Akathisia--a brief review

Treating bipolar disorder in the primary care setting: the role of aripiprazole

OBJECTIVE

The objective of this article is to present practical strategies for detecting and diagnosing bipolar disorder in the primary care setting and to review the evidence for the efficacy and safety of aripiprazole treatment for bipolar disorder.

DATA SOURCES

A review of the literature from 1980 to 2007 was conducted from November 2006 through February 2007 using a MEDLINE search and the key words bipolar disorder, primary care, detection, diagnosis, and aripiprazole.

STUDY SELECTION

A total of 100 articles that focused on the accurate detection and diagnosis of bipolar disorder and the evidence of the efficacy and safety of aripiprazole in the treatment of bipolar disorder were selected.

DATA SYNTHESIS

Patients with bipolar disorder often present to primary care physicians with depressive or mixed symptoms as opposed to purely hypomanic or manic symptoms. Accurate diagnosis of bipolar disorder is essential in order to provide timely and appropriate treatment. One treatment option available is aripiprazole, a partial agonist of dopamine (D)₂ and D₃ and serotonin (5-HT)(₁A) receptors and an antagonist of the 5-HT(₂A) receptor. Clinical trial data have shown aripiprazole to be effective in treating manic and mixed episodes associated with bipolar I disorder, both in the acute phase and over an extended period of treatment lasting from 6 months to 2 years.

CONCLUSIONS

Accurate diagnosis and treatment of bipolar disorder are challenges increasingly faced by primary care physicians. Strategies geared toward detection, diagnosis, and management of bipolar I disorder and other bipolar spectrum disorders may improve the treatment outcome for patients. Aripiprazole may be considered as another first-line choice for the treatment of bipolar I disorder; however, its utility in patients with bipolar spectrum disorders is yet to be determined.

Drug-Induced Movement Disorders in Older Adults: An Overview for Clinical Practitioners

OBJECTIVE

To provide an overview of some of the most common drug-induced movement disorders (DIMD) seen in the elderly by the primary care clinician. The epidemiology, clinical presentation, differential diagnosis, treatment, risk factors, and preventive measures are presented for each DIMD.

DATA SOURCES

Medical literature and research article search utilizing PubMed (National Library of Medicine), Psych INFO (American Psychological Association), CINAHL Database (CINAHL Information Systems), the Library of Congress Catalogue, and the Internet.

STUDY SELECTION

Reviews and articles from 1954 to 2005 concerning various movement disorders associated with medication in older adults. DATA EXTRACTIONS: Data on movement disorders associated with medications ranging from possible or controversial to well-established.

DATA SYNTHESIS

With the aging of populations in the United States and other countries, the use of medications with potential risk of precipitating movement disorders is increasing. The majority of these iatrogenic problems will be first seen in the geriatric patient in various clinical settings, typically in a primary care setting. To a large extent they will be observed in patients with mild cognitive impairment or dementia having impaired recall and reduced capacity to participate in the diagnostic interview. The challenge to clinicians is complicated by the sizable number of medications that may be involved.

Akathisia in adults with severe and profound intellectual disability: a psychometric study of the MEDS and ARMS

BACKGROUND

This study assessed the psychometrics of two measures--the Matson Evaluation of Drug Side-effects (MEDS) and the Akathisia Ratings of Movement Scale (ARMS)--and examined the symptom profile of akathisia in a sample of people with intellectual disability (ID).

METHOD

Sixty-six participants formed three groups of 22 individuals, matched on age, race, sex, and level of ID. The sample comprised Group 1: individuals with no antipsychotic drug use and no diagnosis of akathisia (control group); Group 2: individuals taking antipsychotics and with no diagnosis of akathisia (no akathisia group); and Group 3: individuals taking antipsychotics and with a diagnosis of akathisia (akathisia group).

RESULTS

Both measures indicated the presence of akathisia in those individuals with a diagnosis of akathisia, while the two groups without a diagnosis of akathisia did not qualify for a diagnosis of akathisia on either scale. Interestingly, item analysis of the MEDS and ARMS tended to identify different symptoms of akathisia and were moderately correlated.

CONCLUSIONS

The data appear to suggest that both measures have merit, that they are complementary, and that they should be used together when assessing akathisia in individuals with ID.