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. |
This activity offers CE credit for:
- Physicians (ACCME/AMA PRA Category 1)
- Pharmacists (ACPE)
Credit Expiration Date:
Saturday, April 3, 2010
 | Rakesh Jain, MD, MPH Director, Adult and Child Psychopharmacology Research R/D Clinical Research, Inc. Lake Jackson, TX |
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.
- Young JL, Zonana HV, Shepler L. Medication noncompliance in schizophrenia: codification and update. Bull Am Acad psychiatry Law 1986;14:105-122.
- 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.
- Kinon BJ, Kane JM, Johns C, et al. Treatment of neuroleptic-resistant schizophrenic relapse. Psychopharmacol Bull 1993;29:309-314.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition. 1994; American Psychiatric Association; Washington D.C.
- 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.
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.
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.
Physicians, physician assistants, and other healthcare professionals with an interest in mental health.
CME Outfitters, LLC, gratefully acknowledges an educational grant from No Commercial Supporter in support of this CE activity.
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
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Rakesh Jain, MD, MPH
Rakesh Jain, MD, MPH, is Director of Psychiatric Drug Research for the R/D Clinical
Research Center at Lake Jackson, Texas.
Dr. Jain attended medical school at the University of Calcutta in India. He then attended
graduate school at the University of Texas School of Public Health in Houston, where
he was awarded a National Institute/Center for Disease Control Competitive
Traineeship. His research thesis focused on alcohol abuse issues. He graduated from
the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.
After graduate school, Dr. Jain completed a postdoctoral fellowship in Research
Psychiatry with the Gerontology Center of the University of Texas Mental Sciences
Institute in Houston. He received the National Research Service Award for the support
of the postdoctoral fellowship. After this, he served a three-year residency in Psychiatry
at the Department of Psychiatry and Behavioral Sciences at the University of Texas
Medical School at Houston as well as a two-year fellowship in Child and Adolescent
Psychiatry.
Dr. Jain is currently involved in multiple research projects studying the effects of
medications on short-term and long-term treatment of depression, anxiety, pain/mood
overlap disorders, and psychosis in adult and child/adolescent populations. He is the
author of several articles on the issue of mood and pain conditions. He serves on
several Boards focusing on drug development and disease state education. He was
recently named “Public Citizen of the Year” by the National Association of Social
Workers, Gulf Coast Chapter, in recognition of community and peer education and
championing of mental health issues. He was also recently awarded the “Extra Mile
Award” by the local school district, in recognition of the service to the children of the
school district and consultation to the teachers and counselors.
Disclosure Declaration
It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all its CE activities. Faculty must disclose to the participants any significant relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.
Dr. Jain has disclosed that he receives research support from Abbott Laboratories, Addrenex Pharmaceuticals, Inc., Aspect Medical Systems, Inc., Forest Laboratories, Inc., Eli Lilly and Company, and Pfizer Inc. He is on the speakers bureaus of Cyberonics, Inc., GlaxoSmithKline, Jazz Pharmaceuticals, Eli Lilly and Company, Pfizer Inc., Shire Pharmaceuticals, and Takeda Pharmaceuticals North America, Inc. Dr. Jain serves as a consultant to Addrenex Pharmaceuticals, Inc., IMPAX Laboratories, Inc., Eli Lilly and Company, and Shire Pharmaceuticals.
Unlabeled Use Disclosure
Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.
CME Outfitters, LLC, the faculty, Wyeth Pharmaceuticals, and Solvay Pharmaceuticals do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.
Questions about this activity? Call us at 877.CME.PROS (877.263.7767).
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