Hirose S
Center of Psychiatry and Neurology, Fukui Prefectural Hospital, Japan.
Psychiatry Clin Neurosci. 2001 Feb;55(1):81-2. doi: 10.1046/j.1440-1819.2001.00790.x.
Antipsychotic-induced akathisia is primarily manifested as restlessness, particularly expressed in the legs. Consequently, rating scales and the research criteria of DSM-IV regard restlessness in the legs as the major sign of akathisia, although it has been suggested that such restlessness may occur in other areas of the body. A case of antipsychotic-induced akathisia is reported where the region of inner restlessness (the subjective component) was identified in posterior cervical muscles. The patient was initially suspected to be experiencing somatic delusions and the dose of antipsychotic medication was increased. This did not improve the symptoms, and upon careful questioning about his head discomfort, the patient acknowledged that he felt an inner restlessness in the suboccipital muscles. The restlessness ceased with intramuscular biperiden and subsequent discontinuation of antipsychotic medication. This case suggests that subjective restlessness may occur in muscle groups that are not usually associated with akathisia. Thus, this report may assist clinicians in the diagnosis of akathisia that could be overlooked or misdiagnosed as somatic delusions or the worsening of the patient's psychosis.
抗精神病药物所致静坐不能主要表现为坐立不安，尤其在腿部较为明显。因此，评定量表和《精神疾病诊断与统计手册第四版》（DSM-IV）的研究标准将腿部坐立不安视为静坐不能的主要体征，尽管有人提出这种坐立不安可能出现在身体的其他部位。本文报告了一例抗精神病药物所致静坐不能的病例，其中内心坐立不安的区域（主观成分）被确定在后颈部肌肉。该患者最初被怀疑患有躯体妄想，抗精神病药物的剂量因此增加。但症状并未改善，在仔细询问其头部不适情况后，患者承认在枕下肌肉中有内心坐立不安的感觉。使用肌内注射苯海索后坐立不安症状消失，随后停用抗精神病药物。该病例表明，主观坐立不安可能发生在通常与静坐不能无关的肌肉群中。因此，本报告可能有助于临床医生诊断可能被忽视或误诊为躯体妄想或患者精神病病情恶化的静坐不能。
