Psycho-Babble Medication Thread 428532

Shown: posts 1 to 11 of 11. This is the beginning of the thread.

 

Never underestimate the pain of severe akathisia

Posted by ed_uk on December 12, 2004, at 19:42:12

Arch Gen Psychiatry. 1984 Nov;41(11):1036-9.

Akathisia with haloperidol and thiothixene.

Van Putten T, May PR, Marder SR.

We studied the incidence of akathisia in two populations of newly admitted schizophrenic patients: one group was treated with haloperidol and the other group was treated with thiothixene hydrochloride. Within six hours after taking a 5-mg test dose of haloperidol, 40% of the patients experienced akathisia; during maintenance treatment with 10 mg of haloperidol taken at bedtime, 75% of the patients experienced akathisia by the seventh day. With thiothixene hydrochloride (0.22-mg/kg test dose; 0.44-mg/kg maintenance dose), the respective percentages were 20% and 46%. The akathisia experienced after administration of the test of haloperidol dose was not mild or inconsequential; 28% of the patients experienced moderate, 17% of the patients experienced severe, and 22% of the patients experienced very severe akathisia. Akathisia with haloperidol could not be suppressed completely in half of the patients. Treatment-resistant akathisia was experienced as anxiety and depression. We believe these tallies to be important because akathisia causes much misery and often goes undiagnosed.

Ed.

 

Re: Never underestimate the pain of severe akathisia

Posted by ed_uk on December 12, 2004, at 20:02:37

In reply to Never underestimate the pain of severe akathisia, posted by ed_uk on December 12, 2004, at 19:42:12

Delayed akathisia and suicidal attempts following epidural droperidol infusion--a case report.

Hung YC, Ho YY, Shen CL.

Department of Anesthesiology, Ton Yen General Hospital, Hsin Chu, Taiwan, R.O.C.

Epidural administration of droperidol has been used to prevent postoperative nausea and vomiting (PONV) caused by opioids, but the adverse reactions were relatively neglected. We present a patient who received patient-controlled epidural analgesia (PCEA) with bupivacaine-morphine-droperidol mixture for one and half days following hemorrhoidectomy, developed paroxysmal adverse reactions of akathisia, dysphoria, and suicidal attempts 3 days after the initiation of the treatment. The use of droperidol in PCEA for prevention of nausea and vomiting therefore needs to be re-evaluated according to the serious side effects occurring in our case.


And finally, another reason to initiate AP treatment with low doses......

J Clin Psychiatry. 1987 May;48(5):207-8.

Very low-dose neuroleptic treatment in two patients with agitation associated with Alzheimer's disease.

Risse SC, Lampe TH, Cubberley L.

Two agitated patients with Alzheimer's disease who either failed to respond or worsened with conventional low-dose neuroleptic and other pharmacologic treatment are described. Both patients demonstrated sustained improvement with very low-dose neuroleptics, one with haloperidol 0.125 mg and the other with thioridazine 5 mg.

Ed.

 

Re: Never underestimate the pain of severe akathisia

Posted by linkadge on December 12, 2004, at 20:27:15

In reply to Re: Never underestimate the pain of severe akathisia, posted by ed_uk on December 12, 2004, at 20:02:37

I have always found that akathesia and severe suicidiality go hand in hand for me.

Linkadge

 

Opioids and akathisia

Posted by ed_uk on December 12, 2004, at 20:43:25

In reply to Re: Never underestimate the pain of severe akathisia, posted by linkadge on December 12, 2004, at 20:27:15

With the built-in antiemetic activity of neuroleptics, opioids would seem to be a pleasant treatment option!!!!!

Opioid responsiveness in patients with neuroleptic-induced akathisia.

Walters A, Hening W, Chokroverty S, Fahn S.

Department of Neurology, UMDNJ-Rutgers Medical School, New Brunswick 08903.

Five patients with either acute or tardive neuroleptic-induced akathisia (5 weeks to 1 1/2 years duration) were videotaped before, during, and after a 2-week trial of propoxyphene (Darvon), 100 mg q.i.d., or acetaminophen (Tylenol) with 30 mg codeine, two tabs, q.i.d. Three "blinded" observers, experienced in movement disorders, rated the involuntary movements shown on the videotapes and agreed that, on opioids, all patients showed substantial to complete improvement of their stereotyped restless akathitic movements. Matching placebo was not beneficial. One patient who had improved on opioids was challenged with naloxone while on the opioids. There was a brief but severe reactivation of the akathisia. Our results suggest that opioids offer a selective therapy for patients with neuroleptic-induced akathisia and further suggest that the endogenous opiate system may be involved in patients with neuroleptic-induced akathisia.


Ed.

 

Re: Opioids and akathisia

Posted by olysi79 on December 13, 2004, at 1:12:23

In reply to Opioids and akathisia, posted by ed_uk on December 12, 2004, at 20:43:25

Akithisia is a horrible thing... awful enough to send me into depression immediately.

> With the built-in antiemetic activity of neuroleptics, opioids would seem to be a pleasant treatment option!!!!!
>
> Opioid responsiveness in patients with neuroleptic-induced akathisia.
>
> Walters A, Hening W, Chokroverty S, Fahn S.
>
> Department of Neurology, UMDNJ-Rutgers Medical School, New Brunswick 08903.
>
> Five patients with either acute or tardive neuroleptic-induced akathisia (5 weeks to 1 1/2 years duration) were videotaped before, during, and after a 2-week trial of propoxyphene (Darvon), 100 mg q.i.d., or acetaminophen (Tylenol) with 30 mg codeine, two tabs, q.i.d. Three "blinded" observers, experienced in movement disorders, rated the involuntary movements shown on the videotapes and agreed that, on opioids, all patients showed substantial to complete improvement of their stereotyped restless akathitic movements. Matching placebo was not beneficial. One patient who had improved on opioids was challenged with naloxone while on the opioids. There was a brief but severe reactivation of the akathisia. Our results suggest that opioids offer a selective therapy for patients with neuroleptic-induced akathisia and further suggest that the endogenous opiate system may be involved in patients with neuroleptic-induced akathisia.
>
>
> Ed.

 

Re: Never underestimate the pain of severe akathisia » linkadge

Posted by Bob on December 13, 2004, at 2:11:05

In reply to Re: Never underestimate the pain of severe akathisia, posted by linkadge on December 12, 2004, at 20:27:15

> I have always found that akathesia and severe suicidiality go hand in hand for me.
>
> Linkadge

I'll second that comment. There are other things that are also closely associated with suicidality for me, but akathisia is a prime indicator.

 

Re: Never underestimate the pain of severe akathisia

Posted by pretty_paints on December 13, 2004, at 10:24:48

In reply to Re: Never underestimate the pain of severe akathisia » linkadge, posted by Bob on December 13, 2004, at 2:11:05

Can I ask, Bob, are you Bob as in Dr Bob, the runner of this site? Or are you just somebody else called Bob!

If you're not the Bob who runs this site, does anybody know, who is Bob? Is he a doctor/psychiatrist, or is he a patient??

 

Re: Treatments for drug-induced akathisia

Posted by ed_uk on December 14, 2004, at 8:26:05

In reply to Re: Opioids and akathisia, posted by olysi79 on December 13, 2004, at 1:12:23

Apart from the obvious ie. reducing the dose of the anti-psychotic, stopping it all together and replacing it with something different, which drugs have YOU found to be most effective for AP-induced akathisia.....

propranolol
anticholinergics eg. procyclidine
benzos
opioids
clonidine
etc.

Not nearly enough research has been done into akathisia.

 

Re: Never underestimate the pain of severe akathisia

Posted by Mistermindmasta on December 15, 2004, at 0:06:17

In reply to Never underestimate the pain of severe akathisia, posted by ed_uk on December 12, 2004, at 19:42:12

> Arch Gen Psychiatry. 1984 Nov;41(11):1036-9.
>
> Akathisia with haloperidol and thiothixene.
>
> Van Putten T, May PR, Marder SR.
>
> We studied the incidence of akathisia in two populations of newly admitted schizophrenic patients: one group was treated with haloperidol and the other group was treated with thiothixene hydrochloride. Within six hours after taking a 5-mg test dose of haloperidol, 40% of the patients experienced akathisia; during maintenance treatment with 10 mg of haloperidol taken at bedtime, 75% of the patients experienced akathisia by the seventh day. With thiothixene hydrochloride (0.22-mg/kg test dose; 0.44-mg/kg maintenance dose), the respective percentages were 20% and 46%. The akathisia experienced after administration of the test of haloperidol dose was not mild or inconsequential; 28% of the patients experienced moderate, 17% of the patients experienced severe, and 22% of the patients experienced very severe akathisia. Akathisia with haloperidol could not be suppressed completely in half of the patients. Treatment-resistant akathisia was experienced as anxiety and depression. We believe these tallies to be important because akathisia causes much misery and often goes undiagnosed.
>
> Ed.
>
>


Yeah, no doubt about it. The only time I was ever convinced I wanted to die was when I took Chlorpromazine (I never remember the name + dont feel like looking it up) for nausea even BEFORE i had any medical problems. This drug caused horrible restlessness, depression, boredom, dysphoria, insomnia. Absolutely the worst feeling I've ever felt.

Akasthisia is SEVERELY underrated as a side effect.

 

Re: Treatments for drug-induced akathisia

Posted by darkhorse on December 16, 2004, at 4:05:16

In reply to Re: Treatments for drug-induced akathisia, posted by ed_uk on December 14, 2004, at 8:26:05

> Apart from the obvious ie. reducing the dose of the anti-psychotic, stopping it all together and replacing it with something different, which drugs have YOU found to be most effective for AP-induced akathisia.....
>
> propranolol
> anticholinergics eg. procyclidine
> benzos
> opioids
> clonidine
> etc.
>
> Not nearly enough research has been done into akathisia.
>

Lorazepam 4mg one day..it put me to sleep until the effect was gone OF COURSE I stopped the AP (Stellazine 2mg) the same day and never looked back ...

Yes , Akathisia is the WORST side effect I've ever experienced in my life...I could not sit or stand and walked and walked + severe dysphoria...I looked like totally a mad person..I will never ever approach APs for my problems (anxities/depression)


 

Re: Hello Adam! » darkhorse

Posted by ed_uk on December 16, 2004, at 6:23:54

In reply to Re: Treatments for drug-induced akathisia, posted by darkhorse on December 16, 2004, at 4:05:16

Hi,

I needed 60mg Valium!

I haven't seen you on here for a while, hope you are well :-)

Please could you turn your babblemail on, I was going to send you a little message but I couldn't :-( ..... it tells you how to switch it on in the FAQ at the bottom of the page. Hope you don't mind!

All the best,
Ed.


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