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Restlessness of Respiration as a Manifestation of Akathisia: Five Case Reports of Respiratory Akathisia

J Clin Psychiatry 2000;61(10):737-741

Background: Akathisia is a feeling of subjective or inner restlessness, which causes excessive, semipurposeful movements, commonly in the legs. However, restlessness in respiration, which presents as dyspnea but is best characterized as the sensation of being unable to breathe in a relaxed manner, has never been reported.

Case Reports: Five cases are reported in which dyspnea as a sign of akathisia followed the administration of antipsychotic medications. The clinical features of dyspnea were examined, and all patients manifested both subjective and objective restlessness. The dyspnea was characterized subjectively by the patients' inner feeling of restlessness in respiration, which was perceived as an inability to breathe in a leisurely, relaxed manner, and objectively as restless movements of respiration such as gasping or sighing. The dyspnea was momentarily suppressed when a patient took a quick, full breath to relieve the perceived restlessness and was exacerbated when the patient kept the respiration still. Response to medications commonly used in the treatment of akathisia was also examined in an open, uncontrolled therapeutic trial for each patient. The administration of such medications completely alleviated the respiratory restlessness.

Conclusion: Restlessness in respiration, which clinically presents as dyspnea, may be a manifestation of akathisia. This type of akathisia could be referred to as respiratory akathisia.