Subjective emotional experience and cognitive impairment in drug-induced akathisia

The purpose of this study was to characterize the subjectively experienced symptoms and cognitive impairment associated with akathisia, which is among the most disabling adverse effects associated with antipsychotic drugs. While subjective experience is considered to be an integral part of akathisia, only a few studies have comprehensively investigated the specific contents of the subjective experiences or of the discomforts of patients with drug-induced akathisia. In addition, the precise relationship of akathisia to cognitive impairment, one of the main constituents of subjective experiences, is largely unknown. Forty-one stable and chronic schizophrenic patients, who were receiving maintenance antipsychotic treatment, were rated using the Barnes Akathisia Rating Scale (BARS) for drug-induced akathisia. Subjective experiences were evaluated using the Symptom Checklist-90-Revised (SCL-90-R), and cognitive function was assessed using the Wechsler Memory Scale (WMS). Analysis of covariance (ANCOVA) with relevant variables as covariates revealed that patients with akathisia (n = 17) had significantly higher scores on the depression subscale of the SCL-90-R than those without akathisia (n = 24). Patients with akathisia also had significantly lower scores on the mental control subtest of the WMS. Further analysis using ordinal logistic regression revealed that the depression subscale of SCL90-R and the mental control subtest of WMS were significantly associated with the severity of akathisia. These results suggest that akathisia is significantly associated with depressive symptoms and attentional impairment, which reflects the complex nature of akathisia that includes motor, emotional, and cognitive aspects. Several methodological considerations and future directions are discussed.