improvement in the overall manifestations of the disorder. The patients demonstrated a considerable placebo effect and marked variation in their responses to the drugs. The implications of these findings for the pathophysiology of TA in relation to acute akathisia and tardive dyskinesia are discussed.

Low‐dose apomorphine challenge in tardive akathisia

We challenged seven tardive akathisia patients with low-dose apomorphine (0.01 mg/kg) SC and placebo in a double-blind, random design. Apomorphine caused a significantly greater reduction in the objective (movement) but not the subjective (distress) component of akathisia.

Effect of prolonged treatment with haloperidol on "emotional" defecation and movement in rats in a well-habituated environment.

Sixteen adult male Wistar rats were administered either haloperidol (n = 8), 0.5 mg/kg, or saline (placebo) (n = 8) by subcutaneous injection three times per week for 6 weeks, and were again injected after a 6-week drug-free period. The study was conducted in a well-habituated, distinctive environment to which the rats were introduced 1 hour before the injection on each occasion. The fecal bolus counts 1 hour before and 2 hours after drug injection were obtained, as well as movement counts repeatedly in epochs of 90 seconds upon introduction to the cages and after the injections. Haloperidol produced an overall increase in defecation in the 2 hours after drug injection compared with placebo. The post-drug bolus counts for haloperidol-treated rats were lower in week 2 compared with week 1, but the difference from placebo for this reduction was not significant, and it did not persist beyond week 4. The haloperidol-treated group showed a significant increase in the predrug bolus counts from week 5, suggesting a conditioned response to the cage environment. The haloperidol-treated rats were markedly less mobile than the placebo-treated rats, and with repeated exposure to haloperidol, they tended to develop hypomotility earlier. No tolerance to the movement effect was observed. The defecation and movement effects of haloperidol at 12 weeks were no different from those at week 1. This study supports earlier work indicating that haloperidol produces a dysphoric effect in rats, and it suggests that this effect does not habituate over 6 weeks of repeated administration. It does not replicate the motor aspect of akathisia seen in humans.

Physical and psychological health of carers of young people with first episode psychosis

Objective: Carers of people with psychosis may experience psychological distress and caregiving burden. However, few studies have examined both psychological and physical health of carers of young people with first episode psychosis (FEP). Method: A total of 32 young people with FEP and 42 of their carers were recruited from a mental health service. Standardised scales were administered to assess carers’ psychological distress and risk for development of Type 2 diabetes. Their body mass index, waist circumference and blood pressure were measured. Results: A total of 24% (n = 10) of carers experienced high/very high psychological distress and 39.0% (n = 16) had high risk for Type 2 diabetes. It was common for carers to be overweight (n = 33, 78.6%) and to have hypertension (n = 14, 33.3%). Carers’ higher levels of psychological distress were associated with shorter duration of illness in the young person. Conclusions: Caring for a young person with FEP is associated with poor physical and psychological health. Findings show the importance of supporting carers’ physical and psychological health early in treatment of young people with FEP.