The Relationship of Akathisia with Psychiatric Symptoms, Suicidality and Other Movement Disorders in Patients on Antipsychotic Treatment

Objective: The association of akathisia with psychiatric symptoms and other movement disorders is unclear, and it has been suggested that current evidence degree regarding the relationship between akathisia and suicide is at the level of case-reports. This study aims to investigate the relationship of akathisia with psychiatric symptoms, other movement disorders, and suicidality. Methods: Consecutive patients (N=52) who were initiated on a new antipsychotic or had a dose increment in the antipsychotic medication were evaluated within the first hospitalization week. The Barnes Akathisia Rating Scale (BARS) was used to identify groups with (AG;N=27) and without (CG;N=25) akathisia. The groups were compared using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HDRS), the Beck Anxiety Inventory (BAI), the Abnormal Involuntary Movements Scale (AIMS), the Unified Parkinson's Disease Rating Scale-Motor Exam (UPDRS-me) and in terms of treatment parameters. Results: The severity of general psychopathology, anxiety, suicidality and dyskinesias were higher in the AG. No difference was found between the groups regarding symptoms of Parkinson's disease and depression. Lifetime antipsychotic exposure was longer, multiple antipsychotic use was more frequent in the AG. Conclusion: Although the severity of dyskinesias was greater in AG compared to CG, the similar parkinsonian symptoms in the two groups suggest a reciprocal masking of akathisia and parkinsonism and/or different neuro-pathologic pathways. The severity of general psychopathology and anxiety is associated with disphoria caused by akathisia, or a correlative relationship might be present. Suicidal ideation in the absence of higher depressive symptoms in AG suggests that suicidal behavior associated with akathisia may be an impulsive act related to anxiety and/or dysphoria. Our findings indicate that akathisia must be considered as a risk factor for suicide. The lifetime antipsychotic exposure in akathisia must be studied in larger samples. (Archives of Neuropsychiatry 2010; 47: 307-13)