Posted by ed_uk2010 on February 18, 2012, at 12:52:37
In reply to Re: tardive akathisia » novelagent, posted by SLS on February 18, 2012, at 6:22:48
>I see too many people on Psycho-Babble wrongly interpret their anxiety and restlessness as being akathisia.
I've noticed that too.
In the past, I've experienced both intense akathisia (caused by a typical neuroleptic) and severe anxiety/panic.
Neuroleptic-induced akathisia feels very different to anxiety. The physical restlessness and inability to remain still is much stronger in akathisia - it is the primary symptom. There is an unbearable feeling of not being able to stay still, causing constant pacing or writhing movements, which are frankly exhausting. I remember feeling like my body was going to explode. I felt very afraid that the horrible symptoms would not go away.
In anxiety, it is much easier to remain still, but it is very unpleasant in a different way. There is fear or even dread, terror and panic. Physical tension can be pronounced in severe cases eg. muscle tension and shaking. There is often restlessness but it is easier to stay still than in akathisia. Restlessness is a secondary symptom of anxiety, it is not the primary problem.
Akathisia feels more physical, like pain - both of which have psychological consequences. Anxiety states are more psychological and are often related to specific anxiety-provoking situations.
In akathisia, you experience fear because the physical sensation of restlessness is so overwhelming. In anxiety, you experience physical restless because you are afraid or panicking. When severe, akathisia and anxiety states are both absolutely awful. Both can occur on a continuum of mild/moderate/severe/very severe.
It would be dangerous if a doctor misinterpreted akathisia as a worsening of the patient's condition and increased the dose of the antipsychotic. With typical neuroleptics in particular, akathisia can rapidly occur after a high initial dose or after a abrupt increase in dose. It is often accompanied by a strong dysphoria. I am concerned than akathisia may not be diagnosed correctly in patients who cannot communicate properly (eg. in dementia) or in patients with limited mobility. The resulting agitation and distress may be misdiagnosed, especially by inexperienced doctors who assume that antipsychotics are always calming.
With atypical antipsychotics, akathisia seems to occur more often than standard EPS. Severe akathisia is less likely with atypicals than with say, haloperidol, but it's still a risk. Aripiprazole seems to cause initial restless quite often but it doesn't always last. I've not heard of this scenario with typical APs.
poster:ed_uk2010
thread:1010334
URL: http://www.dr-bob.org/babble/20120212/msgs/1010656.html