Benzodiazepines for neuroleptic-induced acute akathisia.
BACKGROUND
Neuroleptic-induced akathisia is one of the most common and distressing early-onset adverse effects of antipsychotic drugs, being associated with poor compliance with treatment, and thus, ultimately, to an increase risk of relapse. This review assesses the role of benzodiazepines in the pharmacological treatment of this problem.


OBJECTIVE
To determine the effects of benzodiazepines versus placebo for people with neuroleptic-induced acute akathisia.


METHODS
Biological Abstracts (January 1982-March 1999), The Cochrane Library (Issue 3 1999), The Cochrane Schizophrenia Group's Register (May 2001), EMBASE (January 1980-March 1999), LILACS (January 1982-March 1999), MEDLINE (January 1964-March 1999), PsycLIT (January 1974-March 1999), and SCISEARCH were searched. Further references were sought from published trials and their authors.


METHODS
All randomised clinical trials comparing benzodiazepines with placebo for people with antipsychotic-induced acute akathisia.


METHODS
Two reviewers, working independently, selected, quality assessed and extracted data. These data were then analysed on an intention-to-treat basis. For homogeneous dichotomous data the fixed effects relative risk (RR), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, reviewers calculated weighted mean differences.


RESULTS
Two small (total N=27) randomised controlled trials were included. By seven to 14 days, there was a reduction in symptoms for those patients receiving clonazepam compared with placebo (2 RCTs, N=26, RR 0.09 CI 0.01 to 0.6, NNT 1.2 CI 0.9 to 1.5). No significant difference was found for adverse events (2 RCTs, N=26, RR 3.00 CI 0.2 to 62) or the need for anticholinergic medication (2 RCTs, N=26, RR 1.56 CI 0.9 to 2.7). No one left the two studies early. Data on mental, social and family outcomes could not be pooled and there was little or no data on user satisfaction, deaths, violence, criminal behaviour and costs.


CONCLUSIONS
Over a short follow-up period, the use of benzodiazepines may reduce the symptoms of antipsychotic-induced acute akathisia. This review highlights the need for well designed, conducted and reported clinical trials to address the claims of open studies.
Lima
A R
AR
Department of Psychiatry, Federal University of São Paulo, Rua Botucatu, 740 - 3.o andar, Vila Clementino, São Paulo, SP, Brazil, 04023-900. kos@ifxbrasil.com.br
Soares-Weiser
K
K
Bacaltchuk
J
J
Barnes
T R
TR
D000208:Acute Disease; D017109:Akathisia, Drug-Induced / Q000188:drug therapy*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D014150:Antipsychotic Agents; D001569:Benzodiazepines