Distinguishing akathisia and tardive dyskinesia: a review of the literature.J Clin Psychopharmacol 1983; 3(6):343-50JC
Akathisia and tardive dyskinesia, both side effects of neuroleptic drugs, should be easily distinguishable. Akathisia is fundamentally a subjective disorder characterized by a desire to be in constant motion resulting in an inability to sit still and a compulsion to move. Tardive dyskinesia is an involuntary movement disorder characterized by repetitive purposeless movements which typically involve the buccolingual masticatory areas but which can include choreoathetoid limb movement. Clinicians, however, are not always able to distinguish akathisia and tardive dyskinesia. The authors review the literature on akathisia and tardive dyskinesia in an attempt to understand the basis for this diagnostic confusion. They suggest six areas of inquiry which may help in distinguishing the two disorders: (1) the nature of the subjective distress, (2) the voluntary or involuntary nature of the movements, (3) the time of onset of the disorder, (4) the location of signs and symptoms, (5) the presence of other extrapyramidal symptoms, and (6) the response to pharmacologic interventions. In addition to diagnostic confusion, the literature review suggests an association between akathisia and tardive dyskinesia. Because this association is poorly understood, three possibilities are suggested: (1) The occurrence of akathisia may predispose to subsequent tardive dyskinesia; (2) Akathisia may evolve into tardive dyskinesia; and/or (3) There may be a third group of disorders, distinct from akathisia and tardive dyskinesia, which the authors call tardive akathisia. Each of these possibilities are discussed.