Does akathisia influence psychopathology in psychotic patients treated with clozapine?

Background: Akathisia has been reported to predict more severe symptoms and poorer treatment response to typical neuroleptics among patients with schi zophrenia, Akathisia has also been associated with symptom exacerbation Thi s study addressed four questions: 1) Does akathisia predict greater severit y in global psychopathology? 2) Is this effect global or specific? 3) Does clozapine treatment alter this relationship? 4) Does severity of psychopath ology covary with the level of akathisia? Methods: Akathisia and clinical symptoms were examined in 33 "treatment ref ractory" schizophrenic patients treated with clozapine across 16 weeks. Wee kly ratings were Barnes Akathisia Rating Scale, Abbreviated Dyskinesia Rati ng Scale, and Brief Psychiatric Rating Scale (BPRS), Patients were classifi ed as "with" (n = 15) or "without" (n = 18) akathisia. Data analyses involv ed independent t-test comparisons of selected variables, between-group mult ivariate analyses of variance across time for BPRS Total scores and Guy's f ive factors, and partial correlations to assess covariation between BPRS sc ores and level of akathisia, Results: Akathisia predicted more severe global psychopathology, specific t o the Activation (AC) and Thought Disturbance (TH) factors. These relations hips did not change with clozapine treatment even when akathisia declined. Interestingly, level of akathisia did not covary with severity of psychopat hology. Conclusions: In this sample, akathisia predicted more severe psychopatholog y, specific to AC and TH BPRS factor scores, Clozapine treatment did not al ter this relationship. Although the presence of akathisia predicted more se vere symptoms, the level of akathisia did not covary across time with sever ity of psychopathology, suggesting an "uncoupling" of these symptom domains . Biol Psychiatry 1999;45:1376-1383 (C) 1999 Society of Biological Psychiat ry.