Pharmacological and non-pharmacological correlates of acute akathisia in first-episode psychosis

Abstract

Introduction: Acute akathisia is a complex syndrome, secondary to the use of drugs, with a prevalence close to 25% with the use of first-generation antipsychotics (FGA). Akathisia is often difficult for patients to tolerate and may worsen psychosis course. Although some authors have described risk factors for acute akathisia, most evidence originates from chronic samples. The aim of this study is to examine risk factors for the development of acute akathisia in a sample of first-episode of psychosis (FEP) patients. Methods: 505 FEP patients were examined for the presence of akathisia during the six first weeks of antipsychotic treatment. Barnes akathisia scale (BAS) was used for this purpose. Patients were assessed for socio-demographic, clinical and analytic data. Information on pharmacological treatments was also collected. Univariate analyses were performed to identify plausible predictors of akathisia. A logistic regression model was conducted. Results: There were no significant differences between akathisic and non akathisic patients in terms of demographic, clinical and analytical variables. Haloperidol treated patients developed more akathisia. As for second-generation antipsychotics (SGA), akathisia was significantly more frequent with the use of aripiprazole and risperidone. Discussion/conclusions: Previous findings, which linked akathisia and drug abuse or iron deficiency, could not be replicated. Differences between individual antipsychotics in terms of akathisia risk are discussed. There is a need of further studies on this topic, in early psychotic samples.