Hostname: page-component-7dd5485656-bt4hw Total loading time: 0 Render date: 2025-10-31T01:47:20.777Z Has data issue: false hasContentIssue false
  • English
  • Français

Antipsychotic-induced akathisia in delirium: A systematic review

Published online by Cambridge University Press:  19 June 2015

Fernando Espi Forcen ,
Konstantina Matsoukas  and
Yesne Alici
Fernando Espi Forcen*
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, New York
Konstantina Matsoukas
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, New York
Yesne Alici
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Fernando Espi Forcen, 425 East 76th Street, Apartment 4B, New York, New York 10021. E-mail: ferespi@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Akathisia is a neuropsychiatric syndrome characterized by subjective and objective restlessness. It is a common side effect in patients taking antipsychotics and other psychotropics. Patients with delirium are frequently treated with antipsychotic medications that are well known to induce akathisia as a side effect. However, the prevalence, phenomenology, and management of akathisia in patients with delirium remain largely unknown. The purpose of this review was to examine the medical literature in order to establish the current state of knowledge regarding the prevalence of antipsychotic-induced akathisia in patients with delirium.

Method:

A systematic review of the literature was conducted using the EMBASE, MEDLINE, PsycINFO, and CINAHL databases. Ten studies addressing the incidence of akathisia in patients taking antipsychotic medication for delirium were identified and included in our review.

Results:

The included studies reported a variable prevalence of antipsychotic-induced akathisia. A higher prevalence was found in patients taking haloperidol. Among atypical antipsychotics, paliperidone and ziprasidone were associated with a higher risk of akathisia. The risk for akathisia appeared to be a dose-related phenomenon.

Significance of results:

Studies using specific scales for evaluation of akathisia in delirium are lacking. Some populations, such as patients with cancer or terminally ill patients in palliative care settings taking antipsychotics for the treatment of delirium, could be at higher risk for development of akathisia as a side effect.

Keywords

AkathisiaDeliriumAntipsychotics

Information

Type
Review Article
Information
Palliative & Supportive Care , Volume 14 , Issue 1 , February 2016 , pp. 77 - 84
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

American Psychiatric Association (APA) (2013). Diagnostic and statistical manual of mental disorders, 5th ed. [DSM–V]. Arlington, VA: American Psychiatric Publishing.Google Scholar
Barnes, T. & Braude, W. (1985). Akathisia variants and tardive dyskinesia. Archives of General Psychiatry, 42(9), 874–878.Google Scholar
Berrios, G.E. (1995). Lad Haskovec and akathisia. History of Psychiatry, 6(22, Pt. 2), 243–251.Google Scholar
Breitbart, W. & Alici, Y. (2012). Evidence-based treatment of delirium in patients with cancer. Journal of Clinical Oncology, 30(11), 1206–1214.CrossRefGoogle ScholarPubMed
Breitbart, W., Marotta, R., Platt, M.M., et al. (1996). A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. The American Journal of Psychiatry, 153(2), 231–237.Google Scholar
Crawford, G.B., Meera Agar, M., Quinn, S.J., et al. (2013). Pharmaco-vigilance in hospice/palliative care: Net effect of haloperidol for delirium. Journal of Palliative Medicine, 16(11), 1335–1341.CrossRefGoogle Scholar
Fernandez, F. & Levy, J.K. (1993). The use of molindone in the treatment of psychotic and delirious patients infected with the human immunodeficiency virus: Case reports. General Hospital Psychiatry, 15(1), 31–35.Google Scholar
Fleischhacker, W.W., Miller, C.H., Schett, P., et al. (1991). The Hillside Akathisia Scale: A reliability comparison of the English and German versions. Psychopharmacology, 105(1), 141–144.Google Scholar
Frazier, J.A., McClellan, J, Findling, R.L., et al. (2007). Treatment of early-onset schizophrenia spectrum disorders (TEOSS): Demographic and clinical characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8), 979–988.Google Scholar
Friedman, J.I., Soleimani, L., McGonigle, D.P., et al. (2014). Pharmacological treatments of non-substance-withdrawal delirium: A systematic review of prospective trials. The American Journal of Psychiatry, 171(2), 151–159.Google Scholar
Gogtay, N. & Rapoport, J. (2008). Clozapine use in children and adolescents. Expert Opinion on Pharmacotherapy, 9(3), 459–465.CrossRefGoogle ScholarPubMed
Gilchrist, N.A., Asoh, I. & Greenberg, B. (2012). Atypical antipsychotics for the treatment of ICU delirium. Journal of Intensive Care Medicine, 27(6), 354–361.Google Scholar
Girard, T.D., Pandharipande, P.P., Carson, S.S., et al. (2010). Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: The MIND randomized, placebo-controlled trial. Critical Care Medicine, 38(2), 428–437.CrossRefGoogle ScholarPubMed
Han, C.S. & Kim, Y.K. (2004). A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics, 45(4), 297–301.CrossRefGoogle ScholarPubMed
Hatta, K., Kishi, Y., Wada, K., et al. (2014). Antipsychotics for delirium in the general hospital setting in 2453 consecutive inpatients: A prospective observational study. International Journal of Geriatric Psychiatry, 29(3), 253–262.CrossRefGoogle ScholarPubMed
Jung Jin, K., Hyun Kook, L., Chi Un, P., et al. (2009). Comparison of intramuscular olanzapine and haloperidol for the treatment of delirium. European Psychiatry, 24, S1006.Google Scholar
Jung, J.S., Lee, H.J., Cho, C.H., et al. (2014). Association between restless legs syndrome and CLOCK and NPAS2 gene polymorphism in schizophrenia. Chronobiology International, 31(7), 838–844.Google Scholar
Kalisvaart, K.J., de Jonghe, J.F., Bogaards, M.J., et al. (2005). Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: A randomized placebo-controlled study. Journal of the American Geriatrics Society, 53(10), 1658–1666.Google Scholar
Kawanishi, C., Onishi, H., Kato, D., et al. (2007). Unexpectedly high prevalence of akathisia in cancer patients. Palliative & Supportive Care, 5(4), 351–354.Google Scholar
Kim, J.H., Kim, Y.B., Lee, S.Y., et al. (2011). Antipsychotic-associated mental side effects and their relationship to dopamine D2 receptor occupancy in striatal subdivisions: A high-resolution PET study with [11C]raclopride. Journal of Clinical Psychopharmacology, 31(4), 507–511.CrossRefGoogle ScholarPubMed
Kim, J.J., Lim, H.K., Pae, C.U., et al. (2008). Comparison of intramuscular olanzapine and haloperidol for the treatment of delirium. European Neuropsychopharmacology, 18(S4), S424–S425.CrossRefGoogle Scholar
Kim, S.W., Yoo, J.A., Lee, S.Y., et al. (2010). Risperidone versus olanzapine for the treatment of delirium. Human Psychopharmacology, 25(4), 298–302.CrossRefGoogle ScholarPubMed
Kumar, R. & Sachdev, P. (2009). Akathisia and second-generation antipsychotic drugs. Current Opinion in Psychiatry, 22(3), 293–299.Google Scholar
Lieberman, J.A. & Stroup, T.S. (2011). The NIMH–CATIE schizophrenia study: What did we learn? The American Journal of Psychiatry, 168(8), 770–775.Google Scholar
Lonergan, E., Britton, A.M. & Luxenberg, J. (2007). Antipsychotics for delirium. The Cochrane Database of Systematic Reviews, (2), CD005594.Google Scholar
Loonen, A.J.M. & Stahl, S.M. (2011). The mechanism of drug-induced akathisia. CNS Spectrums, 16(1), 7–10.Google Scholar
Maneeton, B., Maneeton, N., Srisurapanont, M., et al. (2013). Quetiapine versus haloperidol in the treatment of delirium: A double-blind, randomized, controlled trial. Drug Design, Development and Therapy, 7, 657–667.Google Scholar
Menza, M.A., Murray, G.B., Holmes, V.F., et al. (1988). Controlled study of extrapyramidal reactions in the management of delirious, medically ill patients: Intravenous haloperidol versus intravenous haloperidol plus benzodiazepines. Heart & Lung, 17(3), 238–241.Google Scholar
Miyaji, S., Yamamoto, K., Hoshino, S., et al. (2007). Comparison of the risk of adverse events between risperidone and haloperidol in delirium patients. Psychiatry and Clinical Neurosciences, 61(3), 275–282.Google Scholar
Ossowska, K. (2002). Neuronal basis of neuroleptic-induced extrapyramidal side effects. Polish Journal of Pharmacology, 54(4), 299–312.Google ScholarPubMed
Page, V.J., Ely, E.W., Gates, S., et al. (2013). Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope–ICU): A randomised, double-blind, placebo-controlled trial. The Lancet, Respiratory Medicine, 1(7), 515–523.CrossRefGoogle ScholarPubMed
Pintor, L., Fuente, E., Bailles, E., et al. (2009). Study on the efficacy and tolerability of amisulpride in medical/surgical inpatients with delirium admitted to a general hospital. European Psychiatry, 24(7), 450–455.CrossRefGoogle Scholar
Sachdev, P. (1994). A rating scale for acute drug-induced akathisia: Development, reliability, and validity. Biological Psychiatry, 35(4), 263–71.Google Scholar
Sachdev, P. (1995). Akathisia and restless legs. Cambridge: Cambridge University Press.Google Scholar
Sachdev, P. & Loneragan, C. (1991) The present status of akathisia. The Journal of Nervous and Mental Disease, 179(7), 381–391.Google Scholar
Seneff, M.G. & Mathews, R.A. (1995). Use of haloperidol infusions to control delirium in critically ill adults. The Annals of Pharmacotherapy, 29(7–8), 690–693.Google Scholar
Takeuchi, T., Furuta, K., Hirasawa, T., et al. (2007). Perospirone in the treatment of patients with delirium. Psychiatry and Clinical Neurosciences, 61(1), 67–70.Google Scholar
Wada, M., Ito, H., Wada, M., et al. (2011). Drug-induced akathisia as a cause of distress in spouse caregivers of cancer patients. Palliative & Supportive Care, 9(2), 209–212.CrossRefGoogle ScholarPubMed
White, C., McCann, M.A. & Jackson, N. (2007). First do no harm … Terminal restlessness or drug-induced delirium. Journal of Palliative Medicine, 10(2), 345–351.Google Scholar
Yoo, J.A., Kim, S.W., Bae, K.Y., et al. (2011). Risperidone versus olanzapine for the treatment of delirium. European Neuropsychopharmacology, 21, S493.CrossRefGoogle Scholar
Yoon, H.K., Kim, Y.K., Han, C., et al. (2011). Paliperidone in the treatment of delirium: Results of a prospective open-label pilot trial. Acta Neuropsychiatrica, 23(4), 179.Google Scholar