Treatment of tardive akathisia with clonidine: a case report

Akathisia is characterized by subjective discomfort and motor restlessness. The motor hyperactivity can express itself by frequent changes of posture, constant limb shaking or restless pacing. If symptoms of akathisia are severe, treatment becomes extremely complicated and patients may even become suicidal as seen in the case described here. In the literature, different forms of akathisia are distinguished (Barnes and Braude, 1985): the acute form of neuroleptic-induced akathisia (recent onset, related to an increase in antipsychotic drug dose), pseudoakathisia (motor signs but no subjective symptoms), and chronic or tardive akathisia. The acute form of akathisia is well known and described (Zubenko et al., 1984a,b). In a retrospective analysis of clinical features and therapeutic trials for tardive akathisia, Burke et al. (1989) showed that almost all of the 52 cases developed this chronic form after an average of 4.5 yr following neuroleptic drug initiation, 34% even within 1 yr. Twenty-six of the patients who were able to stop taking dopamine antagonists still had symptoms of akathisia persisting for 0.3-7 yr (mean = 2.7 yr).