Akathisia

   , or Inability to remain in a sitting posture.

   First description of akathisia (1880). In his Practical Treatise on Nervous Exhaustion (Neurasthenia), New York neurologist and electrotherapist George Beard (1839–1883) described as a characteristic of neurasthenia, "Fidgetiness and inability to keep still—a sensation that amounts to pain—is sometimes unspeakably distressing. . . . When the legs feel this way, the sufferer must get up and walk or run. . . . A gentleman once under my care could not sit still in the chair long enough to take an application of electricity" (pp. 41–42).

   Naming the syndrome akathisia (1901). From Greek "a" (neg.) _ "kathisis" (sitting down). In November 1901, Ladislav Haskovec (1866–1944), a neurologist from Prague who had previously studied with Jean-Martin Charcot, demonstrated to the Paris Neurological Society two patients who were unable to remain seated. At the time he did not know what to make of it and suggested it was close to "astasia-abasia [hysterical ataxia] of the French school." Yet, as he continued in his paper, published in 1901 in the Neurological Review (Revue neurologique), "If this phenomenon is encountered more commonly . . . one might give it the name ‘akathisia.’ " The following July, Pierre Janet highlighted yet a further patient with this "bizarre nervous disease" and published the case in a psychiatric journal (La Nouvelle Iconographie de la Salpêtrière), thus lending his own authority to the neologism. Haskovec, said Janet, had deemed the disorder the exact opposite of hysterical astasia-abasia. But Janet was dubious: These patients are dysphoric while standing as well. "What the patient wants to do, in sum, is unlimited walking, drifting here and there with no particular destination" ( Janet, Les Obsessions, II, 80). In other words, akathisia was a symptom that could not be controlled by will.

   A result of psychoactive medication (from 1947). Although Parkinson’s disease had always been associated with akathisia, in 1947 in the Revue neurologique Jean Sigwald (1903–) and co-workers at the Brousse Psychiatric Hospital in Paris reported that one of the early phenothiazine-type (see Chlorpromazine) drugs, diethazine hydrochloride (Rhône-Poulenc 2987), caused akathisia in patients with Parkinsonism. The advent of more powerful antipsychotic medications in the early 1950s created interest in the subjective feelings of restlessness in akathisia, as well as in the motor component. "Neuroleptic-induced acute akathisia" entered the Diagnostic and Statistical Manual (DSM) series in DSM-IV (1994), in the category of diagnoses provided "for further study." According to the Manual, "The subjective complaints include a sense of inner restlessness, most often in the legs; a compulsion to move one’s legs . . . dysphoria and anxiety." It also noted that, "Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts" (pp. 744–745). According to the Manual, antidepressants as well as antipsychotics could induce the syndrome. For neurologists, akathisia is often seen as a first sign of Parkinsonism.

   In the 1990s and after, concern arose that the selective serotonin-reuptake inhibitor (SSRI)-style drugs could induce in a select subgroup of patients the kind of akathisia that might lead to violent acts including suicide. For details, the reader may consult David Healy, Let Them Eat Prozac (2003).