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The clinical challenges of akathisia

Published online by Cambridge University Press:  18 December 2015

James B. Lohr ,
Carolyn A. Eidt ,
Areej Abdulrazzaq Alfaraj  and
Mounir A. Soliman
James B. Lohr*
Affiliation:
Department of Psychiatry, University of California–San Diego, La Jolla, California, USA Veterans Affairs Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
Carolyn A. Eidt
Affiliation:
Department of Psychiatry, University of California–San Diego, La Jolla, California, USA Veterans Affairs Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
Areej Abdulrazzaq Alfaraj
Affiliation:
Department of Psychiatry, University of California–San Diego, La Jolla, California, USA
Mounir A. Soliman
Affiliation:
Department of Psychiatry, University of California–San Diego, La Jolla, California, USA
*
*Address for correspondence: James B. Lohr, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA. (Email: jlohr@ucsd.edu)
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Abstract

Akathisia is one of the most vexing problems in neuropsychiatry. Although it is one of the most common side effects of antipsychotic medications, it is often difficult to describe by patients, and is difficult to diagnose and treat by practitioners. Akathisia is usually grouped with extrapyramidal movement disorders (ie, movement disorders that originate outside the pyramidal or corticospinal tracts and generally involve the basal ganglia). Yet, it can present as a purely subjective clinical complaint, without overt movement abnormalities. It has been subtyped into acute, subacute, chronic, tardive, withdrawal-related, and “pseudo” forms, although the distinction between many of these is unclear. It is therefore not surprising that akathisia is generally either underdiagnosed or misdiagnosed, which is a serious problem because it can lead to such adverse outcomes as poor adherence to medications, exacerbation of psychiatric symptoms, and, in some cases, aggression, violence, and suicide. In this article, we will attempt to address some of the confusion surrounding the condition, its relationship to other disorders, and differential diagnosis, as well as treatment alternatives.

Keywords

akathisiaantipsychoticmovement disorderParkinsonreview
Type
CME Review Article
Information
CNS Spectrums , Volume 20 , Issue S1: CME SUPPLEMENT , December 2015 , pp. 1 - 16
Copyright
© Cambridge University Press 2015 

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Footnotes

†

We would like to thank Dr. Stephen Stahl and the staff of the Neuroscience Education Institute for their assistance in preparing this article. This activity is supported by an unrestricted educational grant from Vanda Pharmaceuticals Inc.

References

1.Berrios, GE. Lad Haskovec and akathisia: an introduction. Hist Psychiatry. 1995; 6(22): 243–245.CrossRefGoogle ScholarPubMed
2.Mohr, P, Volavka, J. Ladislav Haskovec and akathisia: 100th anniversary. Br J Psychiatry. 2002; 181(6): 537.CrossRefGoogle Scholar
3.Sachdev, P. The development of the concept of akathisia: a historical overview. Schizophr Res. 1995; 16(1): 33–45.CrossRefGoogle ScholarPubMed
4.Baden, EY, Prodany, K, Wiener, SW, Hoffman, RS. Diphenhydramine in the treatment of akathesia induced by prochlorperazine. J Emerg Med. 2005; 28(3): 347–348.CrossRefGoogle ScholarPubMed
5.Keckich, WA. Neuroleptics: violence as a manifestation of akathisia. JAMA. 1978; 240(20): 2185.CrossRefGoogle ScholarPubMed
6.Leong, GB, Silva, JA. Neuroleptic-induced akathisia and violence: a review. J Forensic Sci. 2003; 48(1): 187–189.CrossRefGoogle ScholarPubMed
7.Seemuller, F, Lewitzka, U, Bauer, M, et al. The relationship of akathisia with treatment emergent suicidality among patients with first-episode schizophrenia treated with haloperidol or risperidone. Pharmacopsychiatry. 2012; 45(7): 292–296.Google ScholarPubMed
8.Hansen, L. A critical review of akathisia, and its possible association with suicidal behaviour. Hum Psychopharmacol. 2001; 16(7): 495–505.CrossRefGoogle ScholarPubMed
9.Galynker, II, Nazarian, D. Akathisia as violence. J Clin Psychiatry. 1997; 58(1): 31–32.CrossRefGoogle ScholarPubMed
10.Lipinski, JF Jr, Mallya, G, Zimmerman, P, Pope, HG Jr.Fluoxetine-induced akathisia: clinical and theoretical implications. J Clin Psychiatry. 1989; 50(9): 339–342.Google ScholarPubMed
11.Raskin, DE. Akathisia: a side effect to be remembered. Am J Psychiatry. 1972; 129(3): 345–347.CrossRefGoogle ScholarPubMed
12.Van Putten, T. The many faces of akathisia. Compr Psychiatry. 1975; 16(1): 43–47.CrossRefGoogle ScholarPubMed
13.Duncan, EJ, Adler, LA, Stephanides, M, Sanfilipo, M, Angrist, B. Akathisia and exacerbation of psychopathology: a preliminary report. Clin Neuropharmacol. 2000; 23(3): 169–173.CrossRefGoogle ScholarPubMed
14.Nair, CJ, Josiassen, RC, Abraham, G, Stanilla, JK, Tracy, JI, Simpson, GM. Does akathisia influence psychopathology in psychotic patients treated with clozapine? Biol Psychiatry. 1999; 45(10): 1376–1383.CrossRefGoogle ScholarPubMed
15.Peitl, MV, Proloscic, J, Blazevic-Zelic, S, Skarpa-Usmiani, I, Peitl, V. Symptoms of agitated depression and/or akathisia. Psychiatr Danub. 2011; 23(1): 108–110.Google ScholarPubMed
16.Lohr, JB, Wisniewski, AA. Movement disorders: a neuropsychiatric approach. New York: Guildford Press; 1987.Google Scholar
17.Lohr, JB, Browning, JA. Movement disorders in neuropsychiatry. Curr Opin Psychiatry. 1996; 9(1): 85–88.CrossRefGoogle Scholar
18.Hirose, S. Restlessness in suboccipital muscles as a manifestation of akathisia. Psychiatry Clin Neurosci. 2001; 55(1): 81–82.CrossRefGoogle ScholarPubMed
19.Yamashita, H, Horiguchi, J, Mizuno, S, Kuramoto, Y, Yamawaki, S, Inami, Y. A case of neuroleptic-induced unilateral akathisia with periodic limb movements in the opposite side during sleep. Psychiatry Clin Neurosci. 1999; 53(2): 291–293.CrossRefGoogle ScholarPubMed
20.Bratti, IM, Kane, JM, Marder, SR. Chronic restlessness with antipsychotics. Am J Psychiatry. 2007; 164(11): 1648–1654.CrossRefGoogle ScholarPubMed
21.Sachdev, P. The epidemiology of drug-induced akathisia: Part II. Chronic, tardive, and withdrawal akathisias. Schizophr Bull. 1995; 21(3): 451–461.Google ScholarPubMed
22.Lang, AE. Withdrawal akathisia: case reports and a proposed classification of chronic akathisia. Mov Disord. 1994; 9(2): 188–192.CrossRefGoogle Scholar
23.Bhidayasiri, R, Boonyawairoj, S. Spectrum of tardive syndromes: clinical recognition and management. Postgrad Med J. 2011; 87(1024): 132–141.CrossRefGoogle ScholarPubMed
24.Nishikawa, T, Koga, I, Uchida, Y, Tanaka, M. Treatment of tardive akathisia with clonidine. Kurume Med J. 1990; 37(3): 185–187.CrossRefGoogle ScholarPubMed
25.Munetz, MR, Cornes, CL. Akathisia, pseudoakathisia and tardive dyskinesia: clinical examples. Compr Psychiatry. 1982; 23(4): 345–352.CrossRefGoogle ScholarPubMed
26.Stubbs, JH, Halstead, SM. Pseudoakathisia: a review and two case reports. Compr Psychiatry. 2000; 41(1): 70–72.CrossRefGoogle ScholarPubMed
27.Bing, R. Textbook of Nervous Diseases. St. Louis, MO: C.V. Mosby; 1939.Google Scholar
28.Kumar, R, Sachdev, PS. Akathisia and second-generation antipsychotic drugs. Curr Opin Psychiatry. 2009; 22(3): 293–299.CrossRefGoogle ScholarPubMed
29.Kane, JM, Fleischhacker, WW, Hansen, L, Perlis, R, Pikalov, A 3rd, Assuncao-Talbott, S. Akathisia: an updated review focusing on second-generation antipsychotics. J Clin Psychiatry. 2009; 70(5): 627–643.CrossRefGoogle ScholarPubMed
30.Kemp, DE, Gilmer, WS, Fleck, J, Straus, JL, Dago, PL, Karaffa, M. Aripiprazole augmentation in treatment-resistant bipolar depression: early response and development of akathisia. Prog Neuropsychopharmacol Biol Psychiatry. 2007; 31(2): 574–577.CrossRefGoogle ScholarPubMed
31.Saddichha, S, Kumar, R, Babu, GN, Chandra, P. Aripiprazole associated with acute dystonia, akathisia, and parkinsonism in a single patient. J Clin Pharmacol. 2012; 52(9): 1448–1449.CrossRefGoogle ScholarPubMed
32.Spielmans, GI, Berman, MI, Linardatos, E, Rosenlicht, NZ, Perry, A, Tsai, AC. Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes. PLoS Med. 2013; 10(3): e1001403.CrossRefGoogle ScholarPubMed
33.Oh, GH, Yu, J-C, Choi, K-S, Joo, E-J, Jeong, S-H. Simultaneous comparison of efficacy and tolerability of second-generation antipsychotics in schizophrenia: mixed-treatment comparison analysis based on head-to-head trial data. Psychiatry Investig. 2015; 12(1): 46–54.CrossRefGoogle ScholarPubMed
34.Stahl, SM. Role of alpha1 adrenergic antagonism in the mechanism of action of iloperidone: reducing extrapyramidal symptoms. CNS Spectr. 2013; 18(6): 285–288.CrossRefGoogle ScholarPubMed
35.Citrome, L. Iloperidone: a clinical overview. J Clin Psychiatry. 2011; 72(Suppl 1): 19–23.CrossRefGoogle ScholarPubMed
36.Dargani, NV, Malhotra, AK. Safety profile of iloperidone in the treatment of schizophrenia. Expert Opin Drug Saf. 2014; 13(2): 241–246.CrossRefGoogle ScholarPubMed
37.Tarazi, FI, Stahl, SM. Iloperidone, asenapine and lurasidone: a primer on their current status. Expert Opin Pharmacother. 2012; 13(13): 1911–1922.CrossRefGoogle ScholarPubMed
38.Caccia, S, Pasina, L, Nobili, A. New atypical antipsychotics for schizophrenia: iloperidone. Drug Des Devel Ther. 2010; 4: 33–48.Google ScholarPubMed
39.Grover, S, Sahoo, S. Clozapine induced akathisia: a case report and review of the evidence. Indian J Pharmacol. 2015; 47(2): 234–235.CrossRefGoogle ScholarPubMed
40.Schneider, C, Corrigall, R, Hayes, D, Kyriakopoulos, M, Frangou, S. Systematic review of the efficacy and tolerability of clozapine in the treatment of youth with early onset schizophrenia. Eur Psychiatry. 2014; 29(1): 1–10.Google ScholarPubMed
41.Cohen, BM, Keck, PE, Satlin, A, Cole, JO. Prevalence and severity of akathisia in patients on clozapine. Biol Psychiatry. 1991; 29(12): 1215–1219.CrossRefGoogle ScholarPubMed
42.Wright, MT. Antiemetics, akathisia, and pregnancy. Psychosomatics. 2007; 48(6): 461–466.CrossRefGoogle ScholarPubMed
43.Kawanishi, C, Onishi, H, Kato, D, et al. Unexpectedly high prevalence of akathisia in cancer patients. Palliat Support Care. 2007; 5(4): 351–354.CrossRefGoogle ScholarPubMed
44.Adler, LA, Angrist, BM. Paroxetine and akathisia. Biol Psychiatry. 1995; 37(5): 336–337.CrossRefGoogle ScholarPubMed
45.Baldassano, CF, Truman, CJ, Nierenberg, A, Ghaemi, SN, Sachs, GS. Akathisia: a review and case report following paroxetine treatment. Compr Psychiatry. 1996; 37(2): 122–124.CrossRefGoogle ScholarPubMed
46.Bonnet-Brilhault, F, Thibaut, F, Leprieur, A, Petit, M. A case of paroxetine-induced akathisia and a review of SSRI-induced akathisia. Eur Psychiatry. 1998; 13(2): 109–111.CrossRefGoogle Scholar
47.Grover, S, Valaparla, VL. Venlafaxine induced akathisia: a case report. Indian J Pharmacol. 2014; 46(6): 660–661.CrossRefGoogle ScholarPubMed
48.Hawthorne, JM, Caley, CF. Extrapyramidal reactions associated with serotonergic antidepressants. Ann Pharmacother. 2015; 49(10): 1136–1152.CrossRefGoogle ScholarPubMed
49.Koliscak, LP, Makela, EH. Selective serotonin reuptake inhibitor-induced akathisia. J Am Pharm Assoc (2003). 2009; 49(2): e28–e36; quiz e37–28.CrossRefGoogle ScholarPubMed
50.Lambert, MT, Trutia, C, Petty, F. Extrapyramidal adverse effects associated with sertraline. Prog Neuropsychopharmacol Biol Psychiatry. 1998; 22(5): 741–748.CrossRefGoogle ScholarPubMed
51.Lane, RM. SSRI-Induced extrapyramidal side-effects and akathisia: implications for treatment. J Psychopharmacol. 1998; 12(2): 192–214.CrossRefGoogle ScholarPubMed
52.Olivera, AA. A case of paroxetine-induced akathisia. Biol Psychiatry. 1996; 39(10): 910.CrossRefGoogle ScholarPubMed
53.Vandel, P, Bonin, B, Leveque, E, Sechter, D, Bizouard, P. Tricyclic antidepressant-induced extrapyramidal side effects. Eur Neuropsychopharmacol. 1997; 7(3): 207–212.CrossRefGoogle ScholarPubMed
54.Gill, HS, DeVane, CL, Risch, SC. Extrapyramidal symptoms associated with cyclic antidepressant treatment: a review of the literature and consolidating hypotheses. J Clin Psychopharmacol. 1997; 17(5): 377–389.CrossRefGoogle ScholarPubMed
55.Riesselman, A, El-Mallakh, RS. Akathisia with azithromycin. Ann Pharmacother. 2015; 49(5): 609.CrossRefGoogle ScholarPubMed
56.Sachdev, P. The epidemiology of drug-induced akathisia: Part I. Acute akathisia. Schizophr Bull. 1995; 21(3): 431–449.CrossRefGoogle ScholarPubMed
57.Asser, A, Taba, P. Psychostimulants and movement disorders. Front Neurol. 2015; 6: 75.CrossRefGoogle ScholarPubMed
58.Stacy, M. Nonmotor symptoms in Parkinson’s disease. Int J Neurosci. 2011; 121(Suppl 2): 9–17.CrossRefGoogle ScholarPubMed
59.Pappa, S, Dazzan, P. Spontaneous movement disorders in antipsychotic-naive patients with first-episode psychoses: a systematic review. Psychol Med. 2009; 39(7): 1065–1076.CrossRefGoogle ScholarPubMed
60.Brüne, M. The incidence of akathisia in bipolar affective disorder treated with neuroleptics—a preliminary report. J Affect Disord. 1999; 53(2): 175–177.CrossRefGoogle ScholarPubMed
61.De Fruyt, J, Deschepper, E, Audenaert, K, et al. Second generation antipsychotics in the treatment of bipolar depression: a systematic review and meta-analysis. J Psychopharmacol. 2012; 26(5): 603–617.CrossRefGoogle ScholarPubMed
62.Kane, JM, Barnes, TR, Correll, CU, et al. Evaluation of akathisia in patients with schizophrenia, schizoaffective disorder, or bipolar I disorder: a post hoc analysis of pooled data from short- and long-term aripiprazole trials. J Psychopharmacol. 2010; 24(7): 1019–1029.CrossRefGoogle ScholarPubMed
63.Miller, CH, Hummer, M, Oberbauer, H, Kurzthaler, I, DeCol, C, Fleischhacker, WW. Risk factors for the development of neuroleptic induced akathisia. Eur Neuropsychopharmacol. 1997; 7(1): 51–55.CrossRefGoogle ScholarPubMed
64.Nordström, P, Michaëlsson, K, Gustafson, Y, Nordström, A. Traumatic brain injury and young onset dementia: a nationwide cohort study. Ann Neurol. 2014; 75(3): 374–381.CrossRefGoogle Scholar
65.Stewart, JT. Akathisia following traumatic brain injury: treatment with bromocriptine. J Neurol Neurosurg Psychiatry. 1989; 52(10): 1200–1201.CrossRefGoogle ScholarPubMed
66.Brown, K, Glen, S, White, T. Low serum iron status and akathisia. Lancet. 1987; 329(8544): 1234–1236.CrossRefGoogle Scholar
67.Krieger, J, Schroeder, C. Iron, brain and restless legs syndrome. Sleep Med Rev. 2001; 5(4): 277–286.CrossRefGoogle ScholarPubMed
68.Chong, SA, Mythily, , Remington, G. Clinical characteristics and associated factors in antipsychotic-induced akathisia of Asian patients with schizophrenia. Schizophr Res. 2003; 59(1): 67–71.CrossRefGoogle ScholarPubMed
69.Akagi, H, Kumar, TM. Lesson of the week: akathisia: overlooked at a cost. BMJ. 2002; 324(7352): 1506–1507.CrossRefGoogle ScholarPubMed
70.Hirose, S. The causes of underdiagnosing akathisia. Schizophr Bull. 2003; 29(3): 547–558.CrossRefGoogle ScholarPubMed
71.Stahl, SM. Akathisia and tardive dyskinesia: changing concepts. Arch Gen Psychiatry. 1985; 42(9): 915–917.CrossRefGoogle ScholarPubMed
72.Weiden, PJ, Mann, JJ, Haas, G, Mattson, M, Frances, A. Clinical nonrecognition of neuroleptic-induced movement disorders: a cautionary study. Am J Psychiatry. 1987; 144(9): 1148–1153.Google ScholarPubMed
73.Madruga-Garrido, M, Mir, P. Tics and other stereotyped movements as side effects of pharmacological treatment. In Davide M, Andrea EC eds International Review of Neurobiology. Vol 112. London: Academic Press; 2013: 481–494.Google Scholar
74.Weiden, P, Bruun, R. Worsening of Tourette’s disorder due to neuroleptic-induced akathisia. Am J Psychiatry. 1987; 144(4): 504–505.Google ScholarPubMed
75.Fountoulakis, KN, Samara, M, Siapera, M, Iacovides, A. Tardive Tourette-like syndrome: a systematic review. Int Clin Psychopharmacol. 2011; 26(5): 237–242.CrossRefGoogle ScholarPubMed
76.Stahl, SM. Tardive Tourette syndrome in an autistic patient after long-term neuroleptic administration. Am J Psychiatry. 1980; 137(10): 1267–1269.Google Scholar
77.Burkhard, PR. Acute and subacute drug-induced movement disorders. Parkinsonism Relat Disord. 2014; 20(Suppl 1): S108–S112.CrossRefGoogle ScholarPubMed
78.Dayalu, P, Chou, KL. Antipsychotic-induced extrapyramidal symptoms and their management. Expert Opin Pharmacother. 2008; 9(9): 1451–1462.CrossRefGoogle ScholarPubMed
79.Mihanovic, M, Bodor, D, Kezic, S, Restek-Petrovic, B, Silic, A. Differential diagnosis of psychotropic side effects and symptoms and signs of psychiatric disorders. Psychiatr Danub. 2009; 21(4): 570–574.Google ScholarPubMed
80.Rodnitzky, RL. Drug-induced movement disorders. Clin Neuropharmacol. 2002; 25(3): 142–152.CrossRefGoogle ScholarPubMed
81.Sachdev, PS. Neuroleptic-induced movement disorders: an overview. Psychiatr Clin North Am. 2005; 28(1): 255–274.CrossRefGoogle ScholarPubMed
82.Kahn, EM, Munetz, MR, Davies, MA, Schulz, SC. Akathisia: Clinical phenomenology and relationship to tardive dyskinesia. Compr Psychiatry. 1992; 33(4): 233–236.CrossRefGoogle ScholarPubMed
83.Ekbom, KA. Asthenia crurum paraesthetica («irritable legs»). Acta Med Scand. 1944; 118(1–3): 197–209.CrossRefGoogle Scholar
84.Trenkwalder, C, Paulus, W, Walters, AS. The restless legs syndrome. Lancet Neurol. 2005; 4(8): 465–475.CrossRefGoogle ScholarPubMed
85.Angelini, M, Negrotti, A, Marchesi, E, Bonavina, G, Calzetti, S. A study of the prevalence of restless legs syndrome in previously untreated Parkinson’s disease patients: absence of co-morbid association. J Neurol Sci. 2011; 310(1–2): 286–288.CrossRefGoogle ScholarPubMed
86.Bhalsing, K, Suresh, K, Muthane, UB, Pal, PK. Prevalence and profile of restless legs syndrome in Parkinson’s disease and other neurodegenerative disorders: a case-control study. Parkinsonism Relat Disord. 2013; 19(4): 426–430.CrossRefGoogle ScholarPubMed
87.Möller, JC, Unger, M, Stiasny-Kolster, K, Oertel, WH. Restless legs syndrome (RLS) and Parkinson’s disease (PD)—related disorders or different entities? J Neurol Sci. 2010; 289(1–2): 135–137.CrossRefGoogle ScholarPubMed
88.Nomura, T, Inoue, Y, Nakashima, K. Clinical characteristics of restless legs syndrome in patients with Parkinson’s disease. J Neurol Sci. 2006; 250(1–2): 39–44.CrossRefGoogle ScholarPubMed
89.Rijsman, RM, Schoolderman, LF, Rundervoort, RS, Louter, M. Restless legs syndrome in Parkinson’s disease. Parkinsonism Relat Disord. 2014; 20(Suppl 1): S5–S9.CrossRefGoogle ScholarPubMed
90.Blaisdell, GD. Akathisia: a comprehensive review and treatment summary. Pharmacopsychiatry. 1994; 27(4): 139–146.CrossRefGoogle ScholarPubMed
91.Poewe, W, Hogl, B. Akathisia, restless legs and periodic limb movements in sleep in Parkinson’s disease. Neurology. 2004; 63(8 Suppl 3): S12–S16.CrossRefGoogle ScholarPubMed
92.Linazasoro, G, Massó, JFM, Suárez, JA. Nocturnal akathisia in Parkinson’s disease: treatment with clozapine. Mov Disord. 1993; 8(2): 171–174.CrossRefGoogle ScholarPubMed
93.Takahashi, M, Ikeda, J, Tomida, T, Hirata, K, Hattori, N, Inoue, Y. Daytime symptoms of restless legs syndrome—clinical characteristics and rotigotine effectiveness. Sleep Med. 2015; 16(7): 871–876.CrossRefGoogle ScholarPubMed
94.Walters, AS, Hening, W, Rubinstein, M, Chokroverty, S. A clinical and polysomnographic comparison of neuroleptic-induced akathisia and the idiopathic restless legs syndrome. Sleep. 1991; 14(4): 339–345.Google ScholarPubMed
95.Marsden, CD, Jenner, P. The pathophysiology of extrapyramidal side-effects of neuroleptic drugs. Psychol Med. 1980; 10(1): 55–72.CrossRefGoogle ScholarPubMed
96.Eisensehr, I, Ehrenberg, BL, Noachtar, S. Different sleep characteristics in restless legs syndrome and periodic limb movement disorder. Sleep Med. 2003; 4(2): 147–152.CrossRefGoogle ScholarPubMed
97.Stahl, SM, Loonen, AJ. The mechanism of drug-induced akathisia. CNS Spectr. 2011; 16(1): 7–10.Google Scholar
98.Rios Romenets, S, Dauvilliers, Y, Cochen De Cock, V, et al. Restless legs syndrome outside the blood–brain barrier—exacerbation by domperidone in Parkinson’s disease. Parkinsonism Relat Disord. 2013; 19(1): 92–94.CrossRefGoogle ScholarPubMed
99.Barnes, TRE. The Barnes Akathisia Rating Scale–Revisited. J Psychopharmacol. 2003; 17(4): 365–370.CrossRefGoogle ScholarPubMed
100.Lima, AR, Weiser, KV, Bacaltchuk, J, Barnes, TR. Anticholinergics for neuroleptic-induced acute akathisia. Cochrane Database Syst Rev. 2004; ■(1): CD003727.Google ScholarPubMed
101.Rathbone, J, Soares-Weiser, K. Anticholinergics for neuroleptic-induced acute akathisia. Cochrane Database Syst Rev. 2006; ■(4): CD003727.Google ScholarPubMed
102.Baskak, B, Atbasoglu, EC, Ozguven, HD, Saka, MC, Gogus, AK. The effectiveness of intramuscular biperiden in acute akathisia: a double-blind, randomized, placebo-controlled study. J Clin Psychopharmacol. 2007; 27(3): 289–294.CrossRefGoogle ScholarPubMed
103.Lima, AR, Bacalcthuk, J, Barnes, TR, Soares-Weiser, K. Central action beta-blockers versus placebo for neuroleptic-induced acute akathisia. Cochrane Database Syst Rev. 2004; ■(4): CD001946.Google ScholarPubMed
104.Poyurovsky, M. Acute antipsychotic-induced akathisia revisited. Br J Psychiatry. 2010; 196(2): 89–91.CrossRefGoogle ScholarPubMed
105.Berk, M, Copolov, D, Dean, O, et al. N-acetyl cysteine as a glutathione precursor for schizophrenia—a double-blind, randomized, placebo-controlled trial. Biol Psychiatry. 2008; 64(5): 361–368.CrossRefGoogle ScholarPubMed
106.Guay, DRP. Tetrabenazine, a monoamine-depleting drug used in the treatment of hyperkinetic movement disorders. Am J Geriatr Pharmacother. 2010; 8(4): 331–373.CrossRefGoogle ScholarPubMed
107.Jankovic, J, Clarence-Smith, K. Tetrabenazine for the treatment of chorea and other hyperkinetic movement disorders. Expert Rev Neurother. 2011; 11(11): 1509–1523.CrossRefGoogle ScholarPubMed
108.Fehr, C, Dahmen, N, Klawe, C, Eicke, M, Szegedi, A. Piracetam in the treatment of tardive dyskinesia and akathisia: a case report. J Clin Psychopharmacol. 2001; 21(2): 248–249.CrossRefGoogle ScholarPubMed