Neuroleptic-induced acute
akathisia (NIA) is a distressing condition and an important clinical problem because it is associated with treatment noncompliance and suicidal or impulsive behavior.
Anticholinergics are among the treatment options; however, a review of the literature fails to identify a double-blind, randomized, placebo-controlled study of these medications in NIA. In a randomized, double-blind, placebo-controlled design, we studied the effectiveness of intramuscular
biperiden (n = 15) or isotonic saline (n = 15) in the treatment of NIA diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria.
Injections were repeated up to 3 times unless
akathisia was completely treated (scored 0 for global
akathisia with the Barnes
Akathisia Rating Scale). Patients were assessed for
akathisia, other
movement disorders, and psychiatric symptoms at baseline and 3 times after the first injection at 2-hour intervals. Response was defined as at least a 2-point decline in the global
akathisia score. The numbers of responders in the 2 groups were not significantly different (7 and 5 in the
biperiden and placebo groups, respectively). The courses of individual items on the Barnes
Akathisia Rating Scale were also similar. Our results suggest that intramuscular
biperiden should not be considered as a first-line treatment of NIA.