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Schizophrenia Case Series, Part 4: Differential Diagnosis and Management of Akathisia

neuroscienceCME Medical Simulation

Patient Info: Susan is a 23-year-old female diagnosed with schizophrenia. One month after a recent hospitalization her mother brings Susan to the psychiatrist with a re-emergence of symptoms at which time her antipsychotic dose is increased. Shortly thereafter, Susan is reporting distressing restlessness and an inability to sit still.

Premiere Date: Friday, April 3, 2009

This activity offers CE credit for:

1. Physicians (ACCME/AMA PRA Category 1)
2. Pharmacists (ACPE)

All other clinicians will either receive a CME Attendance Certificate or may choose any of the types of CE credit being offered.
Credit Expiration Date:
Saturday, April 3, 2010

Faculty

Rakesh Jain, MD, MPH Director, Adult and Child Psychopharmacology Research R/D Clinical Research, Inc. Lake Jackson, TX

Faculty Bio and Disclosure Declaration

Click here to view faculty bio and activity disclosures.

Statement of Need

Akathisia is a distressing and potentially disabling side effect of some antipsychotic medications that needs to be managed and followed. It is associated with poor medication adherence,(1) more severe psychotic symptoms,(2) and poorer outcome.(3) The primary symptoms of akathisia include both subjective awareness and distress related to the motor restlessness and compulsion to move the legs, as well as objective, observable signs such as pacing, shifting weight back and forth while standing, and/or difficulty sitting still.(4) Differential diagnosis of akathisia can be challenging, and depends on careful physical examination and the use of standardized scales. There is little difference among second-generation antipsychotics with respect to potential for producing akathisia(5) and misdiagnosis and improper treatment can exacerbate symptoms. A number of approaches are available for managing akathisia in patients with schizophrenia, including antipsychotic dose reduction, switching medication, and/or adding adjunctive therapy targeted specifically toward akathisia. In this interactive, case-based activity, expert faculty provide evidence as well as clinical insight for identifying and managing akathisia while allowing participants to hone their decision-making skills with real-world clinical issues.

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1. Young JL, Zonana HV, Shepler L. Medication noncompliance in schizophrenia: codification and update. Bull Am Acad psychiatry Law 1986;14:105-122.
2. Newcomer JW, Miller LS, Faustman WO, Wetzel MW, Vogler GP, Csernansky JG. Correlations between akathisia and residula psychopathology: a by-product of neuroleptic-induced dysphoria. Br J Psychiatry 1994;164:834-838.
3. Kinon BJ, Kane JM, Johns C, et al. Treatment of neuroleptic-resistant schizophrenic relapse. Psychopharmacol Bull 1993;29:309-314.
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition. 1994; American Psychiatric Association; Washington D.C.
5. Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med 2005;353:1209-1223.

Activity Goal

To provide mental health care practitioners with strategies drawn from the evidence base for assessment and management of akathisia in antipsychotic-treated patients with schizophrenia.

Learning Objectives

At the end of this CE activity, participants should be able to:

• Identify criteria for differential diagnosis of akathisia in patients with schizophrenia treated with antipsychotic medication.
• Review strategies for assessing akathisia in patients with schizophrenia.
• Evaluate approaches for managing akathisia in patients with schizophrenia.

Target Audience

Physicians, physician assistants, and other healthcare professionals with an interest in mental health.

Credit Information

CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CME Outfitters, LLC, designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Note to Physician Assistants: AAPA accepts Category I credit from AOACCME, Prescribed credit from AAFP, and AMA Category I CME credit for the PRA from organizations accredited by ACCME.

CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 0.5 contact hours (0.05 CEUs)
Universal Program Number: 376-000-09-012-H01-P
Activity Type: knowledge-based

Post-tests, credit request forms, and activity evaluations can be completed online at www.neuroscienceCME.com (click on the Testing/Certification link under the Activities tab - requires free account activation), and participants can print their certificate or statement of credit immediately (80% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit www.neurosciencecme.com/technical.asp.

Questions about this activity? Call us at 877.CME.PROS (877.263.7767).