Akathisia is associated with emotional symptoms and cognitive impairment

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Key message: Akathisia is associated with emotional symptoms (e.g., reduced self-esteem, anxiety, depression and paranoid ideation) and cognitive impairment (e.g., problems with mental control, associate learning, perception and coping).

Background

• In a cross-sectional study, 80 patients with a schizophrenic disorder (according to ICD-10 criteria) who had an illness duration of >1 year were investigated, by using various rating scales: Positive and Negative Syndrome Scale (PANSS), the St. Hans Rating Scale for EPS, the UKU Side Effect Rating Scale, the Drug Attitude Inventory, and the Lancashire Quality of Life Profile.^{[Hofer et al., 2004]}
• Mild to moderate akathisia was reported in 23% of all patients, and there was a significant negative correlation between akathisia (St. Hans scale) and self-esteem (-0.32, p<0.01).^{[Hofer et al., 2004]}

• In another study, 67 outpatients with schizophrenia receiving stable doses of specific antipsychotic therapies were evaluated for akathisia and other extrapyramidal adverse events.^{[Kim et al., 2007]}
• Subjective cognitive dysfunction was comprehensively assessed by using the Frankfurt Complaint Questionnaire (FCQ).^{[Kim et al., 2007]}
• The severity of subjective cognitive deficits was compared between the groups with and without akathisia.^{[Kim et al., 2007]}
• The akathisia group (n=25) scored significantly higher (worse) on the FCQ Total score than the non-akathisia group (n=42) (p<0.05).^{[Kim et al., 2007]}
• In phenomenological subscale scores, the akathisia group had significantly higher (worse) scores on various subscales, i.e., ‘anxiety’, ‘disorder of selective attention’, ‘deterioration of discrimination’, ‘perceptual disorder’ and ‘disorder of coping responses’ than the non-akathisia group (p<0.05).^{[Kim et al., 2007]}

• In a third study, 41 stable and chronic patients with schizophrenia, who were receiving maintenance antipsychotic treatment, were rated by using the Barnes Akathisia Rating Scale (BARS) for drug-induced akathisia.^{[Kim et al., 2002]}
• Subjective symptoms were evaluated by using the Symptom Checklist-90-Revised (SCL-90-R), and cognitive function was assessed by using the Wechsler Memory Scale (WMS).^{[Kim et al., 2002]}
• Analysis of covariance (ANCOVA) with relevant variables as covariates revealed that patients with akathisia (n=17) had significantly higher (worse) scores on the depression subscale of the SCL-90-R than those without akathisia (n=24) (p<0.01). Patients with akathisia also had significantly lower (worse) scores on the mental control subtest of the WMS (p<0.05).^{[Kim et al., 2002]}
• Further analysis using ordinal logistic regression revealed that the depression subscale of the SCL-90-R and the mental control subtest of the WMS were significantly associated with the severity of akathisia.^{[Kim et al., 2002]}

References:
Hofer A, Kemmler G, Eder U, et al. Quality of life in schizophrenia: the impact of psychopathology, attitude toward medication, and side effects. J Clin Psychiatry 2004; 65 (7): 932–939.

Kim JH, Byun HJ. Association of subjective cognitive dysfunction with akathisia in patients receiving stable doses of risperidone or haloperidol. J Clin Pharm Ther 2007; 32 (5): 461–467.

Kim JH, Lee BC, Park HJ, et al. Subjective emotional experience and cognitive impairment in drug-induced akathisia. Compr Psychiatry 2002; 43 (6): 456–462.