Central action beta‐blockers versus placebo for neuroleptic‐induced acute akathisia
Abstract
Background
Neuroleptic‐induced akathisia is a common, distressing early‐onset adverse effect of neuroleptic drugs. It has been associated with poor treatment compliance and an increased risk of relapse.
Objectives
To determine the effects of central action beta‐blockers compared with placebo for people with neuroleptic‐induced acute akathisia.
Search methods
We updated previous searches of the Cochrane Schizophrenia Group Register (May 1999), Biological Abstracts (January 1982‐March 1999), The Cochrane Library (issue 3 1999), EMBASE (January 1980‐March 1999), LILACS (January 1982‐March 1999), MEDLINE (January 1964‐March 1999), PsycLIT (January 1974‐March 1999), and SCISEARCH by searching the Cochrane Schizophrenia Group Register (November 2003). We sought further references from published trials and their authors.
Selection criteria
We included all randomised controlled clinical trials of central action beta‐blockers versus placebo for people with neuroleptic‐induced acute akathisia.
Data collection and analysis
Working independently, we selected and critically appraised studies, extracted data and analysed on an intention‐to‐treat basis. Where possible and appropriate we calculated risk ratios (RR) and their 95% confidence intervals (CI) with the number needed to treat (NNT). For continuous data we calculated Weighted Mean Differences (WMD).
Main results
We identified three randomised controlled trials (total n=51, maximum duration 72 hours). We were not able to draw any firm conclusions from such a small data set. In the two 48 hour studies no‐one experienced full remission of akathisia, and only one person in each group experienced a 50% remission (n=11, 1 RCT, RR 1.04 CI 0.59 ‐1.83). One trial stated that no adverse effects occurred in the two groups (n=20, 1 RCT, RR not estimable). The 72 hour study did not show any statistical difference between the central acting beta‐blocker (ICI 118,551) and placebo for the outcome 'no change/worse' (n=10, RR 0.22 CI 0.0 to 1.5).
Authors' conclusions
There are insufficient data to recommend beta‐blocking drugs for akathisia. These drugs are experimental for this problem, and this review highlights the need for more evaluative studies.
PICOs
Plain language summary
Central action beta‐blockers versus placebo for neuroleptic‐induced acute akathisia
Akathisia is recognised as one of the most common and distressing of the early‐onset adverse effects of neuroleptic drugs. This movement disorder is characterised by a subjective report of inner restlessness, mental unease or dysphoria, which can be intense.
This review highlights the limited evidence available to support the use of central action beta‐blockers for neuroleptic‐induced acute akathisia.
