Inada Toshiya
Department of Psychiatry and Psychobiology, Nagoya University, Graduate School of Medicine.
Brain Nerve. 2017 Dec;69(12):1417-1424. doi: 10.11477/mf.1416200927.
Akathisia consists of subjective inner restlessness, such as awareness of the inability to remain seated, restless legs, fidgetiness, and the desire to move constantly, and of objective increased motor phenomena, such as body rocking, shifting from foot to foot, stamping in place, crossing and uncrossing legs, pacing around. Although the broad definition of akathisia includes the inner and motor restlessness observed in patients with idiopathic Parkinson's disease, post-encephalitic parkinsonism, and restless legs syndrome, here we exclusively focus on the narrow definition of antipsychotic-induced akathisia. The most reliable treatment for acute akathisia is the reduction or the withdrawal of antipsychotic medication. However, this is often not possible because it may worsen the patients' mental condition. Various pharmacological agents have been used for the treatment of this condition. These include anticholinergic agents (e.g., biperiden and trihexyphenidyl), benzodiazepines, beta-adrenoceptor blockers (e.g., propranolol), and serotonin 2A receptor antagonists (e.g., mianserin, cyproheptadine, and mirtazapine).
静坐不能表现为主观的内心不安，如意识到无法久坐、腿部不安、坐立不安以及持续运动的欲望，还表现为客观的运动现象增加，如身体摇晃、双脚交替移动、原地跺脚、双腿交叉与放开、来回踱步。虽然静坐不能的广义定义包括特发性帕金森病、脑炎后帕金森综合征和不安腿综合征患者中观察到的内心和运动不安，但在此我们专门关注抗精神病药物所致静坐不能的狭义定义。急性静坐不能最可靠的治疗方法是减少或停用抗精神病药物。然而，这往往不可行，因为这可能会使患者的精神状况恶化。已使用多种药物来治疗这种情况。这些药物包括抗胆碱能药物（如安坦和苯海索）、苯二氮䓬类药物、β-肾上腺素受体阻滞剂（如普萘洛尔）以及5-羟色胺2A受体拮抗剂（如米安色林、赛庚啶和米氮平）。
