Antipsikotik Kullanan Hastalarda Akatizinin Psikiyatrik Belirtiler, Intihar Egilimi ve Diger Hareket Bozukluklari ile Iliskisi/The Relationship of Akathisia with Psychiatric Symptoms, Suicidality and Other Movement Disorders in Patients on Antipsychotic Treatment

ÖZET. Amac: Akatizinin psikiyatrik belirtiler ve diger hareket bozukluklariyla iliskisi konusundaki görüsler celiskilidir ve intihar egilimiyle arasindaki iliskinin kanit derecesinin vaka raporlari düzeyinde oldugu öne sürülmüstür. Bu calismanin amaci akatizinin diger hareket bozukluklari, psikiyatrik belirti siddeti ve intihar egilimi ile iliskisinin arastirilmasidir. Yöntemler: Yeni bir antipsikotik baslanan ya da antipsikotik dozu yükseltilen ardisik hastalara (N=52), yatislarinin ilk haftasinda, Barnes Akatizi Ölcegi (BAÖ) uygulanarak örneklem, akatizisi olan (AG) (N=27) ve akatizisi olmayan (KG) (N=25) gruplara ayrilmistir. Gruplar birbiriyle; sosyodemograSk özellikler, Kisa Psikiyatrik Degerlendirme Ölcegi (KPDÖ), Hamilton Depresyon Derecelendirme Ölcegi (HDDÖ), Beck Anksiyete Envanteri (BAE), Anormal Istemsiz Hareketler Ölcegi (AIHÖ), Birlesik Parkinsonizm Derecelendirme Ölcegimotor muayene (BPDÖmm) ve tedavi özellikleri bakimindan karsilastirilmistir. Bulgular: AG'de, psikiyatrik belirti siddeti, anksiyete düzeyi, intihar egilimi ve diskinezi derecesi daha yüksektir. Depresif belirtiler ve parkinsonizm derecesi bakimindan farklilik bulunmamistir. AG'de antipsikotik maruziyeti daha uzun, coklu antipsikotik kullaniminin daha siktir. Sonuc: AG'de diskineziler daha siddetliyken, parkinsonizm belirtilerinin KG'den farksiz olmasi, parkinsonizm ve akatizinin birbirini maskeledigine ya da patolojik yolaklarinin farkli olduguna isaret etmektedir. Anksiyete ve genel psikiyatrik belirti siddetindeki yükseklik, akatizinin neden oldugu disforiye baglidir ya da arada karsilikli bir iliski olabilir. Gruplar arasinda HDDÖtoplam puani bakimindan fark yokken, ölcegin intihar maddesi puaninin AG'de daha yüksek bulunmasi dikkat cekicidir. Bu durum akatizideki intihar egiliminin, depresif belirtilerden cok anksiyete/disfori ile iliskili oldugunu ve dürtüsel bir örüntüsünün olabilecegini düsündürmektedir. Bulgularimiz, akatizinin intihar bakimindan bir risk etmeni olarak göz ardi edilmemesi gerektigine isaret etmektedir. Toplam antipsikotik maruziyetinin AG'de KG'den uzun olmasi, bilgimiz dâhilinde ilk kez saptanmis bir bulgudur ve daha genis örneklemlerde arastirilmalidir. (Nöropsikiyatri Arsivi 2010; 47: 307-13). Anahtar kelimeler: Akatizi (ilaca bagli), intihar, Parkinson hastaligi, ikincil diskinezi (ilaca bagli). ABSTRACT. Objective: The association of akathisia with psychiatric symptoms and other movement disorders is unclear, and it has been suggested that current evidence degree regarding the relationship between akathisia and suicide is at the level of case-reports. This study aims to investigate the relationship of akathisia with psychiatric symptoms, other movement disorders, and suicidality. Methods: Consecutive patients (N=52) who were initiated on a new antipsychotic or had a dose increment in the antipsychotic medication were evaluated within the first hospitalization week. The Barnes Akathisia Rating Scale (BARS) was used to identify groups with (AG;N=27) and without (CG;N=25) akathisia. The groups were compared using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HDRS), the Beck Anxiety Inventory (BAI), the Abnormal Involuntary Movements Scale (AIMS), the Unified Parkinson's Disease Rating Scale-Motor Exam (UPDRS-me) and in terms of treatment parameters. Results: The severity of general psychopathology, anxiety, suicidality and dyskinesias were higher in the AG. No difference was found between the groups regarding symptoms of Parkinson's disease and depression. Lifetime antipsychotic exposure was longer, multiple antipsychotic use was more frequent in the AG. Conclusion: Although the severity of dyskinesias was greater in AG compared to CG, the similar parkinsonian symptoms in the two groups suggest a reciprocal masking of akathisia and parkinsonism and/or different neuro-pathologic pathways. The severity of general psychopathology and anxiety is associated with disphoria caused by akathisia, or a correlative relationship might be present. Suicidal ideation in the absence of higher depressive symptoms in AG suggests that suicidal behavior associated with akathisia may be an impulsive act related to anxiety and/or dysphoria. Our findings indicate that akathisia must be considered as a risk factor for suicide. The lifetime antipsychotic exposure in akathisia must be studied in larger samples. (Archives of Neuropsychiatry 2010; 47: 307-13). Key words: Akathisia (drug-Induced), Suicide, affect, Parkinson's disease, secondary dyskinesia, (drug Induced).

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