Akinesia PMHNP Exam

Описание: Akinesia in the PMHNP Exam
Akinesia refers to a loss or reduction of voluntary movement, commonly associated with antipsychotic-induced extrapyramidal symptoms (EPS) and neurodegenerative disorders. The PMHNP-BC exam frequently tests its causes, differentiating features, management, and clinical significance.

1. What is Akinesia?
✅ Akinesia = Absence or severe reduction of voluntary movement.✅ Commonly caused by dopamine blockade (D2 receptor antagonism).✅ Different from bradykinesia (slow movement) & rigidity.
Patients describe it as feeling "frozen" or "stiff."
Often mistaken for depression or negative symptoms of schizophrenia.

2. Causes of Akinesia in Psychiatry
Cause Mechanism Clinical Context
Antipsychotic-Induced Akinesia (EPS) D2 blockade in the nigrostriatal pathway Occurs with first-generation antipsychotics (FGAs) & high-dose SGAs (Risperidone, Paliperidone).
Parkinson’s Disease Degeneration of dopaminergic neurons in substantia nigra Progressive loss of movement, tremors, rigidity.
Neuroleptic Malignant Syndrome (NMS) Severe dopamine blockade, muscle rigidity Life-threatening, associated with fever, altered mental status.
Major Depressive Disorder (Severe Cases) Psychomotor retardation, dopamine dysfunction Slowed movement, poor motivation, appears similar to akinesia.
• Antipsychotic-induced akinesia is an EPS symptom and must be distinguished from Parkinsonism.
NMS presents with akinesia plus autonomic instability & fever.

3. Antipsychotic-Induced Akinesia vs. Parkinsonism
Feature Akinesia (EPS) Parkinsonism
Cause D2 blockade in nigrostriatal pathway Dopaminergic neuron degeneration
Onset Days to weeks after starting antipsychotics Gradual onset, progressive
Movement Loss of voluntary movement, stiff posture Tremors, bradykinesia, rigidity
Treatment Lower antipsychotic dose, add anticholinergic (Benztropine, Trihexyphenidyl) Dopaminergic therapy (Levodopa, Carbidopa)
• If akinesia is due to antipsychotics, reducing the dose or switching to an SGA with lower EPS risk (Clozapine, Quetiapine) may help.

4. Medications That Can Cause or Worsen Akinesia
🚨 First-Generation Antipsychotics (FGAs) → Haloperidol, Fluphenazine, Chlorpromazine.🚨 High-Dose Second-Generation Antipsychotics (SGAs) → Risperidone, Paliperidone.🚨 Metoclopramide (Reglan) → Dopamine antagonist, can cause drug-induced Parkinsonism.🚨 SSRIs (in rare cases) → Can worsen EPS, especially when combined with antipsychotics.
High-potency FGAs (Haloperidol) have the highest risk of EPS, including akinesia.
Clozapine and Quetiapine have the lowest risk of causing EPS.

5. Management of Akinesia
✅ Reduce or switch antipsychotic (e.g., switch from Haloperidol to Quetiapine or Clozapine).✅ Add an anticholinergic (Benztropine 1–2 mg/day, Trihexyphenidyl).✅ Consider Amantadine (dopaminergic agent) if symptoms persist.✅ Monitor for tardive syndromes if symptoms do not improve with medication changes.
Anticholinergics (Benztropine) help relieve EPS but should be avoided in elderly due to cognitive side effects.
If akinesia does not improve after stopping the causative drug, evaluate for Parkinsonism.

6. PMHNP Exam Key Takeaways
Akinesia = Loss of voluntary movement (common EPS symptom with antipsychotics).
Caused by dopamine blockade in the nigrostriatal pathway (similar to Parkinsonism).
Most common with high-potency FGAs (Haloperidol, Fluphenazine) & high-dose SGAs (Risperidone, Paliperidone).
Differentiate from Parkinson’s disease & NMS (NMS has fever, autonomic instability).
Treatment: Reduce or switch antipsychotic, add anticholinergic (Benztropine, Trihexyphenidyl).
Avoid long-term anticholinergics in elderly due to cognitive risks.


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