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Akathisia (psychomotor agitation): what it is, symptoms and causes

Akathisia (psychomotor agitation): what it is, symptoms and causes

March 24, 2024

Uneasiness and anxiety are common symptoms of the consumption and withdrawal of some drugs and drugs. Akathisia is a particular case of psychomotor agitation which shows feelings of emotional dysphoria, as well as physical discomfort and pain.

In this article we will describe what is akathisia and what are the symptoms and causes most common of this syndrome, considered a disorder by some professionals and more a consequence of medical malpractice by others.

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What is akathisia?

Akathisia is a syndrome that is characterized by a feeling of constant restlessness, both physiological and mental . This term is used mainly to describe adverse reactions to certain psychoactive substances or symptoms derived from the interruption of its consumption.


It manifests as an emotional state of an anxious type that can include only cognitive symptoms or physical signs, fundamentally related to the need to stay in movement .

The word "akathisia" comes from the Greek and can be translated as "inability to sit down". It was coined by the Czech neuropsychiatrist Ladislav Haškovec, who described this disorder for the first time in the article entitled L'akathisie, in 1901.

Although the akathisia is commonly associated with the consumption of typical antipsychotics Like haloperidol or drug withdrawal, it can also be caused by other medications and substances, as well as by some types of brain injury.


  • Related article: "Types of antipsychotics (or neuroleptics)"

Physical signs and clinical picture

The continuous feelings of agitation are the cardinal symptom of akathisia. Depending on the intensity of the syndrome, this anxiety may manifest itself as psychological restlessness or may produce a extreme discomfort in the body . In particular, a large number of patients with akathisia describe discomfort and pain in the knees.

In many cases the agitation causes the person to carry out movements of different types. Some characteristic behaviors of the akathisia are to walk without stopping, to get up and sit down repeatedly, to rattle the fingers, to swing the trunk, to cross the legs or to make sounds of complaint.

These signs are produced as a reaction to the sensations of physical tension and diffuse pain . Other neuropathic disorders, such as restless legs syndrome and some cases of fibromyalgia, cause symptoms similar to those of akathisia, which is why they are sometimes diagnosed in the wrong way.


As patients refer, constant movement helps to alleviate physical discomfort and pain to some extent; For example, walking and crossing or stretching the legs reduces a little the uncomfortable sensations in the knees.

Psychological symptoms of akathisia

On a cognitive and emotional level They highlight symptoms such as dysphoria (unpleasant feelings opposed to euphoria), worry, irritability, emotional instability and the presence of dark thoughts.

The sensations become so annoying that many patients claim that they want to get out of their skin and even tear it away. People with drug-induced akathisia tend to reject them and to affirm categorically that these are the cause of the discomfort, comparable to chemical torture .

It is also common the presence of other anxious symptoms associated with restlessness; in people with akathisia the likelihood of suffering insomnia and difficulties in falling asleep increases, as well as anguish crisis as a result of the intense psychophysiological activation.

Causes and risk factors

Usually akathisia is related to a alteration in dopamine levels , a neurotransmitter involved in movement and many other functions, such as pleasure, learning and motivation.

Therefore, the substances that cause this syndrome are mainly those that block the action of dopamine in the central nervous system, ie the dopamine antagonists. However, akathisia may also be due to other causes.

1. Antipsychotic drugs

Akathisia has been described with great frequency in people undergoing long-term treatment with antipsychotics, especially the typical or first generation , which block the D2 dopamine receptors. It can occur as a side effect because of the potency of the drug, an excessive dose or abstinence.

Some of the antipsychotics that carry a higher risk of developing akathisia and other extrapyramidal symptoms are haloperidol, chlorpromazine, thiothixene, zuclopenthixol, olanzapine, and risperidone.

2. Antidepressant drugs

Not only dopamine reduction can cause akathisia, but it can also do so increase in serotonin levels . Thus, some serotonergic drugs that are used mainly to treat depression are related to the onset of this syndrome.

Among the antidepressants that cause akathisia include SSRIs or selective serotonin reuptake inhibitors , such as paroxetine, fluoxetine and sertraline, and tricyclics, for example clomipramine and amitriptyline. Venlafaxine, which inhibits the reuptake of serotonin and noradrenaline, has also been associated with symptoms of akathisia.

3. Abstinence from drugs and substances

When there is physical dependence on drugs or dopaminergic drugs, the interruption of consumption frequently causes akathisia in the context of the withdrawal syndrome.

This happens with antipsychotics and antidepressants, described in the previous sections, but also with alcohol, cannabis, cocaine and opiates like heroin Amphetamine stimulants have effects similar to those of cocaine, and barbiturates and benzodiazepines to those of alcohol.

4. Other medications

Other medications that can cause the appearance of akathisia are antiemetics, antihistamines and analgesics used to treat migraine. In general, the higher the potency of the drug, the greater the likelihood that adverse reactions will occur.

5. Parkinson's disease

Akathisia has also been associated with Parkinson's disease, which progressively deteriorates the central nervous system and is characterized mainly by motor, cognitive and emotional symptoms.

However, in these cases it is not always clear whether akathisia is due to the disorder itself or to the medications used to treat it, since they often alter the action of dopamine. Levodopa is the most common drug in the management of Parkinson's disease.


What is PSYCHOMOTOR AGITATION? What does PSYCHOMOTOR AGITATION mean? PSYCHOMOTOR AGITATION meaning (March 2024).


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