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


OBJECTIVE
To determine the clinical effects of anticholinergic drugs for neuroleptic-induced acute akathisia.


METHODS
The reviewers undertook electronic searches of Biological Abstracts (1982-1999), CINAHL (1982-1999), Cochrane Library (Issue 4 1999), Cochrane Schizophrenia Group's Register (October 1999), EMBASE (1980-1999), LILACS (1982-1999), MEDLINE (1966-1999) and PsycLIT (1974-1999). References of all identified studies were inspected for more trials and first authors contacted. Each included study was sought as a citation on the Science Citation Index database.


METHODS
All randomised clinical trials of anticholinergic drugs versus placebo for people with neuroleptic-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
No randomised controlled trials could be included.


CONCLUSIONS
At present, there is no reliable evidence to support or refute the use of anticholinergics for people suffering from neuroleptic-induced acute akathisia. Akathisia is a most distressing movement disorder that remains highly prevalent, both in the developed and developing world. This review highlights the need for well designed, conducted and reported clinical trials to address the claims of open studies as regards the effects of the anticholinergic group of drugs for akathisia.
Psychiatry, Federal University of São Paulo, Botucatu, 740 - 3 andar, São Paulo, São Paulo, Brazil. kos@ifxbrasil.com.br
A R
AR
Lima
K V
KV
Weiser
J
J
Bacaltchuk
T R
TR
Barnes
D017109:Akathisia, Drug-Induced / Q000188:drug therapy*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D006801:Humans
D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists