Objective: This systematic review aims to establish whether a causal association exists between antipsychotic-induced akathisia and suicidality, in order to guide further clinical decision making in this area.

Background: Akathisia is a movement disorder characterised primarily by a subjective sense of inner restlessness and inability to sit still. It is still a relatively common and distressing side effect of psychotropic medication, especially antipsychotics. Furthermore, previous case reports and studies have, albeit inconsistently, linked akathisia to suicidal behaviour, although the relationship to particular treatment options and the potential role of other mediating risk factors remain unclear.

Method: A systematic review was conducted, with two reviewers searching multiple literature databases (Embase, Medline, Cochrane and PsychINFO) using search terms related to suicidality, akathisia and antipsychotics. Relevant research papers and articles were reviewed and scrutinised initially by title and abstract. Full text reviews were undertaken where further clarification was required and adjudication was sought with two additional reviewers in event of any disagreement. The systematic review was conducted in line with PRISMA methodology and reporting.

Results: Following de-duplication, screening and application of exclusion criteria, five eligible studies were identified. All of the available studies were in English and included adult patients. Nevertheless, there was significant variability regarding methodology, case definition and assessment scales, thus introducing great between-study heterogeneity. Of the five studies, two found a correlation between antipsychotic-related akathisia and suicidal ideation, a finding that was not supported by the remaining three studies. There was insufficient data to perform statistical analyses of the results.

Conclusion: On the basis of the existing literature, akathisia cannot be reliably linked to the presence of suicidal behaviour in patients treated with antipsychotic medication. However, the prevention and timely management of akathisia remain essential and proactive screening for emerging suicidal ideation in this vulnerable patient group advisable. Finally, our findings highlight the pressing need for further research in this area.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-association-between-antipsychotic-induced-akathisia-and-suicidality-a-systematic-review/