ICD-10: G25.71

Drug-induced akathisia, classified under ICD-10 code G25.71, is a movement disorder characterized by a compelling need to be in constant motion. This condition is often a side effect of certain medications, particularly antipsychotics and other drugs that affect neurotransmitter systems. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this disorder is crucial for effective diagnosis and management.

Clinical Presentation

Definition and Overview

Akathisia is defined as a state of inner restlessness and an uncontrollable need to be in constant motion. Patients may describe feelings of anxiety and discomfort, which can lead to significant distress and impairment in daily functioning. The onset of akathisia typically occurs within days to weeks after starting or increasing the dosage of a causative medication, although it can also develop after long-term use.

Common Medications Associated with Akathisia

• Antipsychotics: Particularly first-generation (typical) antipsychotics such as haloperidol and chlorpromazine, but also second-generation (atypical) antipsychotics like risperidone and aripiprazole.
• Antidepressants: Some selective serotonin reuptake inhibitors (SSRIs) and other antidepressants can also induce akathisia.
• Stimulants: Medications used for attention-deficit hyperactivity disorder (ADHD) may contribute to the development of akathisia.

Signs and Symptoms

Key Symptoms

1. Restlessness: Patients often report an overwhelming urge to move, which may manifest as pacing, fidgeting, or an inability to sit still.
2. Anxiety: Many individuals experience heightened anxiety levels, which can exacerbate the feeling of restlessness.
3. Irritability: Increased irritability and agitation are common, often leading to difficulty in social interactions.
4. Sleep Disturbances: Patients may have trouble falling asleep or staying asleep due to their discomfort and restlessness.

Physical Signs

• Pacing: Continuous walking or moving around in a confined space.
• Fidgeting: Involuntary movements such as tapping feet or shifting positions frequently.
• Postural Changes: Difficulty maintaining a comfortable position, often leading to frequent changes in posture.

Patient Characteristics

Demographics

• Age: Akathisia can occur in individuals of any age but is more commonly reported in younger adults and adolescents.
• Gender: Some studies suggest a higher prevalence in females, particularly in those taking antipsychotic medications.

Risk Factors

• History of Movement Disorders: Patients with a prior history of movement disorders may be at increased risk.
• Concurrent Medications: The use of multiple medications that affect the central nervous system can heighten the risk of developing akathisia.
• Psychiatric Conditions: Individuals with underlying psychiatric disorders, such as schizophrenia or bipolar disorder, may be more susceptible to drug-induced akathisia.

Clinical Considerations

• Diagnosis: Diagnosis is primarily clinical, based on the patient's history and symptomatology. It is essential to rule out other causes of restlessness, such as anxiety disorders or other movement disorders.
• Management: Treatment often involves adjusting the offending medication, adding beta-blockers, benzodiazepines, or anticholinergic agents to alleviate symptoms.

Conclusion

Drug-induced akathisia (ICD-10 code G25.71) is a significant movement disorder that can severely impact a patient's quality of life. Recognizing the clinical presentation, signs, symptoms, and patient characteristics is essential for healthcare providers to diagnose and manage this condition effectively. Early intervention and appropriate management strategies can help mitigate the distress associated with akathisia, improving overall patient outcomes.

Drug-induced akathisia, classified under ICD-10 code G25.71, is a movement disorder characterized by a feeling of inner restlessness and an uncontrollable need to be in constant motion. This condition is often associated with the use of certain medications, particularly antipsychotics. Below are alternative names and related terms that are commonly associated with this diagnosis.

Alternative Names for Drug-Induced Akathisia

1. Medication-Induced Akathisia: This term emphasizes that the condition is a direct result of medication use, particularly psychotropic drugs.

2. Akathisia Due to Drugs: A straightforward description that specifies the cause of akathisia as drug-related.

3. Drug-Induced Restlessness: This term highlights the primary symptom of restlessness that characterizes akathisia.

4. Pharmacological Akathisia: This term is used in clinical settings to denote akathisia that arises from pharmacological agents.

5. Antipsychotic-Induced Akathisia: Specifically refers to akathisia caused by antipsychotic medications, which are the most common culprits.

Related Terms

1. Akathisia: A broader term that refers to the condition itself, which can be induced by various factors, including drugs.

2. Movement Disorders: A category of neurological conditions that includes akathisia among other disorders like Parkinson's disease and dystonia.

3. Extrapyramidal Symptoms (EPS): A group of side effects that can occur with antipsychotic medications, including akathisia, tardive dyskinesia, and parkinsonism.

4. Restlessness: A symptom often associated with akathisia, indicating a general state of agitation or inability to remain still.

5. Psychotropic Drug Side Effects: A broader category that includes akathisia as a potential side effect of medications affecting mood and behavior.

6. Neuroleptic Malignant Syndrome (NMS): While distinct, this serious condition can sometimes be confused with akathisia due to overlapping symptoms, particularly in the context of antipsychotic use.

Understanding these alternative names and related terms can help in recognizing and diagnosing drug-induced akathisia more effectively, ensuring appropriate treatment and management strategies are employed. If you have further questions or need more specific information, feel free to ask!

Drug-induced akathisia, classified under ICD-10-CM code G25.71, is a movement disorder characterized by a compelling need to be in constant motion, often accompanied by feelings of inner restlessness. The diagnosis of drug-induced akathisia involves specific criteria that clinicians must consider to ensure accurate identification and appropriate management. Below is a detailed overview of the diagnostic criteria and considerations for this condition.

Diagnostic Criteria for Drug-Induced Akathisia

1. Clinical Presentation

• Restlessness: Patients typically report an overwhelming urge to move, which may manifest as pacing, fidgeting, or an inability to sit still.
• Subjective Experience: Individuals often describe feelings of anxiety or discomfort associated with their restlessness, which can significantly impact their quality of life.

2. Temporal Relationship to Medication Use

• Onset: Symptoms of akathisia usually develop after the initiation of a new medication or an increase in dosage of an existing medication, particularly antipsychotics or other dopaminergic agents.
• Duration: The symptoms must persist for a duration that correlates with the exposure to the offending drug, typically appearing within days to weeks after starting or adjusting the medication.

3. Exclusion of Other Causes

• Rule Out Other Disorders: It is essential to exclude other potential causes of restlessness, such as primary movement disorders (e.g., Parkinson's disease), anxiety disorders, or other psychiatric conditions.
• Medication Review: A thorough review of the patient's medication history is crucial to identify any drugs that may contribute to the symptoms, including antipsychotics, antidepressants, and stimulants.

4. Response to Medication Adjustment

• Symptom Relief: A positive response to the reduction or discontinuation of the offending medication can support the diagnosis. Symptoms often improve significantly when the causative agent is modified or withdrawn.

5. Diagnostic Tools and Scales

• Clinical Rating Scales: Tools such as the Barnes Akathisia Rating Scale (BARS) can be utilized to quantify the severity of akathisia and assist in the diagnosis. These scales evaluate both subjective and objective signs of restlessness.

Conclusion

Diagnosing drug-induced akathisia (ICD-10 code G25.71) requires careful consideration of the clinical presentation, timing in relation to medication use, exclusion of other potential causes, and response to treatment adjustments. Clinicians must conduct a comprehensive assessment, including a detailed medication history and possibly the use of standardized rating scales, to ensure accurate diagnosis and effective management of this distressing condition. Proper identification is crucial, as it can significantly influence treatment decisions and improve patient outcomes.

Drug-induced akathisia, classified under ICD-10 code G25.71, is a movement disorder characterized by a compelling need to be in constant motion, often accompanied by feelings of inner restlessness. This condition is typically a side effect of certain medications, particularly antipsychotics and some antidepressants. Understanding the standard treatment approaches for this disorder is crucial for effective management and patient care.

Overview of Drug-Induced Akathisia

Akathisia can manifest as a subjective feeling of restlessness, which may lead to behaviors such as pacing, fidgeting, or an inability to sit still. It is important to differentiate akathisia from other movement disorders, as its treatment may vary significantly depending on the underlying cause and the specific medications involved[1].

Standard Treatment Approaches

1. Medication Adjustments

The first step in managing drug-induced akathisia often involves reviewing and adjusting the patient's current medication regimen:

• Reducing Dosage: If the akathisia is linked to a specific medication, reducing the dosage may alleviate symptoms. This is particularly relevant for antipsychotics, where lower doses can sometimes reduce side effects without compromising therapeutic efficacy[2].

• Switching Medications: In cases where dosage reduction is insufficient, switching to a different medication with a lower risk of inducing akathisia may be necessary. Atypical antipsychotics, such as quetiapine or aripiprazole, are often preferred due to their more favorable side effect profiles[3].

2. Pharmacological Interventions

If medication adjustments do not adequately address the symptoms, additional pharmacological treatments may be employed:

• Beta-Blockers: Propranolol has been shown to be effective in reducing symptoms of akathisia. It is thought to work by modulating adrenergic activity, which may be involved in the sensation of restlessness[4].

• Benzodiazepines: Short-term use of benzodiazepines, such as lorazepam, can help manage acute symptoms of anxiety and restlessness associated with akathisia. However, caution is advised due to the potential for dependence and withdrawal issues[5].

• Anticholinergics: Medications like benztropine may provide relief, particularly if the akathisia is part of a broader spectrum of extrapyramidal symptoms. However, their effectiveness specifically for akathisia is variable[6].

3. Psychosocial Interventions

In addition to pharmacological treatments, psychosocial interventions can play a significant role in managing drug-induced akathisia:

• Cognitive Behavioral Therapy (CBT): CBT can help patients develop coping strategies to manage the distress associated with akathisia. It may also assist in addressing any underlying anxiety or mood disorders that could exacerbate symptoms[7].

• Patient Education: Educating patients about the nature of akathisia and its relationship to their medications can empower them to engage in their treatment actively. Understanding that symptoms may improve with medication adjustments can alleviate anxiety and frustration[8].

4. Monitoring and Follow-Up

Regular follow-up is essential to monitor the effectiveness of treatment strategies and make necessary adjustments. Clinicians should assess the severity of akathisia using standardized scales, such as the Barnes Akathisia Rating Scale (BARS), to guide treatment decisions and evaluate progress[9].

Conclusion

Managing drug-induced akathisia requires a comprehensive approach that includes medication adjustments, pharmacological interventions, psychosocial support, and ongoing monitoring. By tailoring treatment to the individual needs of the patient and considering the specific medications involved, healthcare providers can effectively alleviate symptoms and improve the quality of life for those affected by this challenging condition. If symptoms persist despite these interventions, further evaluation may be warranted to explore other underlying causes or treatment options.

Clinical Description of Drug-Induced Akathisia (ICD-10 Code G25.71)

Definition and Overview
Drug-induced akathisia is a movement disorder characterized by a compelling need to be in constant motion, often accompanied by feelings of inner restlessness. This condition is primarily associated with the use of certain medications, particularly antipsychotics, but can also occur with other drug classes, including antidepressants and antiemetics. The ICD-10-CM code for this condition is G25.71, which falls under the broader category of movement disorders related to drug exposure.

Etiology
The primary cause of drug-induced akathisia is the administration of medications that affect neurotransmitter systems in the brain, particularly those that modulate dopamine pathways. Antipsychotic medications, especially first-generation (typical) antipsychotics, are the most common culprits, but second-generation (atypical) antipsychotics and other drugs that influence dopaminergic activity can also lead to this condition. The onset of symptoms can occur shortly after starting a new medication or increasing the dosage of an existing one.

Clinical Features
Patients with drug-induced akathisia typically present with the following symptoms:

• Restlessness: A persistent urge to move, which may manifest as pacing, shifting weight from one foot to another, or an inability to sit still.
• Anxiety and Agitation: Many patients report feelings of anxiety, irritability, or agitation, which can exacerbate the perception of restlessness.
• Difficulty in Concentration: The overwhelming need to move can interfere with the ability to focus on tasks or engage in conversations.
• Physical Symptoms: Some patients may experience discomfort or pain in the legs, which can further contribute to the urge to move.

Diagnosis
The diagnosis of drug-induced akathisia is primarily clinical, based on the patient's history and symptomatology. Key considerations include:

• Medication History: A thorough review of the patient's medication regimen to identify potential offending agents.
• Symptom Onset: Correlating the onset of akathisia symptoms with the initiation or dosage increase of a medication.
• Exclusion of Other Causes: Ruling out other movement disorders or psychiatric conditions that may present similarly.

Management and Treatment
Management of drug-induced akathisia involves several strategies:

• Medication Adjustment: Reducing the dose of the offending medication or switching to a different agent that has a lower risk of inducing akathisia.
• Pharmacological Interventions: Medications such as beta-blockers (e.g., propranolol), benzodiazepines, or anticholinergic agents may be used to alleviate symptoms.
• Psychosocial Support: Providing reassurance and support to patients can help mitigate anxiety and improve coping strategies.

Prognosis
The prognosis for drug-induced akathisia is generally favorable, especially when the offending medication is identified and appropriately managed. Symptoms often resolve within days to weeks after discontinuation or adjustment of the causative agent. However, some patients may experience persistent symptoms, necessitating ongoing management.

Conclusion

Drug-induced akathisia (ICD-10 code G25.71) is a significant movement disorder that can severely impact a patient's quality of life. Understanding its clinical features, etiology, and management strategies is crucial for healthcare providers to effectively diagnose and treat this condition. Early recognition and intervention can lead to improved outcomes and a better quality of life for affected individuals.