Talk:Akathisia

Tardive Akathisia
This section needs some clarification, especially this statement: "Probably due to neurotoxicity of antidopaminergic drugs" -- this article (and wikipedia psychiatry articles in general) seems to extrapolate a lot of information and contain a lot of original research. I don't believe dopamine antagonists are acknowledged as neurotoxic; even though they can induce TD the exact mechanism behind this is still uncertain. Unfortunately, I'm unable to deactivate the paywall for the sourced review on SGAs, but I seriously doubt the review stated it in terms other than a vague, passing hypothesis because I can't find additional sources for 'DA neurotoxicity' anywhere. Can someone at least pull a quote from the review instead of just flippantly mentioning 'oh yeah probably due to neurotoxicity' because I mean... it's at the very least not encyclopedic. — Preceding unsigned comment added by 47.184.211.178 (talk) 15:53, 5 March 2019 (UTC)

Removing a paragraph
The last paragraph under “signs and symptoms” should be removed as it is completely misleading and could contribute to clinicians misunderstanding the suicidality associated with akathisia. Anyone who gets akathisia becomes suicidal, there is no reason to promote the idea that it is simply a worsening of pre-existing suicidality. AkathisiaInformation (talk) 20:18, 21 July 2020 (UTC)
 * First, please indent your reply using colons at the beginning of the line (like I've done here). You should add one more colon than the number of the comment you're replying to - this allows for threaded discussion that is easy to follow.
 * Second, you must provide sources which are reliable for medical information for the statement "anyone who gets akathisia becomes suicidal".
 * Third, you must explain why the three sources cited in the article now are not appropriate sources. For clarity, there is an article from the reputable journal Pharmacopsychiatry, one from The British Journal of Psychiatry, and one from Human Psychopharmacology. On top of the fact that there are three sources reliable for medical information cited, one of them is a review article - which is an even stronger form of medical source as it compiles and analyzes other articles already published. You must explain why these sources should be considered unreliable, and if you are going to analyze these sources, you must explain your train of thought given the policy on sources reliable for medical information.
 * Fourth, information will not be added/removed from this article just because you claim it is "misleading". You need to clearly articulate why it is misleading (what is it leading people to believe that is untrue), and clearly provide reliable sources for medical information to support the claims you're making. You believing something is (un)true does not mean that Wikipedia must take your word for it.
 * I look forward to your responses to these points and for other editors to chime in as well. Regards, bɜ:ʳkənhɪmez (User/say hi!) 21:20, 21 July 2020 (UTC)
 * "Anyone who gets akathisia becomes suicidal" sounds like a defining attribute, so I went looking for a few sources on what the definitions are. Here's what I found:
 * Under the heading "Definition":  "Akathisia is a condition of motor restlessness in which there is a feeling of muscular quiverring, an urge to move about constantly, and an inability to sit still.  It is a common extrapyramidal side effect of neuroleptic drugs.  It is considered a subjective feeling of restlessness with an objective motor component, most commonly caused by neuroleptic medication—especially high-potency agents."
 * Under the heading "Glossary": "Akathisia:  Restlessness, such as walking on the spot or shuffling, as well as mental unease"
 * "Definition:  A syndrome of increased motor activity and/or subjective sense of desire for motor activity believed to be due to functional irregularities in the extrapyramidal motor system in the brain.  Most blatantly, akathisia may involve fidgeting, inability to remain seated, shuffling gait, shortened stride, cogwheel rigidity, reduced accessory movements such as arm-swing while walking or gesturing, and pacing. It may include more subtle phenomena such as wandering (with attendant boundary issues) and excessive talking (which the patient may be aware of, but unable properly to control).  Akithisia  can also affect small muscle groups, such as those of the face and/or larynx, leading to a reduced amount and range of facial expression and/or monotonous voice tone.  Subjectively, akathisia is frequently experienced as an unpleasant, dysphoric state."
 * The closest I've come to a source along the lines of "Anyone who gets akathisia becomes suicidal" is this book, which says (page 416) "The subjective distress of akathisia, which can be agonizing, has been implicated in suicide attempts", and cites a case report from 35 years ago as its evidence.  That suggests that although it "can be" horrible and may be associated with suicidality, becoming suicidal is not a universal experience.   WhatamIdoing (talk) 22:54, 21 July 2020 (UTC)


 * I agree - I was attempting to assume good faith that this editor could be a valuable contributor, but it's clear now they're here to "right great wrongs" and not to provide encyclopedic information. I've given them a final warning for their most recent edit, and if they repeat, I'll request blocking from an admin. any chance you could watch the page as well, as I know you're an admin who may be willing to block the OP of this section if they repeat their most recent edit style? bɜ:ʳkənhɪmez (User/say hi!) 01:16, 22 July 2020 (UTC)
 * okay, I've watchlisted the page for now. I've left a note on AkathisiaInformation's talk page requesting they bring their sources here. Can I ask that, for now, we all remain prepared to discuss their sources and perhaps explain WP:MEDRS to them if necessary. Trip database gives a reasonable number of secondary sources for akathisia, and Google Scholar finds over 5,000 results since 2016, so we shouldn't need to be using anything but the best sources in our article. I spotted an ongoing 2020 systematic review from NIHR titled "The association between akathisia and suicidality after neuroleptic intervention: a systematic review of the evidence" which we can't use yet, but I feel would be very promising for us to use when it reaches final publication. --RexxS (talk) 02:19, 22 July 2020 (UTC)
 * That sounds like it will be a great paper, whenever it becomes available. WhatamIdoing (talk) 04:53, 22 July 2020 (UTC)
 * The article exemplified a recent trend ... the lead was updated, the body is dismal. I have reverted to the version with the well-cited lead and started flagging problems in the body.  This is typical characteristic recently of all articles in the neuropsych realm.  At any rate, the older version was a better starting place. Sandy Georgia  (Talk)  11:09, 22 July 2020 (UTC)

Suggest revert and rebuild
There is too much damage here to repair. I suggest a revert to this version, and updating to newer secondary reviews from that starting point. There is unencyclopedic tone, dated information, information not in accordance with newer reviews, and a general failure to adhere to WP:MEDRS. This looks like advocacy rather than encyclopedic editing. Repairing from the current version will be too time-consuming. Sandy Georgia (Talk)  00:26, 22 July 2020 (UTC)
 * I've spent most of today's time on this article reverting one user - I agree the linked version should just be a "nuke and start over" - because I don't think anyone has the time or desire to fight these editors trying to RGW and promo their fringe views on this page. I think there's definitely an argument to be had regarding some of the information in the current state - but that cannot happen without a more neutral starting point. bɜ:ʳkənhɪmez (User/say hi!) 01:13, 22 July 2020 (UTC)
 * Should we revert, here is a new review:
 * Sandy Georgia (Talk)  02:08, 22 July 2020 (UTC)
 * Sandy Georgia (Talk)  02:08, 22 July 2020 (UTC)

Misinformation provided
The first paragraph is misleading in that it states that akathisia predates psychiatric drugs. The condition only comes from psychiatric drugs, and not just antipsychotics. This kind of misinformation is dangerous. AkathisiaInformation (talk) 02:36, 22 July 2020 (UTC)
 * please see WP:V And WP:MEDRS; that reflects precisely what a 2020 review says. Sandy Georgia  (Talk)  02:39, 22 July 2020 (UTC)

From: Please read WP:MEDRS, and base your edits on the latest secondary reviews-- not primary sources, not lay sources. Sandy Georgia (Talk)  02:44, 22 July 2020 (UTC)
 * See also, 1901. Sandy Georgia (Talk)  02:52, 22 July 2020 (UTC)

Lead
Seems to be contradiction in defining it as a movement disorder and later..may just be a feeling. ?--Iztwoz (talk) 11:20, 22 July 2020 (UTC)
 * The ref provided supports movement disorder but Lohr separates the purely subjective experience; some refs refer to akathasia as a neuropsychiatric disorder (cannot find a review).--Iztwoz (talk) 11:31, 22 July 2020 (UTC)
 * I have not yet read Lohr ... suggest we find an overall newer review, and the article is a mess. Reminder that we should not write only leads, rather leads that summarize the contents in the body. . So far I have only cleaned out cruft and flagged what needs citation and updating. Sandy Georgia  (Talk)  11:46, 22 July 2020 (UTC)
 * An Australian site says that diagnosis is difficult since akathasia mimics movement disorders.; and quotes from DSM5 as - restlessness may be accompanied by observed excessive movememts (in acute akathasia).--Iztwoz (talk) 12:03, 22 July 2020 (UTC)
 * It would be helpful to write the article first and the lead later. The first problem was the article was lead only, body outdated and out of sync. The second problem was that most new edits were chunked in to the lead.  Wrong way to work.  First, find good, new, comprehensive sources to write the body. Then write the lead.  Picking apart individual things in the lead is a timesink. The Australian report above is a case report: start by finding good quality reviews.  I am done for now, back to sleep!  Sandy Georgia  (Talk)  12:10, 22 July 2020 (UTC)
 * Thanks--Iztwoz (talk) 12:13, 22 July 2020 (UTC)
 * In psychiatric practice it is most commonly considered first and foremost a side effect, specific to antipsychotics. Agree that the body of the article is the place to start and leave the lead till later. Cas Liber (talk · contribs) 13:27, 22 July 2020 (UTC)

Reviews to incorporate






Sandy Georgia (Talk)  13:04, 22 July 2020 (UTC)
 * Salem looks like our best starting place. Sandy Georgia (Talk)  13:17, 22 July 2020 (UTC)
 * Salem uses a source (32) which is to support illicit drugs. The source makes only one loose connection to akathisia in the Cocaine section specifically to movements in crack dancing which cannot be attributed to akathisia since there is no subjective component. it is stated that the individuals are not aware of the movements that resolve when drug effects wear off. There is no other mention of this in the other drug sections.--Iztwoz (talk) 16:33, 27 July 2020 (UTC)

Thoughts
I'm creating a new section as this is about specific things currently included that I am not sure are necessary in the encyclopedia article. While they may be cited/verifiable and true, I don't know if they should be included:
 * Quote from Jack Henry Abbott - it's 30 years old and very long.
 * Full classification table (some of the most important information here likely should be summarized in prose instead, but a full classification scale seems overkill)
 * Healy "attributed" sentences - I see no reason that these need in-sentence attribution instead of being woven into the prose itself with a citation at the end of the sentence. IMO "in text attribution" such as "X says" tends to cause lay readers to think the information is an uncommon belief (hence why it needs attributed to who believes it) and not a common belief. Both Healy citations I see could also be removed as they are ~15 years old, in favor of newer information.

I'll try and find some time this week(end) to go through the sources presented as well as try and find some of my own and work more on the article, for now I've done some copyediting and moving info around especially in the treatment section. bɜ:ʳkənhɪmez (User/say hi!) 18:17, 22 July 2020 (UTC)
 * Agree with all three, Sandy Georgia (Talk)  20:05, 22 July 2020 (UTC)
 * I've shortened the Abbott quotation. Whether to include it at all is largely a question of style, but maybe it'd be nice to have something written from the patient perspective in the article. WhatamIdoing (talk) 21:12, 22 July 2020 (UTC)
 * The shorter one is definitely better and I think can be left as a standalone quote. I think stylistically it may be best to put the patient perspective at the end of the section - but I won't do so right this second (as I'm short on time to even reply here). I'd recommend we combine - with attribution included in the quote template to make it look a tad better. Alternatively, we should make it clear that it's a sole patient example by beginning the sentence something like "Jack Henry Abbott, who was diagnosed with akathisia, described the feelings as follows:" or something - as it stands, it is unclear that it's a patient perspective, and appeared to me at first as potentially a description from a doctor treating akathisia patients. bɜ:ʳkənhɪmez (User/say hi!) 21:25, 22 July 2020 (UTC)


 * I've made the changes I mentioned aside from the Abbott quote (which was kindly fixed by User:WhatamIdoing), and have copied the classification below in case people want to use the information in prose. The reference used was this one:, so it's still kinda decently recent and may have useful information for the rest of the article.

Classification section (content removed)

 * Acute akathisia
 * Duration of less than 6 months
 * Develops soon after:
 * Starting antipsychotic medication or following dose increase
 * Receiving a dose of antiemetics
 * Switching to a high-potency antipsychotic
 * Withdrawal of an anticholinergic medication
 * Intense dysphoria
 * Awareness of restlessness
 * Complex and semipurposeful motor fidgetiness


 * Chronic akathisia
 * Persists for over 6 months after last dosage increment
 * Subjective sense of restlessness may be less marked
 * Mild dysphoria
 * Awareness of restlessness
 * Motor fidgetiness with stereotyped movement
 * Limb and orofacial dyskinesia often present


 * Pseudoakathisia
 * Motor manifestations without subjective component
 * Predominantly in men
 * Possibly late stage of chronic akathisia
 * No dysphoria
 * No awareness of restlessness
 * Motor fidgetiness with stereotyped movement
 * Great overlap with limb and orofacial dyskinesia


 * Tardive akathisia
 * Delayed onset (usually 3 months)
 * Not related to a recent change in drugs or dose
 * Significantly associated with tardive dyskinesia
 * Probably due to neurotoxicity of antidopaminergic drugs


 * Withdrawal or "rebound" akathisia
 * Associated with switching antipsychotic medications
 * Onset usually within 6 weeks of discontinuation or dose decrease
 * Anticholinergic discontinuation reaction

Causes section
This only has one subsection for drug induced - I'll try to add a paragraph or two about historical causes and non-drug causes above this subsection to complete the section sometime.
 * I am not sure about this, because we still have to add "drugs" like cocaine and others. Been busy working on my copyright infringement at DLB thing, sorry I haven't helped. Sandy Georgia (Talk)  18:42, 25 July 2020 (UTC)
 * A quick pmid check for cocaine and akathisia found two that say - cocaine is a risk factor for the development of medication-induced akathisia. DSM5 refers to medication-induced akathisia. am doubtful that there is a separate 'drug-induced' as per recreational. ? --Iztwoz (talk) 19:22, 25 July 2020 (UTC)
 * All reviews I checked mentioned it ... I will catch up here once I finish copyvio stuff, but drug use in the sources I listed. Sandy Georgia  (Talk)  22:47, 25 July 2020 (UTC)

Akathisia vs drug-induced akathisia
1. I think the lead should be altered to cover all forms of akathisia, since movement is described elsewhere to as a sign of akathisia (especially the medication induced form) but akathisia is the urge to move rather than a movement disorder. The lead calls it a "movement disorder" but later on the page describes it sometimes not involving movement. I suggest changing it to a neuropsychological sign since that has support regardless of whether it's more neuropsychological or movement based. The amount of information on drug induced akathisia is vast in comparison to other forms.

2. Differential diagnosis don't make sense. It can't be both a symptom of Parkinsonism, and have a differential diagnosis of Parkinsonism.

3. Different forms include medication induced akathisia, tarditive akathisia (which is drug induced but continues after drugs are stopped), restlessness resulting from extreme anxiety, a symptom of Parkinsonism or other illnesses. Sources below. I couldn't find a reference to serotonin syndrome (in the table).

4. Treatment and medication in the infobox should be merged.

5. More on the link with other EPS would be helpful. Amousey (they/them pronouns) (talk) 23:51, 25 July 2020 (UTC)

Recognized associations of akathisia include Parkinson's disease and neuroleptic medication (acute or tardive side effect), suggesting that dopamine depletion may contribute to the pathophysiology; dopamine depleting agents {e.g., tetrabenazine, reserpine) may cause akathisia. References Sachdev P. Akinasthia and restless legs. Cambridge: CUP, 1995 Cross References Parkinsonism; Tic" - A Dictionary of Neurological Signs
 * "Akathisia is a feeling of inner restlessness, often associated with restless movements of a continuous and often purposeless nature, such as rocking to and fro, repeatedly crossing and uncrossing the legs, standing up and sitting down, pacing up and down. Moaning, humming, and groaning may also be features. Voluntary suppression of the movements may exacerbate inner tension or anxiety.
 * ICD classes the 'medication form only under Diseases of the Nervous system, and subclasses as "Other specified extrapyramidal and movement disorders". DSM-5 classes as "medication induced movement disorder" but only requires "subjective feeling of restlessness" and not movement.
 * characterized by restlessness and agitation Mosby's pocket dictionary of Medicine
 * alternatively a "psychological reaction to extreme anxiety" Dictionary of Science (1992)
 * suicidality  akathisia may magnify hopelessness, cause inescapable distress and be a factor in suicidal ideation p39
 * withdrawal akathisia and pseudoakathisia mentioned here
 * differential diagnosis here are limited to tarditive dyskinesis and restless legs syndrome A to Z of neurological practice p22

Amousey (they/them pronouns) (talk) 23:51, 25 July 2020 (UTC)


 * I've added a source for serotonin syndrome presenting as akathisia in the table, I am torn about the infobox - on the one hand, in a pure sense, you're right, but I think the split helps readability while maintaining all info in the box. I think if we combine, we would have to prune the medicines to avoid wall of text in the infobox. On the parkinson's point, I think it is potentially in the differential - someone presenting with akathisia may be presenting with "true" akathisia - or may be presenting with akathisia as a sign of Parkinson's disease. Thus, when someone presents with akathisia, a doctor would likely consider Parkinson's as well as other causes, as opposed to diagnosing "unknown cause akathisia". No comment at this time on the other points as I'm unable to look into them enough to comment right now. bɜ:ʳkənhɪmez (User/say hi!) 00:09, 26 July 2020 (UTC)
 * Ideally, we would write the main body of the article first, and the lead (including any infobox therein) afterwards. WhatamIdoing (talk) 00:18, 26 July 2020 (UTC)
 * On your point #2, I don't think that the article says that it's a symptom of Parkinsonism.
 * Most of those sources are 10+ years old. Some of them are from the 1990s.  Classifications and accepted ideas of etiology can change a lot in the space of 25 years.   WhatamIdoing (talk) 00:17, 26 July 2020 (UTC)
 * Added source quotes above ... drug induced is Not only antipsychotics. Sorry, iPad typos, Sandy Georgia  (Talk)  01:09, 26 July 2020 (UTC)

My suggestion, per sources, is to section text by antipsychotic-induced akathisia and other drug-induced akathisia, which includes illicit. That separates the most common from all the rest. Sandy Georgia (Talk)  01:21, 26 July 2020 (UTC)

Orphaned references in Akathisia
I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Akathisia's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "DSM": From Mood disorder:  From Psychiatry:  

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT ⚡ 07:06, 27 July 2020 (UTC)
 * but not with either of those :) bɜ:ʳkənhɪmez (User/say hi!) 16:52, 27 July 2020 (UTC)

Relevance of Peterson sentence?
Not sure if one person's medical experience is notable, and cites NY Post, which is a questionable source rubah (talk) 04:15, 25 August 2021 (UTC)


 * Quoting a notable person makes a disorde more real and more "something that could happen to me", it also increases memorability. I don't know if any of these things are relevant to wikipedia. The memorability might be Talpedia (talk) 17:06, 26 August 2021 (UTC)

Contradictive, needs correction
To quote:

"The most severe cases may result in aggression, violence, and/or suicidal thoughts. Akathisia is also associated with threatening behaviour and physical aggression that is greatest in patients with mild akathisia, and diminishing with increasing severity of akathisia."

It is intuitively contradictive to say that the patients with more severe akathisia are less agressieve and at the same time say that agression occurs in the most severe cases.

I suggest correcting it by just removing the first part, leaving:

"Akathisia is also associated with threatening behaviour and physical aggression that is greatest in patients with mild akathisia, and diminishing with increasing severity of akathisia."

But it should also be fact checked if that is truly the case so we are not logically correcting it to a false.

Also the part of increased suicidal thoughts should be added back in

Da4wiki (talk) 09:05, 10 August 2023 (UTC)

Benzodiazepine
Benzodiazepines cause this same disorder from either abrupt discontinuation and prolonged use and slow taper TheTurtleTribalNation (talk) 17:25, 31 October 2023 (UTC)


 * Sounds goods - can you find a recentish systematic review on the topic? That would be my favourite sort of source. My impression is that this is far less prevalent than some of the second generation / partial agonist AP's and it's worth noting that benzodiazapines are often one of the few treatments for this apart from cessation... so we want to be careful about what is WP:DUE (particularly given the potential for WP:RECENTISM following the Peterson case).. Tal pedia 09:45, 6 November 2023 (UTC)

Misconceptions with serious implications
I had akathisia caused by an antipsychotic and i've read all that i could find on the internet to prove to my psychiatrist that i suffered from this indescribable pain inflicting reaction. I had a drug induced psychosis caused by too much amphetamines so i got forced treatment for 4 months. All symptoms of akathisia is derived from 1 cause and that is the immense pain sensation it causes. The reason patients move all the time is because it relieves the pain, a kind of distraction. If you observe movements in patients you'll notice that the movement is non-repetitive, it may seem repetitive but thats because its less exhausting to do similar movements with slight variation than doing something completely different. But the movement has to be consciously to achieve distraction from the pain. I had akathisia (talk) 18:58, 30 June 2024 (UTC)