Akathisia vs Restless Leg Syndrome: What You Need to Know - Dr Sanil Rege Explains

Join us in this informative video to explore the intricate differences between Akathisia and Restless Leg Syndrome (RLS).
Consultant psychiatrist Dr Sanil Rege provides valuable insights into these often perplexing conditions, shedding light on their symptoms, treatments, and underlying mechanisms.

In this must-watch video, Dr Rege expertly guides you through the complexities of Akathisia and RLS. Discover how antipsychotic medications can trigger Akathisia and how this differs from the effects of SSRIs, which can also induce similar symptoms. Gain a comprehensive understanding of how these medications impact the body and learn effective strategies to manage associated side effects.
Time stamps:
0:10 Introduction to Akathisia
2:04 Patient’s clinical experience of akathisia
4:15 Chronic Akathisia
6:22 What are the medications that lead to akathisia?
8:31 The pathophysiology of Akathisia
10:59 The ventral striatum and nucleus accumbens.
13:20 Distinguishing between akathisia and restless leg syndrome.
16:12 How to reduce the dose?
18:06 Medications that modulate the dopaminergic system in the treatment of akathisia
19:23 Reduce dose and add anti-akathisia agents

#akathisia #antipsychotics #antipsychoticsideeffects

Akathisia is defined as :
Subjective complaints of restlessness, often accompanied by observed excessive movements (e.g. fidgety movements of the legs, rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.

The pathophysiology of akathisia appears to be complex, involving several neurotransmitters, including dopamine, acetylcholine, y-aminobutyric acid (GABA), norepinephrine, serotonin, and neuropeptides.

The neurotransmitters most specifically linked to akathisia are gamma-aminobutyric acid (GABA) and serotonin. GABA (mainly via GABAA receptor interactions) exerts an influence on dopamine-dependent signalling, thus, increasing or reducing locomotor activity

One of the critical discussion points is the role of antipsychotic medications in causing Akathisia. We explore how these drugs may lead to this condition and how they differ from SSRIs, which can also induce Akathisia.

Not only does this video address the symptoms and treatments of Akathisia, but it also breaks down the key differences between Restless legs versus Akathisia. Both conditions can cause discomfort and distress, but knowing the distinction can be vital for accurate diagnosis and effective treatment.

Akathisia may result from efforts to compensate for dopaminergic underactivity in the nucleus accumbens
Strategies for management include:
1. Reduce dose
2. Switch to low-risk antipsychotic
3. Adjunctive approaches:
Propranolol 40-80 mg/day
5HT2A receptor antagonists (e.g. mirtazapine 15 mg PO daily, cyproheptadine 8-16 mg PO daily)
Benzodiazepines (e.g. clonazepam 0.5-1 mg PO daily, diazepam 5-15 mg PO daily)
Anticholinergics (e.g. benztropine 1-4 mg PO daily) should be used mainly for patients who have concurrent Parkinsonism
An algorithm is also covered.
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#RestlessLegSyndrome
#ClinicalDifferentiation
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#Pharmacotherapy
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