title: Diagnosis and treatment of akathisia in a cancer patient who cannot stand up or sit down, because of poor performance status: factors that make the diagnosis of akathisia difficult, and diagnosis clues.
abstract: OBJECTIVE
  Akathisia is a common adverse effect of antipsychotics and, less commonly, antidepressants. Akathisia can cause great discomfort and is often described by the patient as a most distressing sensation; however, the condition is often underdiagnosed or misdiagnosed. In oncological settings, neuroleptics and antidepressants that induce akathisia are also administered. However, reports of akathisia in oncology settings are few and a case of akathisia in a bedridden patient has not been reported as far as we know.
  
  
  METHODS
  A 72-year-old man with esophageal cancer who could not sit down or stand up was administered 5 mg/day haloperidol to relieve agitation as a symptom of major depressive disorder. Three days after the administration of haloperidol, the agitation had become worse. Careful observation revealed that the patient sometimes showed slight rubbing movement of the lower extremities and slight twisting movements of the body, which were not observed before the administration of haloperidol. The patient moved his body and lower extremities to relieve restlessness, which had developed after the administration of haloperidol. Although symptoms were atypical, akathisia was suspected and discontinuation of haloperidol resolved the symptoms.
  
  
  RESULTS
  In patients with poor performance status, clues leading to the correct diagnosis of akathisia might be absent, which would not be the case in patients who were able to walk, stand up, or sit down. Careful observations of patients before and after the administration of drugs that may cause akathisia may be required to ensure correct diagnosis.
authors.affiliation: Department of Psycho-Oncology, Saitama Medical University, Japan. honishi@saitama-med.ac.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Onishi
authors.forename: Makoto
authors.initials: M
authors.lastname: Wada
authors.forename: Tomomi
authors.initials: T
authors.lastname: Wada
authors.forename: Mei
authors.initials: M
authors.lastname: Wada
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ishida
authors.forename: Chiaki
authors.initials: C
authors.lastname: Kawanishi
authors.forename: Keiko
authors.initials: K
authors.lastname: Mizuno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Masaru
authors.initials: M
authors.lastname: Narabayashi
authors.forename: Yasutsuna
authors.initials: Y
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D017109:Akathisia, Drug-Induced / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001510:Bed Rest; D003865:Major Depressive Disorder / Q000150:complications* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms; D006220:Haloperidol / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol