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Incidence and risk factors of acute akathisia in 493 individuals with first episode non-affective psychosis: a 6-week randomised study of antipsychotic treatment

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Abstract

Introduction

Acute akathisia is a neuropsychiatric syndrome with a negative effect on illness outcome. Its incidence in patients treated with antipsychotics has shown to be highly variable across studies.

Objectives

Our goals were to investigate prevalence, risk factors for the development of acute akathisia, and differences in incidence between antipsychotics in a sample of 493 first episode non-affective psychosis patients.

Methods

This is a pooled analysis of three prospective, randomized, flexible-dose, and open-label clinical trials. Patients were randomized assigned to different arms of treatment (haloperidol, quetiapine, olanzapine, ziprasidone, risperidone, or aripiprazole). Akathisia was determined using the Barnes Akathisia Scale at 6 weeks after antipsychotic initialization. Univariate analyses were performed to identify demographic, biochemical, substance use, clinical, and treatment-related predictors of acute akathisia. Considering these results, a predictive model based of a subsample of 132 patients was constructed with akathisia as the dependent variable.

Results

The overall incidence of akathisia was 19.5%. No differences in demographic, biochemical, substance use, and clinical variables were found. Significant incidence differences between antipsychotics were observed (Χ 2 = 68.21, p = 0.000): haloperidol (57%), risperidone (20%), aripiprazole (18.2%), ziprasidone (17.2%), olanzapine (3.6%), and quetiapine (3.5%). The predictive model showed that the type of antipsychotic (OR = 21.3, p = 0.000), need for hospitalization (OR = 2.6, p = 0.05), and BPRS total score at baseline (OR = 1.05, p = 0.03) may help to predict akathisia emergence.

Conclusions

Among second generation antipsychotics, only olanzapine and quetiapine should be considered as akathisia-sparing drugs. The type of antipsychotic, having been hospitalized, and a more severe symptomatology at intake seem to predict the development of acute akathisia.

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Acknowledgements

We wish to thank the PAFIP researchers who helped with data collection and specially acknowledge Gema Pardo. Finally, we should also like to thank the participants and their families for enrolling in this study.

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Authors and Affiliations

  1. Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Avda. Vadelcilla s/n, 39008, Santander, Spain

    Maria Juncal-Ruiz, Mariluz Ramirez-Bonilla, Victor Ortiz-Garcia de la Foz, Paula Suarez-Pinilla, Obdulia Martinez-Garcia & Benedicto Crespo-Facorro

  2. Department of Psychiatry, Alcalá de Henares University Hospital, Coslada, Madrid, Spain

    Jorge Gomez-Arnau

  3. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, Spain

    Paula Suarez-Pinilla & Benedicto Crespo-Facorro

  4. Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR, China

    Karl David Neergaard

  5. Department of Medicine, University of Valencia, Centro de Investigación Biomédica en Red en el area de Salud Mental (CIBERSAM), Valencia, Spain

    Rafael Tabares-Seisdedos

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  1. Maria Juncal-Ruiz
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  2. Mariluz Ramirez-Bonilla
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  3. Jorge Gomez-Arnau
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  4. Victor Ortiz-Garcia de la Foz
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  5. Paula Suarez-Pinilla
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  6. Obdulia Martinez-Garcia
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  7. Karl David Neergaard
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  8. Rafael Tabares-Seisdedos
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  9. Benedicto Crespo-Facorro
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Correspondence to Maria Juncal-Ruiz or Benedicto Crespo-Facorro.

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Conflict of interest

Prof. Crespo-Facorro has received speaking honoraria (advisory board and educational lectures) and travel expenses from Otsuka, Lundbeck and Johnson & Johnson in the last three years. Dr. Juncal-Ruiz has received travel expenses from Lundbeck in the last three years. Drs. Ramirez-Bonilla and Suarez-Pinilla have received travel expenses from Lundbeck and Johnson & Johnson in the last three years. Prof. Tabares-Seisdedos, Dr. Gomez-Arnau, Mrs. Martinez-Garcia, Mr. Ortiz-Garcia and Mr. Neergaard report no additional financial or other relationship relevant to the subject of this article.

Funding

The present study was carried out at the Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain, under the following grant support: Instituto de Salud Carlos III PI020499, PI050427, PI060507, Plan Nacional de Drugs Research Grant 2005-Orden sco/3246/2004, SENY Fundació Research Grant CI 2005–0308007 and Fundación Marqués de Valdecilla API07/011. Unrestricted educational and research grants from AstraZeneca, Pfizer, Bristol-Myers Squibb and Johnson & Johnson provided support to PAFIP activities. No pharmaceutical industry has participated in the study concept and design, data collection, analysis and interpretation of the results, and drafting the manuscript. The study, designed and directed by B C-F, conformed to international standards for research ethics and was approved by the local institutional review board.

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Juncal-Ruiz, M., Ramirez-Bonilla, M., Gomez-Arnau, J. et al. Incidence and risk factors of acute akathisia in 493 individuals with first episode non-affective psychosis: a 6-week randomised study of antipsychotic treatment. Psychopharmacology 234, 2563–2570 (2017). https://doi.org/10.1007/s00213-017-4646-1

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