THE PREVALENCE OF AKATHISIA IN PATIENTS RECEIVING STABLE DOSES OF CLOZAPINE

Background. Akathisia is a common side effect of traditional neurolept ic drugs and is associated with medication refusal and impulsive behav ior. While our previous experience indicates that clozapine is effecti ve in treating persistent akathisia, two controlled studies indicate v astly different prevalence rates of akathisia (7% vs. 40%) in patients receiving clozapine. Method. We used the Barnes Rating Scale for Drug -Induced Akathisia to estimate the prevalence of akathisia in patients receiving stable doses of clozapine alone (N = 29) in a state hospita l. Measurements were also made of manifest psychopathology (Brief Psyc hiatric Rating Scale) and tardive dyskinesia (Abnormal Involuntary Mov ement Scale). Results: Two patients (6.8%) receiving clozapine were ra ted as having akathisia. Only 4 (28.6%) of the 14 subjects with a hist ory of moderate-to-severe tardive dyskinesia on traditional neurolepti c drugs continued to show current evidence of tardive dyskinesia, and in 10 patients (71.4%) there was no evidence of the syndrome (p < .002 ). In the 4 subjects with tardive dyskinesia there was amelioration to a milder form of the syndrome. There were no new cases of tardive dys kinesia among clozapine-treated subjects. Conclusion: These data suppo rt the low prevalence of akathisia in patients receiving stable doses of clozapine monotherapy. There is further support that clozapine has an ameliorating effect on tardive dyskinesia associated with tradition al neuroleptic drugs. These and other data indicate the need for a con trolled trial of clozapine in patients experiencing persistent and dis abling akathisia on traditional neuroleptic drugs.