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This section needs some clarification, especially this statement: "Probably due to neurotoxicity of antidopaminergic drugs" -- this article (and wikipedia psychiatry articles in general) seems to extrapolate a lot of information and contain a lot of original research. I don't believe dopamine antagonists are acknowledged as neurotoxic; even though they can induce TD the exact mechanism behind this is still uncertain. Unfortunately, I'm unable to deactivate the paywall for the sourced review on SGAs, but I seriously doubt the review stated it in terms other than a vague, passing hypothesis because I can't find additional sources for 'DA neurotoxicity' anywhere. Can someone at least pull a quote from the review instead of just flippantly mentioning 'oh yeah probably due to neurotoxicity' because I mean... it's at the very least not encyclopedic. — Preceding unsigned comment added by 47.184.211.178 ( talk) 15:53, 5 March 2019 (UTC)
The last paragraph under “signs and symptoms” should be removed as it is completely misleading and could contribute to clinicians misunderstanding the suicidality associated with akathisia. Anyone who gets akathisia becomes suicidal, there is no reason to promote the idea that it is simply a worsening of pre-existing suicidality. AkathisiaInformation ( talk) 20:18, 21 July 2020 (UTC)
References
There is too much damage here to repair. I suggest a revert to this version, and updating to newer secondary reviews from that starting point. There is unencyclopedic tone, dated information, information not in accordance with newer reviews, and a general failure to adhere to WP:MEDRS. This looks like advocacy rather than encyclopedic editing. Repairing from the current version will be too time-consuming. SandyGeorgia ( Talk) 00:26, 22 July 2020 (UTC)
The first paragraph is misleading in that it states that akathisia predates psychiatric drugs. The condition only comes from psychiatric drugs, and not just antipsychotics. This kind of misinformation is dangerous. AkathisiaInformation ( talk) 02:36, 22 July 2020 (UTC)
From: Poyurovsky M, Weizman A (June 2020). "Treatment of Antipsychotic-Induced Akathisia: Role of Serotonin 5-HT2a Receptor Antagonists". Drugs (Review). 80 (9): 871–882. doi: 10.1007/s40265-020-01312-0. PMID 32385739.
Akathisia is characterised by typical restless movements associated with a subjective sense of inner restlessness and mental distress. Akathisia was identifed in patients with Parkinson’s disease and other neuro-psychiatric disorders well before the development of psychopharmacological agents. However, the introduction of antipsychotic medications for the treatment of schizophrenia brought akathisia to the forefront of clinical care. Subsequent detection of a meaningful incidence of akathisia among patients with mood and anxiety disorders treated with selective serotonin reuptake inhibitors (SSRIs) further highlights its clinical relevance. Akathisia also afflicts some patients treated with calcium channel blockers, antibiotics, anti-emetic and anti-vertigo agents, posing a diagnostic and treatment challenge in non-psychiatric populations as well.
Please read WP:MEDRS, and base your edits on the latest secondary reviews-- not primary sources, not lay sources. SandyGeorgia ( Talk) 02:44, 22 July 2020 (UTC)
Seems to be contradiction in defining it as a movement disorder and later..may just be a feeling. ?-- Iztwoz ( talk) 11:20, 22 July 2020 (UTC)
Subsequent detection of a meaningful incidence of akathisia among patients with mood and anxiety disorders treated with selective seroto- nin reuptake inhibitors (SSRIs) further highlights its clini- cal relevance.
Akathisia also afflicts some patients treated with calcium channel blockers, antibiotics, anti-emetic and anti-vertigo agents, posing a diagnostic and treatment challenge in non-psychiatric populations as well.
Akathisia is a common and distressing movement disorder that can be associated with the use of antipsychotics. It is characterized by a subjective (inner restlessness) and an objective (excessive movements) component. Akathisia can have a negative impact on clinical outcome and even lead to treatment discontinuation. Although medication-induced akathisia is more commonly associated with the use of first-generation antipsychotics (FGAs), it also occurs with second-generation antipsychotics (SGAs), including the newly approved antipsychotics (NAPs) asenapine, lurasidone, iloperidone, cariprazine, and brexpiprazole.
Akathisia can have a negative impact on clinical outcome [13]. It may be disturbing for the patient and increase the risk of suicidal ideation and impulsive behavior, in extreme cases leading to suicide or aggressive behavior (homicide) [7, 14, 15]. Moreover, akathisia can become a cause of poor medication adherence and even treatment discontinuation [4, 15]. Although several medications across a number of categories, including antidepressants (particularly selective serotonin receptor inhibitors [SSRIs], such as paroxetine), calcium channel blockers, antibiotics (e.g., azithromycin), antiemetics (e.g., metoclopramide), and even illicit drugs (e.g., cocaine) can induce akathisia [1, 3–5, 7, 10, 12, 16–20], it is principally seen in association with antipsychotic medications [2, 3, 5].
However, akathisia is not limited to antipsychotic medication. Other psychotropic medications especially SSRI [25], monoamine oxidase inhibitor (MAOI) [26], and tricyclic (TCA) antidepressants [27] have been associated with akathisia. In fact, 10-18% of bipolar I patients taking antidepressants are estimated to develop akathisia [28, 29]. In addition, antibiotics [30], calcium channel blockers [31], and even illicit drug use such as amphetamine, methamphetamine, and cocaine [32] can elicit akathisia.
SandyGeorgia ( Talk) 13:04, 22 July 2020 (UTC)
I'm creating a new section as this is about specific things currently included that I am not sure are necessary in the encyclopedia article. While they may be cited/verifiable and true, I don't know if they should be included:
I'll try and find some time this week(end) to go through the sources presented as well as try and find some of my own and work more on the article, for now I've done some copyediting and moving info around especially in the treatment section. bɜ:ʳkənhɪmez ( User/ say hi!) 18:17, 22 July 2020 (UTC)
Extended content
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References
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This only has one subsection for drug induced - I'll try to add a paragraph or two about historical causes and non-drug causes above this subsection to complete the section sometime.
1. I think the lead should be altered to cover all forms of akathisia, since movement is described elsewhere to as a sign of akathisia (especially the medication induced form) but akathisia is the urge to move rather than a movement disorder. The lead calls it a "movement disorder" but later on the page describes it sometimes not involving movement. I suggest changing it to a neuropsychological sign since that has support regardless of whether it's more neuropsychological or movement based. The amount of information on drug induced akathisia is vast in comparison to other forms.
2. Differential diagnosis don't make sense. It can't be both a symptom of Parkinsonism, and have a differential diagnosis of Parkinsonism.
3. Different forms include medication induced akathisia, tarditive akathisia (which is drug induced but continues after drugs are stopped), restlessness resulting from extreme anxiety, a symptom of Parkinsonism or other illnesses. Sources below. I couldn't find a reference to serotonin syndrome (in the table).
4. Treatment and medication in the infobox should be merged.
5. More on the link with other EPS would be helpful. Amousey (they/them pronouns) (talk) 23:51, 25 July 2020 (UTC)
Sources:
|
---|
Recognized associations of akathisia include Parkinson's disease and neuroleptic medication (acute or tardive side effect), suggesting that dopamine depletion may contribute to the pathophysiology; dopamine depleting agents {e.g., tetrabenazine, reserpine) may cause akathisia. References Sachdev P. Akinasthia and restless legs. Cambridge: CUP, 1995 Cross References Parkinsonism; Tic" - A Dictionary of Neurological Signs
|
Amousey (they/them pronouns) (talk) 23:51, 25 July 2020 (UTC)
My suggestion, per sources, is to section text by antipsychotic-induced akathisia and other drug-induced akathisia, which includes illicit. That separates the most common from all the rest. SandyGeorgia ( Talk) 01:21, 26 July 2020 (UTC)
I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Akathisia's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.
Reference named "DSM":
I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT ⚡ 07:06, 27 July 2020 (UTC)
Not sure if one person's medical experience is notable, and cites NY Post, which is a questionable source rubah ( talk) 04:15, 25 August 2021 (UTC)
To quote:
"The most severe cases may result in aggression, violence, and/or suicidal thoughts. Akathisia is also associated with threatening behaviour and physical aggression that is greatest in patients with mild akathisia, and diminishing with increasing severity of akathisia."
It is intuitively contradictive to say that the patients with more severe akathisia are less agressieve and at the same time say that agression occurs in the most severe cases.
I suggest correcting it by just removing the first part, leaving:
"Akathisia is also associated with threatening behaviour and physical aggression that is greatest in patients with mild akathisia, and diminishing with increasing severity of akathisia."
But it should also be fact checked if that is truly the case so we are not logically correcting it to a false.
Also the part of increased suicidal thoughts should be added back in
Da4wiki (
talk) 09:05, 10 August 2023 (UTC)
Benzodiazepines cause this same disorder from either abrupt discontinuation and prolonged use and slow taper TheTurtleTribalNation ( talk) 17:25, 31 October 2023 (UTC)
This is the
talk page for discussing improvements to the
Akathisia article. This is not a forum for general discussion of the article's subject. |
Article policies
|
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL |
Archives: 1 |
This article is rated C-class on Wikipedia's
content assessment scale. It is of interest to multiple WikiProjects. | |||||||||||||||||||||
|
Ideal sources for Wikipedia's health content are defined in the guideline
Wikipedia:Identifying reliable sources (medicine) and are typically
review articles. Here are links to possibly useful sources of information about Akathisia.
|
This article is substantially duplicated by a piece in an external publication. Please do not flag this article as a copyright violation of the following source: |
This section needs some clarification, especially this statement: "Probably due to neurotoxicity of antidopaminergic drugs" -- this article (and wikipedia psychiatry articles in general) seems to extrapolate a lot of information and contain a lot of original research. I don't believe dopamine antagonists are acknowledged as neurotoxic; even though they can induce TD the exact mechanism behind this is still uncertain. Unfortunately, I'm unable to deactivate the paywall for the sourced review on SGAs, but I seriously doubt the review stated it in terms other than a vague, passing hypothesis because I can't find additional sources for 'DA neurotoxicity' anywhere. Can someone at least pull a quote from the review instead of just flippantly mentioning 'oh yeah probably due to neurotoxicity' because I mean... it's at the very least not encyclopedic. — Preceding unsigned comment added by 47.184.211.178 ( talk) 15:53, 5 March 2019 (UTC)
The last paragraph under “signs and symptoms” should be removed as it is completely misleading and could contribute to clinicians misunderstanding the suicidality associated with akathisia. Anyone who gets akathisia becomes suicidal, there is no reason to promote the idea that it is simply a worsening of pre-existing suicidality. AkathisiaInformation ( talk) 20:18, 21 July 2020 (UTC)
References
There is too much damage here to repair. I suggest a revert to this version, and updating to newer secondary reviews from that starting point. There is unencyclopedic tone, dated information, information not in accordance with newer reviews, and a general failure to adhere to WP:MEDRS. This looks like advocacy rather than encyclopedic editing. Repairing from the current version will be too time-consuming. SandyGeorgia ( Talk) 00:26, 22 July 2020 (UTC)
The first paragraph is misleading in that it states that akathisia predates psychiatric drugs. The condition only comes from psychiatric drugs, and not just antipsychotics. This kind of misinformation is dangerous. AkathisiaInformation ( talk) 02:36, 22 July 2020 (UTC)
From: Poyurovsky M, Weizman A (June 2020). "Treatment of Antipsychotic-Induced Akathisia: Role of Serotonin 5-HT2a Receptor Antagonists". Drugs (Review). 80 (9): 871–882. doi: 10.1007/s40265-020-01312-0. PMID 32385739.
Akathisia is characterised by typical restless movements associated with a subjective sense of inner restlessness and mental distress. Akathisia was identifed in patients with Parkinson’s disease and other neuro-psychiatric disorders well before the development of psychopharmacological agents. However, the introduction of antipsychotic medications for the treatment of schizophrenia brought akathisia to the forefront of clinical care. Subsequent detection of a meaningful incidence of akathisia among patients with mood and anxiety disorders treated with selective serotonin reuptake inhibitors (SSRIs) further highlights its clinical relevance. Akathisia also afflicts some patients treated with calcium channel blockers, antibiotics, anti-emetic and anti-vertigo agents, posing a diagnostic and treatment challenge in non-psychiatric populations as well.
Please read WP:MEDRS, and base your edits on the latest secondary reviews-- not primary sources, not lay sources. SandyGeorgia ( Talk) 02:44, 22 July 2020 (UTC)
Seems to be contradiction in defining it as a movement disorder and later..may just be a feeling. ?-- Iztwoz ( talk) 11:20, 22 July 2020 (UTC)
Subsequent detection of a meaningful incidence of akathisia among patients with mood and anxiety disorders treated with selective seroto- nin reuptake inhibitors (SSRIs) further highlights its clini- cal relevance.
Akathisia also afflicts some patients treated with calcium channel blockers, antibiotics, anti-emetic and anti-vertigo agents, posing a diagnostic and treatment challenge in non-psychiatric populations as well.
Akathisia is a common and distressing movement disorder that can be associated with the use of antipsychotics. It is characterized by a subjective (inner restlessness) and an objective (excessive movements) component. Akathisia can have a negative impact on clinical outcome and even lead to treatment discontinuation. Although medication-induced akathisia is more commonly associated with the use of first-generation antipsychotics (FGAs), it also occurs with second-generation antipsychotics (SGAs), including the newly approved antipsychotics (NAPs) asenapine, lurasidone, iloperidone, cariprazine, and brexpiprazole.
Akathisia can have a negative impact on clinical outcome [13]. It may be disturbing for the patient and increase the risk of suicidal ideation and impulsive behavior, in extreme cases leading to suicide or aggressive behavior (homicide) [7, 14, 15]. Moreover, akathisia can become a cause of poor medication adherence and even treatment discontinuation [4, 15]. Although several medications across a number of categories, including antidepressants (particularly selective serotonin receptor inhibitors [SSRIs], such as paroxetine), calcium channel blockers, antibiotics (e.g., azithromycin), antiemetics (e.g., metoclopramide), and even illicit drugs (e.g., cocaine) can induce akathisia [1, 3–5, 7, 10, 12, 16–20], it is principally seen in association with antipsychotic medications [2, 3, 5].
However, akathisia is not limited to antipsychotic medication. Other psychotropic medications especially SSRI [25], monoamine oxidase inhibitor (MAOI) [26], and tricyclic (TCA) antidepressants [27] have been associated with akathisia. In fact, 10-18% of bipolar I patients taking antidepressants are estimated to develop akathisia [28, 29]. In addition, antibiotics [30], calcium channel blockers [31], and even illicit drug use such as amphetamine, methamphetamine, and cocaine [32] can elicit akathisia.
SandyGeorgia ( Talk) 13:04, 22 July 2020 (UTC)
I'm creating a new section as this is about specific things currently included that I am not sure are necessary in the encyclopedia article. While they may be cited/verifiable and true, I don't know if they should be included:
I'll try and find some time this week(end) to go through the sources presented as well as try and find some of my own and work more on the article, for now I've done some copyediting and moving info around especially in the treatment section. bɜ:ʳkənhɪmez ( User/ say hi!) 18:17, 22 July 2020 (UTC)
Extended content
| ||
---|---|---|
References
|
This only has one subsection for drug induced - I'll try to add a paragraph or two about historical causes and non-drug causes above this subsection to complete the section sometime.
1. I think the lead should be altered to cover all forms of akathisia, since movement is described elsewhere to as a sign of akathisia (especially the medication induced form) but akathisia is the urge to move rather than a movement disorder. The lead calls it a "movement disorder" but later on the page describes it sometimes not involving movement. I suggest changing it to a neuropsychological sign since that has support regardless of whether it's more neuropsychological or movement based. The amount of information on drug induced akathisia is vast in comparison to other forms.
2. Differential diagnosis don't make sense. It can't be both a symptom of Parkinsonism, and have a differential diagnosis of Parkinsonism.
3. Different forms include medication induced akathisia, tarditive akathisia (which is drug induced but continues after drugs are stopped), restlessness resulting from extreme anxiety, a symptom of Parkinsonism or other illnesses. Sources below. I couldn't find a reference to serotonin syndrome (in the table).
4. Treatment and medication in the infobox should be merged.
5. More on the link with other EPS would be helpful. Amousey (they/them pronouns) (talk) 23:51, 25 July 2020 (UTC)
Sources:
|
---|
Recognized associations of akathisia include Parkinson's disease and neuroleptic medication (acute or tardive side effect), suggesting that dopamine depletion may contribute to the pathophysiology; dopamine depleting agents {e.g., tetrabenazine, reserpine) may cause akathisia. References Sachdev P. Akinasthia and restless legs. Cambridge: CUP, 1995 Cross References Parkinsonism; Tic" - A Dictionary of Neurological Signs
|
Amousey (they/them pronouns) (talk) 23:51, 25 July 2020 (UTC)
My suggestion, per sources, is to section text by antipsychotic-induced akathisia and other drug-induced akathisia, which includes illicit. That separates the most common from all the rest. SandyGeorgia ( Talk) 01:21, 26 July 2020 (UTC)
I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Akathisia's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.
Reference named "DSM":
I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT ⚡ 07:06, 27 July 2020 (UTC)
Not sure if one person's medical experience is notable, and cites NY Post, which is a questionable source rubah ( talk) 04:15, 25 August 2021 (UTC)
To quote:
"The most severe cases may result in aggression, violence, and/or suicidal thoughts. Akathisia is also associated with threatening behaviour and physical aggression that is greatest in patients with mild akathisia, and diminishing with increasing severity of akathisia."
It is intuitively contradictive to say that the patients with more severe akathisia are less agressieve and at the same time say that agression occurs in the most severe cases.
I suggest correcting it by just removing the first part, leaving:
"Akathisia is also associated with threatening behaviour and physical aggression that is greatest in patients with mild akathisia, and diminishing with increasing severity of akathisia."
But it should also be fact checked if that is truly the case so we are not logically correcting it to a false.
Also the part of increased suicidal thoughts should be added back in
Da4wiki (
talk) 09:05, 10 August 2023 (UTC)
Benzodiazepines cause this same disorder from either abrupt discontinuation and prolonged use and slow taper TheTurtleTribalNation ( talk) 17:25, 31 October 2023 (UTC)