What about the hidden face of Akathisia

Introduction Akathisia is commonly known for its objective components such as rocking while standing or sitting and lifting feet. However, little is known about its psychiatric impact that can even lead to suicidal attempts. Objectives The aim of this study is to investigate the main psychiatric symptoms associated with akathisia in a Tunisian sample of patients under treatment for Schizophrenia, Schizoaffective or Bipolar Disorder. Methods Fifteen patients were diagnosed with akathisia using the Barnes Akathisia Scale. Psychiatric symptoms related to akathisia such as mood lability, sadness, anxiety, aggressivity, suicidal ideation, insomnia and social and professional impairment were assessed. Results The average age of the sample was 47 years. The average antipsychotic chlorpromazine-equivalent total dosage was 1756 mg. All patients reported at least one psychiatric symptom imputed to akathisia. These were: mood lability ( n  =  11), inner restlessness ( n  = 10), anxiety ( n  = 10), sadness ( n  = 10), aggressivity ( n  = 6), and insomnia ( n  = 12). Eight patients described suicidal ideation and five confessed having committed a suicide attempt. Four and ten said akathisia had professional and social impact respectively. The prevalence of psychiatric symptoms did not differ according to sex, age, diagnosis, illness duration, presence of a comorbid anxiety disorder, the number and types of antipsychotics used, the antipsychotic chlorpromazine-equivalent total dosage or the reported drug compliance. Conclusions Psychiatric symptoms resulting from Akathisia remain frequently undetected. Special interest by the clinician is required to elicit these symptoms.