Talk:Akathisia/Archive 1

reference needed

I see that there's a paragraph regarding causes; 'Psychogenic mechanisms such as anxiety or distress' Could someone in the know, perhaps the one adding the paragraph put up a link to a source of reference? —Preceding unsigned comment added by 84.210.100.232 (talk) 14:18, 29 September 2010 (UTC)

Citation issues

Sorry guys, I have to mention this here... I screwed up the citations several times, and there's a huge history of edits for 29 July 2007. I couldn't figure out how to preview this in the sandbox (as there were multiple sections of the article involved).

70.236.16.34 14:38, 29 July 2007 (UTC) (The guy who forgot to login as "herrfous")

Benadryl and Haldol

There is conflicting information: Akathisia says it is a side effect of diphenhydramine (Benadryl), while that article says Benadryl 'prevents' akathisia. Which is correct? --zandperl 03:53, 4 May 2006 (UTC)

Benedryl causes it for me BIG TIME. Benedryl is no on my no meds list.

Me too. The combination of paroxetine and diphenhydramine was extremely unpleasant. I haven't tried the antihistamine on its own since for fear of it returning. Both drugs are known to cause it, I guess the combination just caused it to trigger. Potkettle 08:45, 3 August 2007 (UTC)

I had a shot of Haldol in an IV last night and I've been struggling with restless in and out of my body. It's a compulsion that I have to move at all times . How long does this last???

—The preceding unsigned comment was added by 71.246.158.220 (talk • contribs).

I'm guessing the sedative effect of diphenhydramine can alleviate the symptoms in some people, without doing anything about the root cause. Zuiram 08:10, 17 April 2007 (UTC)

Benadryl does cause irritation and exitability some people, particularly in children and the elderly, but in the vast majority of cases it acts as a sedative and doesn't cause akanthisia or paradoxical stimulation. —Preceding unsigned comment added by 98.160.104.186 (talk) 00:14, 4 December 2007 (UTC)

Not only neuroleptics

It seems that antidepressants can also cause akathisia.

• In 2004 the FDA ordered pharmaceutical companies to add a “black box” warning to antidepressants, saying the drugs could cause suicidal thoughts and actions in children and teenagers. The agency also directed the manufacturers to print and distribute medication guides with every antidepressant prescription and to inform patients of the risks (“Suicidality in Children and Adolescents Being Treated With Antidepressant Medications”, FDA Public Health Advisory, 15 Oct. 04).

• The same month the European Medicines Agency scientific committee issued a statement concluding that suicide-related behavior and hostility were more frequently observed in clinical trials among children and adolescents treated with antidepressants compared to those treated with placebos (“European Medicines Agency finalises Review of Antidepressants in Children and Adolescents”, European Medicines Agencies Press release, 25 Apr. 05).

• On June 2005 the FDA issued a Public Health Advisory entitled “Suicidality in Adults Being Treated with Antidepressant Medications”. The advisory states that several recent scientific publications suggest the possibility of an increased risk of suicidal behavior in adults taking antidepressants; and while a review of all available data is being undertaken by the FDA, it is recommended that physicians should monitor adults who take antidepressants for suicidal tendencies (“Suicidality in Adults Being Treated with Antidepressant Medications”, FDA Public Health Advisory, 30 June 05).

• On August 2005 the Commission of the European Communities, representing 25 countries, issued its decision to endorse and issue the strongest warning yet against child antidepressants use as recommended by Europe’s Committee for Medicinal Products for Human Use (CHMP). This followed a review of clinical trials that showed the drugs cause suicidal behavior including suicide attempts, aggression, hostility and/or related behavior (“Annex II”, Commission Decision of 19-VIII-2005, Commission of the European Communities, 19 Aug. 05).

However, I dislike the above claims since they’re a leap of logic. The right way to formulate them is something like this: “Some people on antidepressants suffer from akathisia: a state of extreme inner anxiety. As a result, in some cases psychiatric drugs may be iatrogenic. Some patients with a previous mental history may commit suicide in order to escape the torment of akathisia”. —Cesar Tort 12:54, 15 June 2006 (UTC)

Serotonergic antidepressants sometimes cause akathisia, yes, and not just in the anxiety sense. It usually isn't as bad as for neuroleptics, although it is one of the plausible contributing factors to antidepressant-induced suicides. I think it would be better to point out that the slightly increased risk of suicide during treatment is offset by a significant reduction in lifetime prevalence of suicide thanks to succesful treatment, as well as the improvement in quality of life.

And akathisia doesn't require a mental health history to be a serious problem, including being a strong factor in suicide or attempted suicide. Some healthy volunteers have experienced significant akathisia from e.g. neuroleptics.

Zuiram 08:15, 17 April 2007 (UTC)

I have added mirtazapine (Remeron, atypical antidepressant) to the table. I personally experienced akathisia severe enough to make me suicidal, and there is at least one report in the literature. D A Patriarche, BSc (talk) (talk) 03:34, 28 March 2016 (UTC)

It doesn't make sense that these drugs have been prescribed by psychiatrists for years under the pretense that they would prevent suicide when in reality they actually promoted it. It appears that some evil motive was involved in this hoax that involved eugenics and the desired effect all along was to push these people to suicide under the pretense of a hoax that they were trying to prevent it. Dr CareBear (talk) 20:46, 30 November 2009 (UTC)

I have had episodes of Akathisia for over 3 years now. This was originally caused by the SSRI Lexapro (10mg). 34 years prior to the ingestion of the Lexapro I had never felt such a dreadful, painful sensation. Now I have what appears to be permanent brain damage from it since it has been 3.5 years and I still get these attacks once in a while which are severe and somewhat disabling. Contact me at lberteinstein@gmail.com —Preceding unsigned comment added by 74.136.217.190 (talk) 09:48, 9 March 2010 (UTC)

I abruptly stopped taking Prozac in 2002, after many years of taking 20mg/day, and within 2 or 3 weeks I started feeling jumpy. Over the next several weeks this progressed through anxiety to full blown Akathisia, agoraphobia, and severe social anxiety. I had insomnia, couldn't work, and felt dizzying electric jolts in my brain. After trying Cymbalta and several other SSRIs, none of which worked as well as Prozac and required that I take Klonopin for persistent anxiety, I finally decided to try Prozac again. I'm addicted to Prozac, and will definitely taper off it if I ever stop taking it again. Blobowens (talk) 11:10, 27 June 2010 (UTC)

GHB?

How can GHB, a downer, cause akathisia? Maybe it should be GHB withdrawal instead.

As I understand it, GHB lowers dopamine levels. Other drugs - primarily anti-psychotics - which lower dopamine also cause akathisia. —Preceding unsigned comment added by Clay201 (talk • contribs) 07:51, 9 April 2010 (UTC)

Removed blog-like commentary

I removed the following from the article, [1]. While I agree that akathisia is serious issue with drugs like haloperidol, etc., I'm not sure if the manner that it is discussed fits the tones of the article. Andrew73 15:11, 6 June 2007 (UTC)

Please discuss here further before reincorporating it into the article. Andrew73 13:11, 7 June 2007 (UTC)

Some inclusion of subjective criteria would be helpful for diagnosis and recognition. If there were descriptions of the experience of pharmacologically-induced akathisia that practitioners could use to compare to patients' accounts, and to draw out better articulation of what the patient is experience, then perhaps the condition wouldn't be so difficult to diagnose. Having experienced the condition twice, once for an extended period, I'd have to say that restlessness and itchiness are the dominant characteristics of what I experienced, but a notably physical, as opposed to mental restlessness. It felt like the sensation that compels one to stretch, magnified a hundredfold, but stretching doesn't relieve the itchiness, and indeed, sometimes makes it worse. It's a muscular itchiness, which, when intense, feels like some kind of carnivorous worms embedded in one's muscles and eating at them. Exercise doesn't help, either, though stretching and exercise usually provide some relief for normally-encountered physical itchiness and restlessness. The physical nature of the itchiness may be tough to discern at first, since the strength of the physical restlessness feels very much like the physical component of extreme anxiety, a sensation one doesn't usually experience in isolation from the anxiety. In diagnostic contexts, this might be ameliorated by a practitioner's taking steps to calm the patient, reassuring him or her that the relief is close at hand, and then explore the fine points of the physicality. Another approach is to sort through how much of a patient's anxiety is derived from the physical sensation, and how much is independent of it, and might then be construed as causing it. The only verifiability currently available here lies in anecdotal evidence, and it's helpful to remember that sociological surveys of experienced symptoms are ultimately just anecdotal evidence multiplied. The removed passage doesn't seem to be of much use as a diagnostic tool, but dismissing it as not having the appropriate "tone" isn't helpful. A dry, clinical tone isn't of much help when the relevant criteria for diagnostic differentiation are intrinsically subjective. —Preceding unsigned comment added by 71.243.35.175 (talk) 23:53, 4 September 2010 (UTC)

References to be added? (Listed by MastCell)

Primary sources:

• PMID 17545174: Midazolam vs. Diphenhydramine for the Treatment of Metoclopramide-induced Akathisia: A Randomized Controlled Trial. (treatment)
• PMID 11679859: Intravenous administration of prochlorperazine by 15-minute infusion versus 2-minute bolus does not affect the incidence of akathisia: a prospective, randomized, controlled trial. No appreciable difference in akathisia rates based on rate of infusion.
• Kendler K. A medical student’s experience with akathisia. Am J Psychiatry. 1976;133:454-455. A truly primary source.
• PMID 9489098: Suicide attempt due to metoclopramide-induced akathisia. I don't think we need to play scare tactics, but it does happen and should probably be mentioned (though note these are case reports - a larger study found no association - see below).
• PMID 3976927: Suicide attempts associated with akathisia. See above; worth mentioning, but these are a total of 3 cases. See below.
• PMID 15358982: No Association between Akathisia or Parkinsonism and Suicidality in treatment-Resistant Schizophrenia. "Akathisia and drug-induced Parkinsonism have traditionally been associated with depression and suicidality based on case study evidence. In this subanalysis, patients with treatment resistant schizophrenia were rated on the Comprehensive Psychopathological Rating Scale, Barnes Akathisia Scale and Simpson–Angus extrapyramidal side-effect scale... At no time point was there any significant relationship between akathisia and depression/suicidality or distress associated with akathisia and Parkinsonism with suicidality."

This last study is not on schizophrenia in general but treatment resistent schizophrenia. People resistent to treatment are resistent to the drugs so therefore would not be affected by side effects so much like akathisia so logically would not be compelled to committ suicide because they are not suffering. Dr CareBear 04:18, 12 July 2007 (UTC)

Secondary sources:

• PMID 7972345: Akathisia: a comprehensive review and treatment summary. From 1994, so possibly a bit outdated, but still a good secondary source.
• PMID 8794604: Drug-induced akathisia revisited. Another good review/secondary source, from 1996.
• PMID 10647977: Managing antipsychotic-induced acute and chronic akathisia. Another review, focused on treatment.

Thoughts? MastCell ^Talk 18:45, 26 June 2007 (UTC)

Seem like good additions. The suicide link (or lack thereof) sources may be of particular note, to avoid...misrepresentation. Do you have access to the full text of all/any? Fvasconcellos (t·c) 14:50, 2 July 2007 (UTC)

I've got full-text for most, if not all, of them. When other issues quiet down, I'll take a shot at incorporating them (or feel free to go for it). MastCell ^Talk 15:49, 2 July 2007 (UTC)

I'll leave it to you :) Mop and bucket keeping you busy, I see... Fvasconcellos (t·c) 01:39, 3 July 2007 (UTC)

Mo' buttons, mo' problems. MastCell ^Talk 02:21, 3 July 2007 (UTC)

Good work on finding references MASTCELL. Add them all including the "secondary references". They would be a good addition to the article. Dr CareBear 02:57, 10 July 2007 (UTC)

Opiate Withdrawal

This syndrome sounds remarkably similar to the jonesing fidgets. These can last well beyond the 72 hours or so of acute withdrawal - some have it for weeks, usually along with intractable insomnia. Anecdotal evidence puts this as a major factor in the short-term relapse rate figures. Although usually thought to be due to hyper-stimulation of the CNS (and not to be confused with the muscle cramps usually thought to be behind all such symptoms) this occurs during withdrawal both with and without sedating meds like benzodiazepines or the chlorpromzaine tribe. Interesting... Plutonium27 10:02, 28 June 2007 (UTC)

I can explain to you why this is so. Dopamine agonists and drugs that end in dopamine stimulation (although they produce pleasent euphoria) which are drugs of abuse result in depleating dopamine in the brain so when they are discontinued these unpleasant side effects occur such as anxiety and dysphoria the opposite of euphoria. Interestingly these drugs are oftain given to drug abusers which only exasperates their withdrawl discomfort. Klonopin would threfore be the drug of choice to treat the condition you describe. Antipsychotic drugs should never be given to people suffering form dysphoria because it only increases their suffering. But yet they are. Klonopin would be administered to aid in withdrawl. You might be interested in reading this related article that is very informative. Reward Deficiency Syndrom also see:Report on Psychiatric Drugs Written By One of the "Psychiatric Surviors" of that movement. Dr CareBear 12:15, 2 July 2007 (UTC)

Your theory, CareBear, does not explain why some antipsychotic medication works very well for symptoms of depression/dysphoria. Arguing on the basis of --at the point of writing at best poorly understood-- receptor action of individual compounds and neurotransmitter models of psychiatric illness does not help to accurately predict clinical outcome. Hence the need for clinical tests and studies. BTW, your gripe seems to sit mainly with psychiatry, as I infer from your link to a "psychiatric survivor" page. However, all of medicine works on the basis of clinical tests and there is virtually no substance without unpredicted or predicted side-effects. The main difference is, that treatment in psychiatry may be involuntary. Just my 2 ¢. Ft. Jack Hackett 21:29, 26 July 2007 (UTC)

Opiate Withdrawal, but no Alcohol Withdrawal??

I would think that this would best describe alcohol withdrawal symptoms, why is it not listed?

Mild to moderate psychological symptoms:

   * Feeling of jumpiness or nervousness
   * Feeling of shakiness
   * Anxiety
   * Irritability or easily excited
   * Emotional volatility, rapid emotional change
   * Rapid heart rate (palpitations)
   * Abnormal movements
     ** Tremor of the hands
     ** Involuntary, abnormal movements of the eyelids

Akathisia: That is central nervous system is over stimulated causing a need to move about. The person feels irritable and is compelled to stand up, pace, shuffle etc. The sense of anxiety causing an inability to control impulses. Msjayhawk (talk) 02:17, 18 December 2008 (UTC)

Barnes's Akathisia Scale

• Akathisia, Barnes's Akathisia Scale

i only wanted to place comment from my experience;

they installed 'akatisia' in vancouver bc canada when i staged protest to blockage of petition for 'time extension' to file complaint against fifa (and its employees in canada and concacaf) in 2001

bc ambulance employee had injested me with 'artificial coma' when my nervous system was knocked down, then they declared me 'clinicaly dead' (but i moved my finger)

later against my will they installed 'atakisia' using so called "medications" (outlawed because their "medications" psychiatric dos not cure but sends one to cementary of crematorium)

their "doctor" had brochure which he askem me to deliver to my son and former wife that i would go soon to cementary (in 2002) when the 'atakisia' was developped and when i notified him that his "medication" is bad he added more "medications" and ordered illegal 'blood tests' (he was not allowed to do so by law)

nazi doctors were tried in 45 see :https://en.wikipedia.org/wiki/Doctors%27_trial

in fact nazi doctors in downtown eastside (canada vancouver bc) are running illegal 'concentration camp' (resposible for that is 'ministry of health of bc' and 'canadian health ministry' perhaps canadian prime minister justin trudeau dos not know

take notice this particullar 'criminal activity' in downtown vancouver bc canada and elswhere like 'opiate deaths in us' (from atakisia from "medications" cost billions of billions dollars and also was already condemned at nazi doctos trial — Preceding unsigned comment added by 2A02:A03F:3EC3:CD00:2D6E:29E4:68A6:5217 (talk) 15:28, 19 February 2018 (UTC)

Rephrase

The following line needs rephrasing and clarification : Although these side effects disappear quickly and remarkably when the medication is stopped, tardive, or late-persisting akathisia may go on long after the offending drug is discontinued, sometimes for a period of years—unlike the related tardive dyskinesia, which can be permanent. — Preceding unsigned comment added by 78.133.91.5 (talk) 15:02, 24 October 2012 (UTC)

"Likely other neurological diseases."

Is this speculation? 78.156.109.166 (talk) 09:35, 30 April 2013 (UTC)

Comments

Hi Wiki Community, We are Middlebury College undergraduate students working on a project for our Introduction to Neuroscience course. We will be making edits to this page from September - mid December 2013 to provide people with more information on this condition. Thank you! - Mauli Whitney and Noah Klammer

Welcome! Lova Falk talk 11:42, 24 October 2013 (UTC)

Thank You!

Thank You!

Whom ever just added the video to http://en.wikipedia.org/wiki/Akathisia just helped me properly discriminate between dystonia, tardive dyskinesia to properly perhaps my son rather having the beginning signs of Akathisia. The video is what is helping me to see the beginnings of this condition. What would you do if your son ran/walked 58 miles because he "had to" and could not stop? When he would not stop to give us much attention, by running in place or walking in place, it reminds me... maybe it could be, like the video. He also had movements of the tongue when on Zyprexa before taking him off it for fear of Tardive Dyskineisia.

The addition of the video might say it all and whomever is responsible for adding it needs a big high five BECAUSE Akathisia can be the biggest pain producer of hell on earth that there ever was and if it is missed, they keep giving these patients the same meds they HATE precisely because it IS making them worse, the internal discomforting hell they experience. So, whomever added the video did a HUGE service to my family as I think Brett, my son, has a right to say if these meds are hurting him and making him worse! Yet, we've felt the need to keep pushing them on him at times. I gain so much from Wikipedia all the time, thank you for your blessing of the world and mankind!!! Do you see what a difference this can make????? in our lives! Thank you sooooooooo verrrrrrry much!!!!!! I'd like this thank you email to get to the person responsible pretty please. — Preceding unsigned comment added by 74.211.22.159 (talk) 02:15, 9 November 2013 (UTC)

Peer Review

Comment 1

It looks good so far! I just have a few suggestions.

Firstly, there are a few little things that I think the Wikipedia community has already pointed out (the little blue superscripts- [self published source?][citation needed] [clarification needed] [further explanation needed]), so I would begin by addressing those.

The only “citation needed” remaining follows a paragraph that existed before Mauli and I started work on the page. While we did not come across explicit evidence of this during our research, it is self-evident that temporary relief from withdrawal symptoms can be assuaged from the reintroduction of the offending drug. The sentence was first tagged in July 2013 by an editor and it seems most political to leave the fixing to either the author or the editor who tagged the sentence.Nklammer (talk) 04:03, 9 December 2013 (UTC)

Another little thing is that "pseudoakathisia" doesn't have an article on Wikipedia, so you may want to remove that link (I looked to see if it was under another name and didn't find anything in its place).

It appears a Wikipedia “Gnome” solved addressed this issue before I could get to it.Nklammer (talk) 04:03, 9 December 2013 (UTC)

An organizational thing to consider- you may want to move the epidemiology information to the lead section (before the table of contents) because it's relatively short and I think is relevant in the beginning to inform people on how common the disorder is.

Here I disagree: The statistics on akathisia’s epidemiology are noticeably broad and so the Epidemiology paragraph is placed beneath the Description Paragraph to reinforce the notion of akathisia’s symptoms’ subjectivity.Nklammer (talk) 04:03, 9 December 2013 (UTC)

Now some content ideas:

One thing that your article made me still curious about is what parts of the brain specifically are thought to be connected to displays of akathisia. You mention dopamine and norepinephrine interactions, which do seem to be a big cause, and I know that it's hard to find studies that suggest ties to specific brain regions, but I think it could be useful to try. I would guess that either the basal ganglia or the motor cortex (or maybe even the cerebellum) would have to be related to the disorder considering it involves movement. I was able to find one article on PubMed that suggested involvement of the pontine in akathisia, which is interesting and could be looked into in more depth (article: http://www.ncbi.nlm.nih.gov/pubmed/23953640).

Ugh! I was we could find more on neurobiology and pathways too! In our research, even the most recent studies could only theorize a potential correlation between D2 Dopamine receptors and akathisia. Thank you for the article suggestion, it was very pertinent and I have made the necessary additions to the page.Nklammer (talk) 04:03, 9 December 2013 (UTC)

It may also be useful to discuss the difference between akathisia and related motor restlessness disorders (dyskinesia and Restless Leg Syndrome) in order to distinguish it as a unique display of motor dysfunction.

Using the article you offered I have added in a sentence that describes researchers who offer that RLS is a “focal akathisia.” I hope that helps clarify.Nklammer (talk) 04:03, 9 December 2013 (UTC)

A last thing that I might suggest would be going into more depth of how the treatments interact with the systems you mention (dopamine, norepinephrine, any specific brain structures you find related to akathisia).

The best we can do is offer the randomized case studies that suggest these drugs reduce the severity of akathisia. The studies reveal only data correlation in small trials, not any pharmaceutical explanation.Nklammer (talk) 04:03, 9 December 2013 (UTC)

So, best of luck! I know there's a lot here, but some of my suggestions might not even be doable considering lack of research. I hope the comments have been helpful and your work on the page goes well!

Alex.traxler (talk) 18:26, 24 November 2013 (UTC)

Comment 2

I really like the way this whole page is organized. It flows really well and is easy to read. Also, you guys do a great job linking to other pages. I want to know more in the description.

I assume you are referring to wanting to know more about the symptoms of the disorder. I think you will find more of that type of information in the diagnosis section.Nklammer (talk) 04:12, 9 December 2013 (UTC)

Is there any physiological change or are the symptoms all mental?

In our research we only came across changes in behavior, but as we know, changes in behavior relate to changes in the brain. As it mentions elsewhere, the drugs that can cause akathisia, mostly affect the dopamine receptor antagonists and so logically the altering of these receptors must influence akathisia.Nklammer (talk) 04:12, 9 December 2013 (UTC)

In one sentence you say that a treatment relieves muscle stiffness, but I think you need to lay out what if anything is actually happening to the body as a result of Akathesia. I am not sure that the Jack Abbot quote necessarily adds to the understanding of Akathisia.

I agree that the Abbot quote seems too dramatic for a medical article, initially I didn’t have conviction to remove what seems like a semi-relevant example of a patients experience of the disorder. A later editor did not seem so conflicted to cut up the quote into relevant passages describing the feeling of the disorder.Nklammer (talk) 04:12, 9 December 2013 (UTC)

I like that you are including a first hand account but I think the violent description may be distracting from the rest of the page. • In your next section, diagnosis, maybe list and link the “multitude of disorders” with the same symptoms. The link to “pseudoakathesia” does not seem to be working. The classification section is awesome. It is easy to compare the spectrum of symptoms.

Fixed.Nklammer (talk) 04:12, 9 December 2013 (UTC)

• It seems like the table only lists the category and examples, not causes as you indicate in the sentence above the table. The epidemiology section is only two sentences so you may want to consider either moving it to be a sub-category or expanding. Is this ever caused not as a side-effect? Are there other treatments besides pharmological? So far, great job. I think just a little more depth on what the diseases is doing internally and this page will be great. |Maddierawding — Preceding unsigned comment added by 140.233.136.61 (talk) 01:14, 26 November 2013 (UTC)

Comment 3

This page looks really good so far, the headlines and sub headings are definitely very clearly laid out, so good job on that organization!

The description could be longer, also the video didn’t work for me, it was probably just a personal problem, but maybe just check it again and make sure that it works on the page. Also a citation for the first sentence would be good, even though that seems like very general knowledge.

Something I’m a little bit confused about is whether Akathisia is a mental problem or a physical one. Is it both? You describe it as both anxiety and an intense pressure on the knees which seems different to me.

In the Diagnosis section, you referenced pseudoakathisia, which is not a real Wikipedia page. The second paragraph should probably be cited more as well. Other than that great job! Looks good Hasstheboss (talk) 01:59, 26 November 2013 (UTC)

Thanks for your input! I went back and made sure the video worked. It was fine for me, so it's possibly just some plugin you need in order to view it (hopefully)! I agree we should clarify whether Akathisia is mental or physical. Our research focuses on the physical symptoms because those are the most prevalent effects which allow it to be diagnosed. From what we found, the patients show no change in mental state or ability. I will add this to our description both to lengthen it and make that clarification. Also, I have removed the pseudoakathisia link and double checked our sources. Thank you! - Mauliwhitney —Preceding undated comment added 19:21, 9 December 2013 (UTC)

Comment 4

Fantastic page! You may want to classify akathisia under the broader types of movement disorders, Hypokinesia and Hyperkinesia. My partner and I wrote the hypokinesia page, which encompasses disorders featuring slow or stopped muscle movement, and your page also briefly mentions that akathisia is sometimes misdiagnosed as hyperkinesia (overactivity). I would argue that this is not a misdiagnosis, just a very broad diagnosis that does not yet correctly identify the specific kind of hyperkinesia plaguing the patient. Explaining akathisia’s classification under both types of movement disorders may help to prove the point that akathisia can take many forms, and is therefore difficult to diagnose and treat.

You will find on our page a related discussion of the blockage of dopaminergic transmission that may lead you to more sources about physiopathology. Perhaps a brief discussion of GABA and glutamate receptors may be helpful to you as well. We looked at the following articles to discuss those topics: PMID 23010935. PMID 23973720.

Since your page focuses heavily on drugs as an instigator of akathisia symptoms, you may want to peruse this article about drug-induced movement disorder emergencies,

In the treatment section, you mention that benzodiazepines are effective at treating akathisia two times.

Great use of a table and video! LavigneNSCI101 (talk) 00:02, 26 November 2013 (UTC)

Wow, thanks for your informative comments. Akathisia is in fact often incorrectly diagnosed due to the subjectivity of its symptoms, but you are right that we didn't clarify that it is indeed a subset of Hyperkinesia. We will address this in the article. I will definitely look into the additional physiopathology of this disorder. That article you posted is great! I'll make sure to include extra information on the dopamine receptor antagonists which are shown to cause Akathisia. Thanks for picking up on the benzodiazepines information. I'll fix that up now! - Mauliwhitney —Preceding undated comment added 19:27, 9 December 2013 (UTC)

Akathisia vs. akisthesia

I am here because while reading a book about schizophrenia, something called "akisthesia" was mentioned. Nothing came up on Wikipedia, which surprised me, so I did a Google search, which has given results for both that and "akathisia". On the web the terms often seemed to be used interchangeably, with similarities in some of the symptoms (anxiety, restlessness) and causes (antipsychotic medications). For instance, from this webpage (an excerpt from a book on bipolar disordr):

Akisthesia. An intense internal sensation of physical restlessness, itchiness, and jumpiness--a need to move constantly. A person with akisthesia will look and feel uncomfortable if she tries to be still.

Aside from this link, I can't seem to find any references to the term "akisthesia" coming from professional sources — mostly mental health forum posts written by lay people. But I can find plenty of references to "akathisia" in online dictionaries and other professional online sources like NCBI. Therefore, I am inclined to think that "akisthesia" is simply a common misspelling — except that the book I was reading in the first place, in its description of akisthesia, makes no reference to restlessness or physical symptoms, only anxiety:

After I had been working in my new job for about a year, I began to experience an unpleasant new side effect of the anti-psychotic medication. I started to feel an unusual type of anxiety that was different from anything I had felt before. It was intense and extremely discomforting. I could not concentrate on any task for more than a few seconds, and my job performance was suffering. I had confided in my boss that I had schizophrenia, and she let me go home early on occasion. Unfortunately, the anxiety became so commonplace that I was having it for several hours every day. I certainly couldn’t leave work early every day. I reported this to my doctor and he explained that I was probably having akisthesia—an effect of the antipsychotic drugs. This akisthesia is by far the worst emotional feeling I have ever experienced in my entire life. While I was suffering from it, I wanted to escape from existence. If it ever became a permanent feeling, suicide might have seemed like a good op- tion. I can’t stress enough how horrible this feeling was.

So this makes me really wonder — do these terms genuinely refer to the same thing? Or is akisthesia often being used incorrectly to refer to akathisia, while technically meaning something else? Or is akisthesia simply a common misspelling?

Despite not describing any physical symptoms, the last quote's description seems similar enough to that of akathisia — to say nothing of the first quote's almost identical description — that I'm willing to bet it's probably just a common misspelling. But on the other hand, its usage seems suspiciously consistent for being so wrong. Not to mention that it being so far off seems suspicious in itself. How do you get "akISthEsia from "akAthIsia"? Especially if you're having the word said to you, as the author of the book I'm reading almost certainly did? Where does that "s" come from?? I think the "s" is what bothers me more than anything. (In my search, I think I may have seen it spelled without the "s" once or twice, but for the most part it was spelled exactly the same everywhere.) And lastly, the spelling "akisthesia" did appear in at least one professional source — my first quote, from a book on bipolar disorder. That bothers me, too. It doesn't sound like the author was a doctor or anything, but the book would have been researched, so if "akisthesia" were a misspelling you wouldn't expect to see it there. Could be a fluke, but...*shrug*.

So that's why I'm asking about this — I want to be sure. If nothing else, we should find out because if it is just a misspelling, it would be wise to add a redirect for it...and if it's not, then I think we may have to add a new article to Wikipedia. NoriMori (ノリモリ) 05:06, 22 January 2014 (UTC)

[ANSWER: IT IS INDEED JUST A MISSPELLING. Actually the misspelling is very uncommon, but the corresponding mispronunciation is very common, even among professionals.] — Preceding unsigned comment added by 100.2.69.179 (talk) 06:55, 3 October 2015 (UTC)

opiate part of treatment section

"If the patient is experiencing akathisia due to opioid withdrawal, a moderate dose of any opioid (e.g., morphine, fentanyl, methadone, oxycodone) will relieve it all together."

I'm editing this wording- it's obvious and can do without saying and that whole part is without citation.

Not to mention that, however unwise it is to use wikipedia to determine self-medication, I'm sure many people who are experiencing opiate withdrawals have come to this page to research treatment for this particular symptom. Such a suggestion is the last thing they should be reading- it'll increase temptation and be a slap in the face. I'm going to edit it in a still-objective manner, while taking that into consideration, to be more relevant than "taking a certain drug will cure withdrawals from that drug" DustBowlTroubadour (talk) 19:15, 6 August 2014 (UTC)

Copyright issues

This text was originally added in 2005 by User:InFairness:

"Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still with overwhelming anxiety and severe dysphoria (manifesting as an almost undescribable sense of terror and doom)."[2]

The wording was than adjusted by User:DragonflySixtyseven in June of 2017.[3]

In Dec 2009 it was:

"Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still, accompanied by overwhelming anxiety, malaise, and severe dysphoria (manifesting as an almost indescribable sense of terror and doom)."

This textbook appears to have copied and pasted from the later version.[4] As what they have at the end of page 17 is word for word and punctuation exactly the same.

That Academic Press / Elsevier is copy and pasting from Wikipedia is interesting to say the least.

Doc James (talk · contribs · email) 18:13, 23 May 2018 (UTC)

Anyway will continue analysis the rest of their peice.

Other bits copied from us "The presence and severity of akathisia can be measured using the Barnes Akathisia Scale" Doc James (talk · contribs · email) 18:24, 23 May 2018 (UTC)

I see people compile these lists here and there. I do not know how to log all these kinds of reports in a central place. Hmm... Blue Rasberry (talk) 19:16, 23 May 2018 (UTC)

I add Template:Backwards copy Doc James (talk · contribs · email) 19:19, 23 May 2018 (UTC)

Benzodiazepine withdrawal

This source https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/026_1214CP_Cook_Cov_FINAL.pdf is not pubmed indexed.

The publisher is involved in targeted marketing https://www.frontlinemedcom.com/brands-posts/current-psychiatry/

This is a much better source https://www.ncbi.nlm.nih.gov/pubmed/26683525 and does not mention benzo withdrawal... Doc James (talk · contribs · email) 20:14, 1 December 2018 (UTC)

agree w/ Doc James, it is a better source--Ozzie10aaaa (talk) 22:13, 1 December 2018 (UTC)

User:BenzoInfo the ref you linked shows "Xanax" emergence has no really effect on rates akathisia compared to placebo? https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdf Doc James (talk · contribs · email) 22:05, 1 December 2018 (UTC)