Akathisia and exacerbation of psychopathology: A preliminary report

Akathisia has previously been reported to exacerbate psychopathology and to be associated with noncompliance, suicidality, and violence. One previous study found brisk decrements in psychopathology after acute treatment of ak athisia with intramuscular biperiden. This study assessed changes in akathi sia and psychopathology in 19 patients after separate one-day treatments wi th intramuscular benztropine and oral propranolol. Benztropine and proprano lol led to clinically meaningful and statistically significant decrements i n ratings of subjective and objective measures of akathisia and in psychopa thology scores. Changes in psychopathology correlated significantly with ch anges in subjective measures of akathisia after benztropine and with subjec tive and objective measures of akathisia after propranolol. Changes in akat hisia accounted for 9%-42% of the variance in changes in psychopathology. A fter treatment, statistically significant decrements in Brief psychiatric R ating Scale (BPRS) positive symptoms were noted, and individual items not d irectly related to the akathisia syndrome, such as conceptual disorganizati on, hallucinatory behavior, and unusual thought content declined, although not significantly. These findings, taken together with the results of a sim ilar previous study, indicate that the effect of akathisia in exacerbating psychopathology is large. If suspected, akathisia should be treated promptl y.