{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:34:49Z","timestamp":1791844489267,"version":"4.3.4"},"reference-count":85,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2018,4,23]],"date-time":"2018-04-23T00:00:00Z","timestamp":1524441600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Psychiatry"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT\n                      <jats:sub>2A<\/jats:sub>\n                      antagonists, benzodiazepines, and vitamin B6.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0706743718760288","type":"journal-article","created":{"date-parts":[[2018,4,23]],"date-time":"2018-04-23T22:45:08Z","timestamp":1524523508000},"page":"719-729","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":87,"title":["The Assessment and Treatment of Antipsychotic-Induced Akathisia"],"prefix":"10.1177","volume":"63","author":[{"given":"Tamara","family":"Pringsheim","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Pharmacy, Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Addington","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Martino","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Morgante","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"},{"name":"Institute of Molecular and Clinical Sciences, St George\u2019s University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Ricciardi","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular and Cell Sciences, St George\u2019s University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"Poole","sequence":"additional","affiliation":[{"name":"Department of Philosophy, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Remington","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and Psychological Clinical Science, Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Neurology, St Georges University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Carson","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R. E.","family":"Barnes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,4,23]]},"reference":[{"key":"bibr1-0706743718760288","first-page":"1107","volume":"9","author":"Haskovec L","year":"1901","journal-title":"Revue Neurologique"},{"key":"bibr2-0706743718760288","first-page":"683","volume":"79","author":"Sigwald J","year":"1947","journal-title":"Revue Neurologique"},{"key":"bibr3-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.117.2.152"},{"key":"bibr4-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.129.3.345"},{"key":"bibr5-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/0010-440X(75)90019-X"},{"key":"bibr6-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.143.2.139"},{"key":"bibr7-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1985.01790320042006"},{"key":"bibr8-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.154.5.672"},{"issue":"7","key":"bibr9-0706743718760288","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1007\/BF00788184","volume":"32","author":"Raja M","year":"1997","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"bibr10-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.109.070540"},{"issue":"11","key":"bibr11-0706743718760288","first-page":"435","volume":"49","author":"Dufresne RL","year":"1988","journal-title":"J Clin Psychiatry"},{"key":"bibr12-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870090211"},{"key":"bibr13-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-013-0079-5"},{"key":"bibr14-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1007\/BF02245462"},{"key":"bibr15-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870040208"},{"key":"bibr16-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/0010-440X(82)90084-0"},{"issue":"4","key":"bibr17-0706743718760288","first-page":"301","volume":"5","author":"Barnes TR","year":"1987","journal-title":"Psychiatr Dev"},{"key":"bibr18-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-977X(00)00090-0"},{"key":"bibr19-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.144.9.1148"},{"key":"bibr20-0706743718760288","first-page":"13","volume":"48","author":"Van Putten T","year":"1987","journal-title":"J Clin Psychiatry"},{"key":"bibr21-0706743718760288","volume-title":"Adverse effects of psychotropic drugs","author":"Barnes TR","year":"1992"},{"key":"bibr22-0706743718760288","first-page":"128","volume":"101","author":"Margolese HC","year":"2001","journal-title":"Acta Psychiatrica Belgica"},{"key":"bibr23-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1002\/hup.2536"},{"key":"bibr24-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e3182677958"},{"key":"bibr25-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1520\/JFS2002173"},{"issue":"4","key":"bibr26-0706743718760288","first-page":"CD001946","author":"Lima AR","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"bibr27-0706743718760288","first-page":"CD001950","author":"Lima AR","year":"2002","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"bibr28-0706743718760288","first-page":"CD003727","author":"Lima AR","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"bibr29-0706743718760288","first-page":"CD003727","author":"Rathbone J","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"bibr30-0706743718760288","first-page":"CD000203","author":"Alabed S","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"bibr31-0706743718760288","first-page":"CD000458","author":"El-Sayeh HG","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"bibr32-0706743718760288","first-page":"CD000205","author":"Bhoopathi PS","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"bibr33-0706743718760288","first-page":"CD000209","author":"Soares-Weiser K","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"bibr34-0706743718760288","first-page":"CD000459","author":"Soares-Weiser K","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr35-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31829d86b6"},{"key":"bibr36-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1093\/pch\/16.9.590"},{"key":"bibr37-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1192\/apt.6.5.332"},{"key":"bibr38-0706743718760288","unstructured":"COD G. A guide to the extrapyramidal side-effects of antipsychotic drugs. Cambridge: Cambridge University Press, 1999."},{"key":"bibr39-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1176\/jnp.5.1.56"},{"key":"bibr40-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1017\/S1461145700002066"},{"key":"bibr41-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1177\/0269881103174013"},{"key":"bibr42-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2004.05.003"},{"key":"bibr43-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2005.02.013"},{"key":"bibr44-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/S0924-977X(96)00041-7"},{"key":"bibr45-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2015.10.040"},{"key":"bibr46-0706743718760288","unstructured":"CADTH. Optimal use report: optimal use recommendations for atypical antipsychotics: combination and high-dose treatment strategies in adolescents and adults with schizophrenia. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health Care, 1: 2011."},{"key":"bibr47-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2011.10060908"},{"key":"bibr48-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbq042"},{"key":"bibr49-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1177\/0269881111424929"},{"key":"bibr50-0706743718760288","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X13666150115220221"},{"key":"bibr51-0706743718760288","unstructured":"Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines in psychiatry, 12th edn. Hoboken, NJ: Wiley Blackwell, 2015."},{"key":"bibr52-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.149.1.42"},{"key":"bibr53-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2005.12.007"},{"issue":"2","key":"bibr54-0706743718760288","first-page":"283","volume":"29","author":"Adler LA","year":"1993","journal-title":"Psychopharmacol Bull"},{"key":"bibr55-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.149.5.647"},{"issue":"2","key":"bibr56-0706743718760288","first-page":"244","volume":"10","author":"Irwin M","year":"1988","journal-title":"Hillside J Clin Psychiatry"},{"issue":"2","key":"bibr57-0706743718760288","first-page":"107","volume":"11","author":"Kramer MS","year":"1989","journal-title":"Hillside J Clin Psychiatry"},{"key":"bibr58-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/0006-3223(88)90260-0"},{"key":"bibr59-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-200112000-00013"},{"key":"bibr60-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/0006-3223(90)90540-I"},{"key":"bibr61-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2009.02.006"},{"issue":"1","key":"bibr62-0706743718760288","first-page":"21","volume":"23","author":"Adler L","year":"1987","journal-title":"Psychopharmacol Bull"},{"issue":"6","key":"bibr63-0706743718760288","first-page":"255","volume":"52","author":"Wells BG","year":"1991","journal-title":"J Clin Psychiatry"},{"key":"bibr64-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/00002826-199308000-00004"},{"key":"bibr65-0706743718760288","first-page":"519","volume":"23","author":"Adler L","year":"1987","journal-title":"Psychopharmacol Bull"},{"key":"bibr66-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1976.01770050055008"},{"key":"bibr67-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/jcp.0b013e3180582439"},{"key":"bibr68-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1983.tb00339.x"},{"key":"bibr69-0706743718760288","doi-asserted-by":"publisher","DOI":"10.2190\/RAFD-AXDF-RJAD-FL1R"},{"key":"bibr70-0706743718760288","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200022010-00006"},{"key":"bibr71-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0000000000000412"},{"key":"bibr72-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/00002826-200603000-00002"},{"key":"bibr73-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.174.3.238"},{"key":"bibr74-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/01.jcp.0000084027.22282.16"},{"key":"bibr75-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/WNF.0b013e3181ee7f63"},{"key":"bibr76-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-198912000-00003"},{"key":"bibr77-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/00002826-199406000-00003"},{"key":"bibr78-0706743718760288","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v65n1118"},{"key":"bibr79-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1990.tb28064.x"},{"key":"bibr80-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/j.expneurol.2004.07.013"},{"key":"bibr81-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.3_Part_1.544"},{"key":"bibr82-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1781(84)90040-4"},{"key":"bibr83-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1097\/00004850-200505000-00011"},{"key":"bibr84-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.12030069"},{"key":"bibr85-0706743718760288","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003388"}],"container-title":["The Canadian Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0706743718760288","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0706743718760288","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0706743718760288","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:14:45Z","timestamp":1777392885000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0706743718760288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,23]]},"references-count":85,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1177\/0706743718760288"],"URL":"https:\/\/doi.org\/10.1177\/0706743718760288","relation":{},"ISSN":["0706-7437","1497-0015"],"issn-type":[{"value":"0706-7437","type":"print"},{"value":"1497-0015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,23]]}}}